Hirano Kenji, Tada Minoru, Isayama Hiroyuki, Sasahira Naoki, Umefune Gyotane, Akiyama Dai, Watanabe Takeo, Saito Tomotaka, Takagi Kaoru, Takahara Naminatsu, Hamada Tsuyoshi, Mizuno Suguru, Miyabayashi Koji, Mohri Dai, Kogure Hirofumi, Yamamoto Natsuyo, Nakai Yousuke, Arizumi Toshihiko, Toda Nobuo, Koike Kazuhiko
*Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku†Department of Gastroenterology, Tokyo Takanawa Hospital, Takanawa Minato-ku‡Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
J Clin Gastroenterol. 2016 Apr;50(4):331-7. doi: 10.1097/MCG.0000000000000440.
To predict the duration of steroid maintenance therapy required to achieve good prognosis in patients with autoimmune pancreatitis.
The study sample comprised 21 patients with autoimmune pancreatitis who met the following criteria: (1) they received steroid therapy (ST) for at least 3 years without clinical relapse; and (2) immunoglobulin (Ig) G<1600 mg/dL was observed in the past year with a prednisolone maintenance dose ≤5 mg. All patients could be diagnosed with international consensus diagnostic criteria. Patients were prospectively followed up after tapering and cessation of steroids. Clinical relapse was defined as the need to resume ST. Serological relapse was defined as having an IgG level of >1600 mg/dL.
During the 43-month (range, 19 to 48 mo) follow-up period, clinical relapse occurred in 10 patients: pancreatic lesion in 4; coronary lesion in 2; submandibular lesion in 1; both pulmonary and renal lesions in 1; pulmonary, retroperitoneal, and submandibular lesions in 1; and bronchial asthma in 1. Serological relapse was observed in 12 patients. Although clinical and serological relapse occurred concomitantly in 3 patients, serological relapse preceded clinical relapse in 4 patients. Five patients experienced serological relapse alone, and no clinical or serological relapse occurred in 6 patients. According to Cox proportional hazard analysis, the duration of ST before tapering was a significant predictive parameter (hazard ratio, 0.969/month; 95% confidence interval, 0.940-0.998; P=0.038).
ST cessation resulted in a high rate of clinical relapses, even in patients with long-term maintenance therapy. Therefore, it appears desirable to continue steroid maintenance therapy for a period >3 years to prevent relapse.
预测自身免疫性胰腺炎患者实现良好预后所需的类固醇维持治疗持续时间。
研究样本包括21例符合以下标准的自身免疫性胰腺炎患者：（1）接受类固醇治疗（ST）至少3年且无临床复发；（2）过去一年观察到免疫球蛋白（Ig）G<1600mg/dL，泼尼松龙维持剂量≤5mg。所有患者均符合国际共识诊断标准。患者在类固醇逐渐减量和停用后进行前瞻性随访。临床复发定义为需要恢复ST。血清学复发定义为IgG水平>1600mg/dL。
在43个月（范围19至48个月）的随访期内，10例患者发生临床复发：胰腺病变4例；冠状动脉病变2例；颌下病变1例；肺部和肾脏病变均1例；肺部、腹膜后和颌下病变1例；支气管哮喘1例。12例患者出现血清学复发。虽然3例患者临床和血清学复发同时发生，但4例患者血清学复发先于临床复发。5例患者单独出现血清学复发，6例患者未发生临床或血清学复发。根据Cox比例风险分析，逐渐减量前ST的持续时间是一个显著的预测参数（风险比，0.969/月；95%置信区间，0.940 - 0.998；P = 0.038）。
即使是长期维持治疗的患者，停用ST也导致较高的临床复发率。因此，为预防复发，继续类固醇维持治疗超过3年似乎是可取的。
