[两例2型自身免疫性胰腺炎的比较]
[Comparison of two cases of type 2 autoimmune pancreatitis].
作者信息
Ikeda Shinya, Mori Taiki, Takeuchi Yasuo, Takagaki Kosuke, Uemura Takashi, Shirai Naohito
机构信息
Department of Gastroenterology, Enshu Hospital.
Department of Pathology, Enshu Hospital.
出版信息
Nihon Shokakibyo Gakkai Zasshi. 2021;118(12):1151-1159. doi: 10.11405/nisshoshi.118.1151.
We describe two cases of type 2 autoimmune pancreatitis (AIP). A 39-year-old man presented to our hospital with complaints of epigastric and back pain. Pancreatic enzyme levels were elevated, but serum levels of immunoglobulins G and G4 (IgG and IgG4) were normal. Computed tomography (CT) showed diffuse pancreatic enlargement, and endoscopic retrograde pancreatography revealed diffuse narrowing of the pancreatic duct. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed granulocytic epithelial lesions and very few IgG4-positive cells. Colonoscopy revealed ulcerative colitis. Type 2 AIP was diagnosed, and 5-aminosalicylic acid (5-ASA) and prednisolone were administered. The clinical course has since been favorable, and the prednisolone dose is currently being reduced. A 47-year-old woman presented to our hospital with complaints of bloody stools. Colonoscopy revealed ulcerative colitis. CT depicted diffuse pancreatic enlargement with a capsule-like rim. Pancreatic enzyme levels were elevated, but serum levels of IgG and IgG4 were normal. On magnetic resonance cholangiopancreatography, the pancreatic duct could not be delineated. No pathological findings of type 2 AIP were obtained on EUS-FNA. Type 2 AIP was suspected, and 5-ASA and steroid enemas were administered. To date, recurrence has not been observed, and 5-ASA management continues. The two cases differed with regard to sex of patient, clinical course, pathological findings, and treatment.
我们描述了两例2型自身免疫性胰腺炎(AIP)。一名39岁男性因上腹部和背部疼痛前来我院就诊。胰腺酶水平升高,但血清免疫球蛋白G和G4(IgG和IgG4)水平正常。计算机断层扫描(CT)显示胰腺弥漫性肿大,内镜逆行胰胆管造影显示胰管弥漫性狭窄。内镜超声引导下细针穿刺活检(EUS-FNA)显示粒细胞上皮病变,IgG4阳性细胞极少。结肠镜检查显示溃疡性结肠炎。诊断为2型AIP,给予5-氨基水杨酸(5-ASA)和泼尼松龙治疗。此后临床过程良好,目前泼尼松龙剂量正在减少。一名47岁女性因便血前来我院就诊。结肠镜检查显示溃疡性结肠炎。CT显示胰腺弥漫性肿大,有包膜样边缘。胰腺酶水平升高,但血清IgG和IgG4水平正常。磁共振胰胆管造影未能显示胰管。EUS-FNA未发现2型AIP的病理表现。怀疑为2型AIP,给予5-ASA和类固醇灌肠治疗。迄今为止,未观察到复发,继续使用5-ASA治疗。这两例在患者性别、临床过程、病理表现和治疗方面存在差异。