Department of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
PLoS One. 2012;7(9):e44808. doi: 10.1371/journal.pone.0044808. Epub 2012 Sep 18.
To improve the early identification of autoimmune pancreatitis in China by a retrospective analysis of clinical data from AIP patients.
METHODOLOGY/PRINCIPAL FINDINGS: The analysis included 36 patients admitted by the surgery department of our hospital from January 2003 to October 2011 whose postoperative pathological confirmations were consistent with the histological criteria of Honolulu Consensus Document. The clinical phenotypes associated with the histopathologic patterns of LPSP and IDCP were referred to as type 1 and type 2 of AIP, respectively. A retrospective analysis of clinical features, serological data, pathological findings and imageological records was performed in line with the subtypes of AIP. Type 1 showing a sex predilection (males) was commonly more dominant than type 2 in all AIP. Type 2 without a gender predilection was, on average, a decade younger than type 1. Type 1 was inferior to type 2 in ALT, ALP and γ-GT with statistical significance (P = 0.044, 0.025 and 0.013). Type 1 was inferior to type 2 in AST with difference close to statistical significance (P = 0.072). Histopathology revealed frequent lymphoplasmacytic infiltration with less frequent infiltration of neutrophils, eosinophils and fibroblasts. Diffuse and intensive interstitial fibrosis could be seen. The changes of pancreatic head were more frequently seen in type 2 than in type 1 (P = 0.05). Plasma cells staining of IgG4 at a density of over 30 or more cells per high-power field appeared to be a specific finding in China with type 1. Imageology found a diffusely or focally enlarged pancreas, most frequently a mass or enlargement in the pancreatic head, characteristic capsule-like rim, calcification or pancreatic calculus and cystic degeneration.
CONCLUSIONS/SIGNIFICANCE: AIP is a unique type of chronic pancreatitis and has distinctive serological, pathological and imageological characteristics, which should be used for differentiation from pancreatic cancer.
通过对我院手术科室收治的经术后病理证实符合 Honolulu 共识文件组织学标准的 AIP 患者的临床资料进行回顾性分析，旨在提高我国对 AIP 的早期识别。
方法/主要发现：分析纳入了我院手术科室自 2003 年 1 月至 2011 年 10 月收治的 36 例患者，术后病理与 Honolulu 共识文件的组织学标准相符。与 LPSP 和 IDCP 的组织病理模式相关的临床表型分别称为 AIP 的 1 型和 2 型。根据 AIP 的亚型对临床特征、血清学数据、病理学发现和影像学记录进行回顾性分析。1 型（男性优势）比 2 型更常见，在所有 AIP 中更占主导地位。无性别倾向的 2 型平均比 1 型年轻 10 岁。1 型在 ALT、ALP 和 γ-GT 方面劣于 2 型，具有统计学意义（P=0.044、0.025 和 0.013）。1 型在 AST 方面劣于 2 型，差异接近统计学意义（P=0.072）。组织病理学显示常见淋巴细胞浆细胞浸润，较少见中性粒细胞、嗜酸性粒细胞和纤维母细胞浸润。弥漫性和密集性间质纤维化可见。2 型较 1 型更常出现胰头部变化（P=0.05）。IgG4 阳性浆细胞密度超过 30 个/高倍视野可能是中国 AIP 的一个特有表现，以 1 型为主。影像学检查发现弥漫性或局灶性胰腺增大，最常见为胰头部肿块或增大、特征性包膜样边缘、钙化或胰管结石和囊性变性。
结论/意义：AIP 是一种独特类型的慢性胰腺炎，具有独特的血清学、病理学和影像学特征，应与胰腺癌相鉴别。
