Han Dong-Ge, Ying Chun-Lin, Tian Lu-Gao, Liu Wei, He Zheng
The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang, 443000, China.
Clin Rheumatol. 2025 Aug 27. doi: 10.1007/s10067-025-07663-x.
IgG4-related autoimmune pancreatitis (IgG4-AIP) is a rare inflammatory pancreatic disorder mediated by autoimmune mechanisms, primarily characterized by two forms of presentation: diffuse enlargement and focal enlargement. This study aims to analyze the clinical characteristics of diffuse and focal enlargement in IgG4-AIP, thereby enhancing clinicians' understanding of the differences between these two patient groups and ultimately improving patient outcomes.
This study conducted a retrospective analysis of the clinical data from 40 patients with IgG4-AIP admitted to Yichang Central People's Hospital between January 2019 and December 2024.
Among the 40 patients with IgG4-AIP, 23 (57.50%) presented with diffuse pancreatic enlargement, while 17 (42.50%) exhibited focal pancreatic enlargement. In the diffuse enlargement group, the most common clinical symptom was abdominal pain (13/23 patients, 56.52%), whereas the focal enlargement group predominantly presented with jaundice (11/17 patients, 64.71%). Additionally, patients in the focal enlargement group were more likely to be misdiagnosed as pancreatic tumors (47.06% vs. 13.04%, P < 0.05). In the focal enlargement group, serum levels of gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were significantly elevated compared to the diffuse enlargement group, while serum albumin (ALB) levels were markedly reduced (P < 0.05). The incidence of pancreatic dilatation was significantly higher in the focal enlargement group compared to the diffuse enlargement group (47.06% vs. 13.04%, P < 0.05).
The clinical features of focal enlargement in IgG4-AIP are notably more complex. Clinicians should conduct a thorough analysis of the two presentation forms to develop personalized treatment strategies, thereby improving the prognosis for patients with different manifestations of IgG4-AIP.
IgG4相关性自身免疫性胰腺炎（IgG4-AIP）是一种罕见的由自身免疫机制介导的炎症性胰腺疾病，主要有两种表现形式：弥漫性肿大和局灶性肿大。本研究旨在分析IgG4-AIP中弥漫性和局灶性肿大的临床特征，从而增强临床医生对这两组患者差异的理解，并最终改善患者预后。
本研究对2019年1月至2024年12月期间在宜昌市中心人民医院住院的40例IgG4-AIP患者的临床资料进行回顾性分析。
40例IgG4-AIP患者中，23例（57.50%）表现为胰腺弥漫性肿大，17例（42.50%）表现为胰腺局灶性肿大。在弥漫性肿大组中，最常见的临床症状是腹痛（13/23例患者，56.52%），而局灶性肿大组主要表现为黄疸（11/17例患者，64.71%）。此外，局灶性肿大组患者被误诊为胰腺肿瘤的可能性更高（47.06%对13.04%，P<0.05）。与弥漫性肿大组相比，局灶性肿大组血清γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）水平显著升高，而血清白蛋白（ALB）水平明显降低（P<0.05）。局灶性肿大组胰腺扩张的发生率明显高于弥漫性肿大组（47.06%对13.04%，P<0.05）。
IgG4-AIP局灶性肿大的临床特征明显更为复杂。临床医生应全面分析这两种表现形式，制定个性化治疗策略，从而改善不同表现形式的IgG4-AIP患者的预后。
