Nikolic Sara, Maisonneuve Patrick, Dahlman Ingrid, Löhr J-Matthias, Vujasinovic Miroslav
Department of Medicine, Huddinge, Karolinska Institute, 14186 Stockholm, Sweden.
Department of Gastroenterology, Clinic of Internal Medicine, University Medical Centre Maribor, 2000 Maribor, Slovenia.
J Clin Med. 2022 Jun 28;11(13):3724. doi: 10.3390/jcm11133724.
Autoimmune pancreatitis (AIP) is a specific form of chronic pancreatitis with a high relapse rate after treatment. AIP patients are burdened with an increased risk of long-term sequelae such as exocrine and endocrine insufficiency. Our objective was to investigate if pharmacological treatment affects both endocrine and exocrine pancreatic function in patients with AIP.
We included 59 patients with definite AIP in the final analysis. Screening for diabetes mellitus (DM) and pancreatic exocrine insufficiency (PEI) was performed at the time of AIP diagnosis and during follow-up.
There were 40 (67.8%) males and 19 (32.2%) females; median age at diagnosis was 65 years. Median follow-up after the diagnosis of AIP was 62 months. PEI prevalence at diagnosis was 72.7% and was 63.5% at follow-up. The cumulative incidence of DM was 17.9%, with a prevalence of DM at diagnosis of 32.8%. No strong association was found between pharmacological treatment and occurrence of PEI and DM. Univariate analysis identified potential risk factors for PEI (other organ involvement and biliary stenting) and for DM (overweight, blue-collar profession, smoking, weight loss or obstructive jaundice as presenting symptoms, imaging showing diffuse pancreatic enlargement, smoking). In a multivariate analysis, only obstructive jaundice was identified as a risk factor for DM both at diagnosis and during follow-up.
Our results suggest that the prevalence of endocrine and exocrine insufficiency in AIP is high at diagnosis with an additional risk of PEI and DM during follow-up despite pharmacological treatment.
自身免疫性胰腺炎（AIP）是慢性胰腺炎的一种特殊形式，治疗后复发率较高。AIP患者面临着诸如外分泌和内分泌功能不全等长期后遗症风险增加的负担。我们的目的是研究药物治疗是否会影响AIP患者的内分泌和外分泌胰腺功能。
最终分析纳入了59例确诊为AIP的患者。在AIP诊断时及随访期间进行糖尿病（DM）和胰腺外分泌功能不全（PEI）筛查。
男性40例（67.8%），女性19例（32.2%）；诊断时的中位年龄为65岁。AIP诊断后的中位随访时间为62个月。诊断时PEI患病率为72.7%，随访时为63.5%。DM的累积发病率为17.9%，诊断时DM患病率为32.8%。未发现药物治疗与PEI和DM的发生之间有强关联。单因素分析确定了PEI（其他器官受累和胆道支架置入）和DM（超重、蓝领职业、吸烟、体重减轻或梗阻性黄疸作为首发症状、影像学显示胰腺弥漫性肿大、吸烟）的潜在危险因素。在多因素分析中，仅梗阻性黄疸被确定为诊断时和随访期间DM的危险因素。
我们的结果表明，AIP患者在诊断时内分泌和外分泌功能不全的患病率较高，尽管进行了药物治疗，但随访期间仍有发生PEI和DM的额外风险。
