Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Medicine (Baltimore). 2023 Sep 8;102(36):e35089. doi: 10.1097/MD.0000000000035089.
We previously reported respiratory involvement in 25 patients with autoimmune pancreatitis, a pancreatic manifestation of IgG4-related disease that responds well to glucocorticoid treatment. However, whether all respiratory lesions in patients with autoimmune pancreatitis have genuine respiratory involvement is unclear. This study aimed to update respiratory lesions' clinical and radiological characteristics in patients with autoimmune pancreatitis. We retrospectively reviewed the clinical and radiological data of 74 consecutive patients diagnosed with autoimmune pancreatitis at Shinshu University Hospital and treated with glucocorticoid. Clinical features and chest high-resolution computed tomography findings before and after therapy were reviewed. Fifty-one patients (68.9%) had respiratory lesions. In 65 of the 74 patients, chest high-resolution computed tomography results were evaluated before and after treatment. Patients with IgG4-related disease and respiratory lesions showed significantly higher serum IgG4 levels and hypocomplementemia than those without respiratory lesions; they also had more affected organs. While most abnormal thoracic findings improved, 4 cases of 7 with reticular opacities and all 11 cases with emphysema did not improve. Therefore, these lesions with poor response to glucocorticoid treatment should not be considered due to respiratory involvement of autoimmune pancreatitis based on the current classification criteria for IgG4-related disease. Patients with autoimmune pancreatitis and respiratory lesions exhibited higher disease activity than those without. Most chest high-resolution computed tomography lesions were responsive to glucocorticoid treatment, whereas reticular opacities and emphysema were poorly responsive.
我们之前报道了 25 例自身免疫性胰腺炎患者的呼吸系统受累情况，这是 IgG4 相关疾病的胰腺表现，对糖皮质激素治疗反应良好。然而，自身免疫性胰腺炎患者的所有呼吸系统病变是否都有真正的呼吸系统受累尚不清楚。本研究旨在更新自身免疫性胰腺炎患者呼吸系统病变的临床和影像学特征。我们回顾性分析了在信州大学医院诊断为自身免疫性胰腺炎并接受糖皮质激素治疗的 74 例连续患者的临床和影像学数据。回顾了治疗前后的临床特征和胸部高分辨率计算机断层扫描结果。51 例（68.9%）患者有呼吸系统病变。在 74 例患者中的 65 例中，评估了治疗前后的胸部高分辨率计算机断层扫描结果。有 IgG4 相关疾病和呼吸系统病变的患者的血清 IgG4 水平和低补体血症显著高于无呼吸系统病变的患者；他们也有更多受影响的器官。虽然大多数异常的胸部发现有所改善，但在 7 例网状阴影中有 4 例和所有 11 例肺气肿没有改善。因此，根据目前 IgG4 相关疾病的分类标准，不应将这些对糖皮质激素治疗反应不佳的病变视为自身免疫性胰腺炎的呼吸受累。有呼吸系统病变的自身免疫性胰腺炎患者的疾病活动度高于无呼吸系统病变的患者。大多数胸部高分辨率计算机断层扫描病变对糖皮质激素治疗有反应，而网状阴影和肺气肿则反应不佳。
