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自身免疫性胰腺炎的诊断、分类及管理综述

Review of the diagnosis, classification and management of autoimmune pancreatitis.

作者信息

O'Reilly Derek A, Malde Deep J, Duncan Trish, Rao Madhu, Filobbos Rafik

机构信息

Derek A O'Reilly, Deep J Malde, Trish Duncan, Department of Hepatobiliary and Pancreatic Surgery, North Manchester General Hospital, Manchester M8 5RB, United Kingdom.

出版信息

World J Gastrointest Pathophysiol. 2014 May 15;5(2):71-81. doi: 10.4291/wjgp.v5.i2.71.

Abstract

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis, with as yet undetermined incidence and prevalence in the general population. Our understanding of it continues to evolve. In the last few years, 2 separate subtypes have been identified: type 1 AIP has been recognised as the pancreatic manifestation of a multiorgan disease, named immunoglobulin G4 (IgG4)-related disease while type 2 AIP is a pancreas specific disorder not associated with IgG4. International criteria for the diagnosis of AIP have been defined: the HISORt criteria from the Mayo clinic, the Japan consensus criteria and, most recently, the international association of pancreatology "International Consensus Diagnostic Criteria". Despite this, in clinical practice it can still be very difficult to confirm the diagnosis and differentiate AIP from a pancreatic cancer. There are no large studies into the long-term prognosis and management of relapses of AIP, and there is even less information at present regarding the Type 2 AIP subtype. Further studies are necessary to clarify the pathogenesis, treatment and long-term outcomes of this disease. Critically for clinicians, making the correct diagnosis and differentiating the disease from pancreatic cancer is of the utmost importance and the greatest challenge.

摘要

自身免疫性胰腺炎(AIP)是一种罕见的慢性胰腺炎形式,在普通人群中的发病率和患病率尚未确定。我们对它的认识仍在不断发展。在过去几年中,已确定了两种不同的亚型:1型AIP被认为是一种多器官疾病(称为免疫球蛋白G4(IgG4)相关疾病)的胰腺表现,而2型AIP是一种与IgG4无关的胰腺特异性疾病。已定义了AIP的国际诊断标准:梅奥诊所的HISORt标准、日本共识标准以及最近的国际胰腺病学协会“国际共识诊断标准”。尽管如此,在临床实践中,确诊AIP并将其与胰腺癌区分开来仍然非常困难。目前尚无关于AIP复发的长期预后和管理的大型研究,关于2型AIP亚型的信息甚至更少。需要进一步研究以阐明该疾病的发病机制、治疗方法和长期预后。对临床医生来说至关重要的是,做出正确诊断并将该疾病与胰腺癌区分开来是至关重要的,也是最大的挑战。

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