Moon S-H, Kim M-H, Park D H, Hwang C Y, Park S J, Lee S S, Seo D W, Lee S K
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea.
Gut. 2008 Dec;57(12):1704-12. doi: 10.1136/gut.2008.150979. Epub 2008 Jun 26.
Autoimmune pancreatitis (AIP) is a peculiar type of chronic pancreatitis that responds dramatically to steroid therapy. To date, there are no worldwide consensus criteria for AIP. Different criteria with institutional preference (HISORt, revised Kim and the revised Japanese criteria) are being used to diagnose AIP, and there is controversy regarding the inclusion of steroid responsiveness in the diagnostic criteria. In contrast to the HISORt and revised Kim criteria, the revised Japanese criteria do not include steroid responsiveness as a diagnostic component.
This study was performed to evaluate whether "a 2-week steroid trial and subsequent assessment of its response" is a useful diagnostic tool for the differentiation of AIP from pancreatic cancer. A further aim was to discover the surgical and clinical outcome for a patient who followed the treatment algorithm based on the steroid responsiveness.
From January 2004 to June 2007, in the setting of clinically suspected AIP, 22 consecutive patients with atypical imaging for AIP, while not meeting the classic imaging criteria for pancreatic cancer, were challenged to undergo 2 weeks of steroid therapy (0.5 mg/kg of oral prednisolone per day). After the 2-week steroid trial, steroid responsiveness was assessed based on a marked improvement of narrowing of the main pancreatic duct and a reduction of the pancreatic mass. The steroid trial was continued in the case of positive steroid responsiveness, whereas surgical exploration was conducted in the case of negative steroid responsiveness. The final diagnosis was made by surgical exploration or long-term clinical and radiological follow-up.
All patients (n = 15) who responded to steroids were diagnosed as having AIP, whereas all patients (n = 7) who did not show a response to steroids were confirmed as having pancreatic cancer. Complete resection was possible in all (6/6; 100%), except one individual who refused surgery.
In the clinical setting of suspected AIP with the continued need for differentiation from pancreatic cancer due to atypical imaging for AIP, "a 2-week steroid trial and subsequent assessment of its response" may be helpful in confirming the diagnosis of AIP without negative consequences for resectable pancreatic cancer. However, a steroid trial should be performed carefully only by specialists in pancreatology.
自身免疫性胰腺炎（AIP）是一种特殊类型的慢性胰腺炎，对类固醇治疗反应显著。迄今为止，全球尚无AIP的共识诊断标准。目前使用不同的、具有机构偏好的标准（HISORt标准、修订后的Kim标准和修订后的日本标准）来诊断AIP，且在诊断标准中是否纳入类固醇反应性存在争议。与HISORt标准和修订后的Kim标准不同，修订后的日本标准未将类固醇反应性纳入诊断要素。
本研究旨在评估“为期2周的类固醇试验及随后对其反应的评估”是否是区分AIP与胰腺癌的有用诊断工具。另一个目的是了解遵循基于类固醇反应性的治疗方案的患者的手术及临床结局。
2004年1月至2007年6月，在临床怀疑为AIP的情况下，连续22例AIP影像学表现不典型但不符合胰腺癌经典影像学标准的患者接受了为期2周的类固醇治疗（口服泼尼松龙0.5mg/kg/天）。在为期2周的类固醇试验后，根据主胰管狭窄的明显改善和胰腺肿块的缩小来评估类固醇反应性。类固醇反应性为阳性的患者继续进行类固醇试验，而类固醇反应性为阴性的患者则进行手术探查。最终诊断通过手术探查或长期临床及影像学随访做出。
所有对类固醇有反应的患者（n = 15）均被诊断为AIP，而所有对类固醇无反应的患者（n = 7）均被确诊为胰腺癌。除1例拒绝手术的患者外，所有患者（6/6；100%）均可行根治性切除。
在因AIP影像学表现不典型而仍需与胰腺癌进行鉴别的临床疑似AIP病例中，“为期2周的类固醇试验及随后对其反应的评估”可能有助于确诊AIP，且对可切除胰腺癌无不良影响。然而，类固醇试验应仅由胰腺病学专家谨慎进行。
