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自身免疫性胰腺炎的临床管理

Clinical management of autoimmune pancreatitis.

作者信息

Kamisawa T, Satake K

机构信息

Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.

出版信息

Adv Med Sci. 2007;52:61-5.

Abstract

Autoimmune pancreatitis (AIP) is a newly described entity with characteristic clinical, radiological, serological, and histological features, in which autoimmune mechanisms seem to be involved in pathogenesis. Many new clinical aspects of AIP have been clarified during 10 years, and AIP has become a distinct entity recognized worldwide. However, precise pathogenesis or pathophysiology remains unclear. As AIP responds dramatically to steroid therapy, accurate diagnosis of AIP is necessary to avoid unnecessary laparotomy or pancreatic resection. It is importance to misdiagnose pancreatic cancer as AIP as well as to misdiagnose AIP as pancreatic cancer. In the absence of a diagnostic serological marker for AIP, its diagnosis rests on identifying unique patterns of abnormalities. Japanese criteria are based on the minimum consensus features of AIP and aim to avoid misdiagnosis of malignancy. It contain 3 items: (1) enlargement of the pancreas and narrowing of the main pancreatic duct; (2) high serum gammaglobulin, IgG, or IgG4, or the presence of autoantibodies; (3) histological findings of lymphoplasmacytic infiltration and fibrosis in the pancreas. For diagnosing AIP, the presence of the imaging criterion is essential. Other clinical characteristics of AIP are elderly male preponderance, fluctuating obstructive jaundice without pain, occasional association with diabetes mellitus and extrapancreatic lesions, and favorite responsiveness to oral steroid therapy. Elevation of serum IgG4 levels and infiltration of abundant IgG4-positive plasma cells in various organs are rather specific in AIP patients. In an elderly male presenting obstructive jaundice and pancreatic mass, AIP should be considered as one of differential diagnoses.

摘要

自身免疫性胰腺炎(AIP)是一种新描述的疾病,具有特征性的临床、放射学、血清学和组织学特征,其发病机制似乎涉及自身免疫机制。在过去10年中,AIP的许多新临床方面已得到阐明,AIP已成为一种全球公认的独特疾病。然而,确切的发病机制或病理生理学仍不清楚。由于AIP对类固醇治疗反应显著,准确诊断AIP对于避免不必要的剖腹手术或胰腺切除术至关重要。将胰腺癌误诊为AIP以及将AIP误诊为胰腺癌都很重要。在缺乏AIP诊断血清学标志物的情况下,其诊断依赖于识别独特的异常模式。日本标准基于AIP的最低共识特征,旨在避免恶性肿瘤的误诊。它包含3项:(1)胰腺肿大和主胰管狭窄;(2)血清球蛋白、IgG或IgG4升高,或存在自身抗体;(3)胰腺淋巴细胞浆细胞浸润和纤维化的组织学表现。对于诊断AIP,影像学标准的存在至关重要。AIP的其他临床特征包括老年男性居多、无痛性波动性梗阻性黄疸、偶尔与糖尿病和胰腺外病变相关,以及对口服类固醇治疗有良好反应。血清IgG4水平升高以及各种器官中大量IgG4阳性浆细胞浸润在AIP患者中较为特异。在出现梗阻性黄疸和胰腺肿块的老年男性中,AIP应被视为鉴别诊断之一。

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