自身免疫性胰腺炎复发的危险因素和治疗：利妥昔单抗安全有效。
Risk factors and treatment of relapses in autoimmune pancreatitis: Rituximab is safe and effective.
机构信息
Pancreatology department, Beaujon Hospital, France and Paris-Diderot University, Clichy, France.
Radiology department, Beaujon Hospital, France and Paris-Diderot University, Clichy, France.
出版信息
United European Gastroenterol J. 2019 Oct;7(8):1073-1083. doi: 10.1177/2050640619862459. Epub 2019 Jul 3.
BACKGROUND AND AIMS
Steroid therapy is the first-line treatment for autoimmune pancreatitis but relapses are frequent. The aims were to assess the efficacy and the safety of immunomodulator treatments for relapsing autoimmune pancreatitis and rituximab in particular and to identify relapsing risk factors.
METHODS
Patients followed for autoimmune pancreatitis from 2000 to 2016 were included. Data were retrospectively analysed regarding autoimmune pancreatitis treatment.
RESULTS
In total, 162 patients with autoimmune pancreatitis type 1 ( = 92) and type 2 ( = 70) were included (median follow-up: 3 years (0.5-14). Relapse occurred in 46.5% of patients with autoimmune pancreatitis type 1 (vs 19.3% in autoimmune pancreatitis 2; < 0.001). Risk factors of relapse were cholangitis, initial use of steroids, other organ involvement and chronic pancreatitis in autoimmune pancreatitis type 1 and initial use of steroids, tobacco consumption and chronic pancreatitis for autoimmune pancreatitis type 2. Overall, 21 patients were treated with immunomodulators (azathioprine, = 19, or methotrexate, = 2) for relapses. The efficiency rate was 67%. A total of 17 patients were treated with rituximab, with two perfusions at 15 days apart. The efficacy was 94% (16/17), significantly better than immunomodulator drugs ( = 0.03), with a median follow-up of 20 months (11-44). Only two patients needed two supplementary perfusions.
CONCLUSION
In relapsing autoimmune pancreatitis, rituximab is more efficient than immunomodulator drugs and shows better tolerance.
背景与目的
激素治疗是自身免疫性胰腺炎的一线治疗方法，但复发率较高。本研究旨在评估免疫调节剂治疗，尤其是利妥昔单抗治疗复发性自身免疫性胰腺炎的疗效和安全性，并确定复发的相关危险因素。
方法
回顾性分析 2000 年至 2016 年期间随访的自身免疫性胰腺炎患者的资料，分析自身免疫性胰腺炎的治疗数据。
结果
共纳入 162 例自身免疫性胰腺炎 1 型（92 例）和 2 型（70 例）患者（中位随访时间：3 年（0.5-14））。自身免疫性胰腺炎 1 型患者中 46.5%（42/92）出现复发，而自身免疫性胰腺炎 2 型患者中仅 19.3%（13/70）复发（ < 0.001）。1 型自身免疫性胰腺炎的复发危险因素为胆管炎、初始激素治疗、其他器官受累和慢性胰腺炎，2 型自身免疫性胰腺炎的复发危险因素为初始激素治疗、吸烟和慢性胰腺炎。共有 21 例复发性自身免疫性胰腺炎患者接受免疫调节剂（硫唑嘌呤 19 例，甲氨蝶呤 2 例）治疗。有效率为 67%。17 例患者接受利妥昔单抗治疗，每 15 天 2 次输注。有效率为 94%（16/17），明显优于免疫调节剂（ = 0.03），中位随访时间为 20 个月（11-44）。仅 2 例患者需要补充 2 次输注。
结论
在复发性自身免疫性胰腺炎中，利妥昔单抗比免疫调节剂更有效，且具有更好的耐受性。
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