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通常被误诊为恶性肿瘤的肿块型自身免疫性胰腺炎的特征。

Characteristics of mass-forming autoimmune pancreatitis commonly misdiagnosed as a malignant tumor.

作者信息

Chen Si, Zhang Hanlei, Fang Fang, Ye Chao, Zhang Kaiguang

机构信息

Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.

Department of Gastroenterology, the Affiliated Provincial Hospital, Anhui Medical University, Hefei, China.

出版信息

Front Surg. 2023 Jan 25;10:1017621. doi: 10.3389/fsurg.2023.1017621. eCollection 2023.

Abstract

OBJECTIVE

This study aimed to explore the clinical characteristics and differential diagnosis of patients with autoimmune pancreatitis (AIP) and pancreatic cancer to prevent misdiagnosis and mistreatment.

METHODS

The clinical data of patients with AIP with suspected pancreatic or bile duct malignancy and pancreatic cancer were retrospectively analyzed. The risk factors and the diagnostic value of IgG4 and Tbil levels before treatment for AIP was investigated. Moreover, the imaging features and response to hormone therapy were analyzed.

RESULTS

AIP was commonly observed in men. Compared to patients with pancreatic cancer, the incidence of poor appetite and weight loss and carbohydrate antigen 19-9 (CA19-9) level was lower in patients with AIP, while the immunoglobulin G4 (IgG4) level was higher (< 0.05). After treatment, the IgG4 and CA19-9 levels in patients with AIP were decreased (< 0.001). IgG4 level before treatment (OR = 2.452, 95%CI: 1.180-5.096,  = 0.016) and total bilirubin (Tbil) level before treatment (OR = 0.992, 95%CI: 0.985-0.998,  = 0.013) were independent risk factors of AIP. Furthermore, the diagnostic value of IgG4 level before treatment, Tbil level before treatment, IgG4/Tbil before treatment, and a combination of these indicators was high. Moreover, 15 (68.18%) patients with AIP had space-occupying lesions of the pancreas, and 16 (72.73%) had autoimmune cholangitis. Most patients with AIP were sensitive to hormone therapy.

CONCLUSIONS

The Tbil and IgG4 levels, imaging findings, and hormone therapy reactivity could differentiate AIP from pancreatic cancer. A combination of IgG4, Tbil, and IgG4/Tbil before treatment might be a promising diagnostic biomarker for AIP.

摘要

目的

本研究旨在探讨自身免疫性胰腺炎(AIP)患者与胰腺癌患者的临床特征及鉴别诊断方法,以防止误诊和误治。

方法

回顾性分析疑似胰腺或胆管恶性肿瘤的AIP患者及胰腺癌患者的临床资料。研究AIP治疗前IgG4和总胆红素(Tbil)水平的危险因素及诊断价值。此外,分析其影像学特征及对激素治疗的反应。

结果

AIP常见于男性。与胰腺癌患者相比,AIP患者食欲减退、体重减轻的发生率及糖类抗原19-9(CA19-9)水平较低,而免疫球蛋白G4(IgG4)水平较高(<0.05)。治疗后,AIP患者的IgG4和CA19-9水平降低(<0.001)。治疗前IgG4水平(OR=2.452,95%CI:1.180-5.096,P=0.016)和治疗前总胆红素(Tbil)水平(OR=0.992,95%CI:0.985-0.998,P=0.013)是AIP的独立危险因素。此外,治疗前IgG4水平、治疗前Tbil水平、治疗前IgG4/Tbil以及这些指标的组合具有较高的诊断价值。此外,15例(68.18%)AIP患者有胰腺占位性病变,16例(72.73%)有自身免疫性胆管炎。大多数AIP患者对激素治疗敏感。

结论

Tbil和IgG4水平、影像学表现及激素治疗反应性可将AIP与胰腺癌区分开来。治疗前IgG4、Tbil和IgG4/Tbil的组合可能是AIP有前景的诊断生物标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a156/9905684/6efd4ac668f3/fsurg-10-1017621-g001.jpg

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