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日本自身免疫性胰腺炎管理共识指南:III. AIP 的治疗和预后。

Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP.

机构信息

Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan.

出版信息

J Gastroenterol. 2010 May;45(5):471-7. doi: 10.1007/s00535-010-0221-9. Epub 2010 Mar 9.

Abstract

Steroid therapy appeared to be a standard treatment for autoimmune pancreatitis (AIP), although some AIP patients improve spontaneously. The indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, and back pain, and the presence of symptomatic extrapancreatic lesions. Before steroid therapy, jaundice should be managed by biliary drainage in patients with obstructive jaundice, and blood glucose levels should be controlled in patients with diabetes mellitus. For the initial oral prednisolone dose for induction of remission, 0.6 mg/kg/day is recommended. The initial dose is administered for 2-4 weeks, and the dose is tapered by 5 mg every 1-2 weeks, based on changes in the clinical manifestations, biochemical blood tests (such as liver enzymes and IgG or IgG4 levels), and repeated imaging findings (US, CT, MRCP, ERCP, etc.). The dose is tapered to a maintenance dose (2.5-5 mg/day) over a period of 2-3 months. Steroid therapy should be stopped based on the disease activity in each case. Stopping of maintenance therapy should be planned within at least 3 years in cases with radiological and serological improvement. Re-administration or dose-up of steroid is effective for treating AIP relapses. The prognosis of AIP appears to be good over the short-term with steroid therapy. It is unclear whether the long-term outcome is good because there are many unknown factors, such as relapse, pancreatic exocrine or endocrine dysfunction, and associated malignancy.

摘要

类固醇治疗似乎是自身免疫性胰腺炎(AIP)的标准治疗方法,尽管有些 AIP 患者会自行改善。AIP 患者接受类固醇治疗的指征是出现阻塞性黄疸、腹痛和背痛等症状,以及存在有症状的胰外病变。在接受类固醇治疗之前,对于阻塞性黄疸的患者应通过胆道引流来治疗黄疸,对于糖尿病患者应控制血糖水平。对于诱导缓解的初始口服泼尼松龙剂量,建议使用 0.6mg/kg/天。初始剂量给药 2-4 周,然后根据临床表现、生化血液检查(如肝酶和 IgG 或 IgG4 水平)和重复影像学检查结果(US、CT、MRCP、ERCP 等)每 1-2 周减少 5mg,逐渐减少剂量。剂量减少至维持剂量(2.5-5mg/天),持续 2-3 个月。应根据每个病例的疾病活动情况来停止类固醇治疗。对于影像学和血清学改善的病例,应计划在至少 3 年内停止维持治疗。重新给予或增加类固醇剂量对于治疗 AIP 复发是有效的。在短期应用类固醇治疗后,AIP 的预后似乎良好。由于存在许多未知因素,如复发、胰腺外分泌或内分泌功能障碍和相关恶性肿瘤,长期预后是否良好尚不清楚。

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