Department of Gastroenterology and Hepatology, The Chinese People's Liberation Army General Hospital, Beijing, China.
Digestion. 2013;88(2):128-34. doi: 10.1159/000353597. Epub 2013 Sep 4.
To search for the key factors of autoimmune pancreatitis (AIP) in China and to improve the early identification of AIP in order to avoid misdiagnosing it as pancreatic carcinoma.
Clinical, imaging, laboratory, and pathological data about AIP were collected and analyzed from 1996 to 2011 in The Chinese People's Liberation Army General Hospital.
A total of 33 patients (male 29, female 4) aged 35-76 years (52.3 ± 9.3 years) meeting the International Consensus Diagnostic Criteria for type 1 (n = 32) or type 2 (n = 1) AIP were included. With improved understanding of AIP, the misdiagnosis rate and unnecessary laparotomy rate was decreased from 95.7% (22/23) and 91.3% (21/23) before 2006, to 20.0% (2/10) (p = 0.001) and 0.0% (p = 0.001) respectively after 2006. The major symptoms were jaundice in (24/33, 72.7%) and abdominal pain (12/33, 36.4%). Half of the patients had other accompanied autoimmune disorders. Laboratory tests showed an elevated level of serum IgG in 9 out of 11 patients (81.8%) and an increased eosinophil count in 16 out of 33 patients (48.5%). The serum IgG4 levels were twice the upper limit of the normal value. CT scan showed a low-contrast margin characterized by a capsule-like rim in 24 of 32 patients (75.0%). Pathologic examinations showed fibrosis and infiltration of massive lymphocytes and plasma cells in the pancreas. Prednisone was given to the patients and proved to be quite effective for all of them (12/12, 100%).
Type 1 AIP shows a sex predilection compared with type 2 AIP in China. In order to diagnose AIP exactly, a comprehensive strategy, especially including imaging and pathological examination, should be used. With growing awareness, fewer AIP patients with this diagnosis would be misdiagnosed and incorrectly treated.
寻找中国自身免疫性胰腺炎（AIP）的关键因素，提高对 AIP 的早期识别，避免误诊为胰腺癌。
收集并分析了 1996 年至 2011 年期间中国人民解放军总医院符合 1 型（n = 32）或 2 型（n = 1）AIP 国际共识诊断标准的 AIP 患者的临床、影像学、实验室和病理学资料。
共纳入 33 例患者（男 29 例，女 4 例），年龄 35-76 岁（52.3 ± 9.3 岁），符合 1 型（n = 32）或 2 型（n = 1）AIP 的国际共识诊断标准。随着对 AIP 的认识不断提高，2006 年之前误诊率和不必要剖腹探查率分别为 95.7%（22/23）和 91.3%（21/23），2006 年之后误诊率和不必要剖腹探查率分别降至 20.0%（2/10）（p = 0.001）和 0.0%（p = 0.001）。主要症状为黄疸（24/33，72.7%）和腹痛（12/33，36.4%）。半数患者伴有其他自身免疫性疾病。实验室检查显示，11 例患者中有 9 例（81.8%）血清 IgG 水平升高，33 例患者中有 16 例（48.5%）嗜酸性粒细胞计数升高。血清 IgG4 水平是正常值上限的两倍。32 例患者中有 24 例（75.0%）CT 扫描显示低对比度边缘，具有胶囊样边缘特征。病理检查显示胰腺纤维化和大量淋巴细胞及浆细胞浸润。给予患者泼尼松治疗，所有患者（12/12，100%）均有效。
与 2 型 AIP 相比，中国 1 型 AIP 存在性别倾向。为了准确诊断 AIP，应采用综合策略，特别是包括影像学和病理学检查。随着认识的提高，这种诊断的 AIP 患者误诊和不正确治疗的比例会更少。
