Sugumar Aravind, Takahashi Naoki, Chari Suresh T
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Curr Gastroenterol Rep. 2010 Apr;12(2):91-7. doi: 10.1007/s11894-010-0098-z.
Both autoimmune pancreatitis (AIP) and pancreatic cancer frequently present with obstructive jaundice. However, AIP is a rare disease and its diagnosis carries vastly different therapeutic and prognostic implications compared with that of pancreatic cancer. The clinical challenge is to distinguish AIP from pancreatic cancer, because the price of misdiagnosis can be heavy. Recently, two strategies for differentiating AIP from pancreatic cancer were published, one from Japan and the other from the United States. The Japanese strategy relies on cross-sectional imaging, endoscopic retrograde pancreatogram, and serum IgG4. The American strategy uses imaging (CT scan), serology (serum IgG4), and evidence of other organ involvement (on CT scan) as the first tier of tests. If the differentiation cannot be made by these methods, a core biopsy of the pancreas, steroid trial, or surgical resection is recommended. The two strategies reflect differences in clinical practice and local preferences in the use of certain diagnostic tests. However, both strategies require thorough familiarity with the diseases and the tests being used.
自身免疫性胰腺炎（AIP）和胰腺癌常常都表现为梗阻性黄疸。然而，AIP是一种罕见疾病，与胰腺癌相比，其诊断具有截然不同的治疗和预后意义。临床面临的挑战是将AIP与胰腺癌区分开来，因为误诊的代价可能很大。最近，发表了两种区分AIP与胰腺癌的策略，一种来自日本，另一种来自美国。日本的策略依赖于横断面成像、内镜逆行胰胆管造影和血清IgG4。美国的策略将成像（CT扫描）、血清学（血清IgG4）以及其他器官受累的证据（CT扫描显示）作为一级检测手段。如果通过这些方法无法做出鉴别诊断，则建议进行胰腺核心活检、类固醇试验或手术切除。这两种策略反映了临床实践的差异以及在使用某些诊断检测方法方面的局部偏好。然而，两种策略都需要对疾病和所使用的检测方法有透彻的了解。
