Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course
Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course
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DOI：
10.1007/s00535-011-0510-y
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发表时间：
2012-05-01
影响因子：
6.3
通讯作者：
Kawa, Shigeyuki
中科院分区：
文献类型：
--
作者：
Maruyama, Masahiro;Arakura, Norikazu;Kawa, Shigeyuki
自身免疫性胰腺炎（AIP）有可能进展为慢性状态，形成胰腺结石。本研究的目的是阐明AIP胰腺结石形成的危险因素。69例随访至少3年的AIP患者入组，评估临床和实验室因素以及计算机断层扫描和内窥镜逆行胰胆管造影结果。在本研究过程中，28例患者出现结石形成增加或新发结石，他们被定义为结石形成组。32例患者未观察到结石，被定义为非结石形成组。9例在诊断时有结石但在研究过程中没有变化的患者被排除在我们的队列之外。单变量分析显示，两组之间与AIP特异性炎症相关的临床或实验室因素无显著差异。然而，胰头肿胀（P = 0.006）和胰头区域的Wirsung管和Santorini管狭窄（P = 0.010）在结石形成组中明显更常见。此外，多因素分析确定诊断时Wirsung和Santorini管狭窄是胰腺结石形成的显著独立危险因素（OR 4.4，P = 0.019），AIP中胰腺结石形成的主要危险因素是Wirsung和Santorini管狭窄，这最可能导致胰液淤积和结石发展。
Autoimmune pancreatitis (AIP) has the potential to progress to a chronic state that forms pancreatic stones. The aim of this study was to clarify the risk factors underlying pancreatic stone formation in AIP.Sixty-nine patients with AIP who had been followed for at least 3 years were enrolled for evaluation of clinical and laboratory factors as well as computed tomography and endoscopic retrograde cholangiopancreatography findings.During the course of this study, increased or de novo stone formation was seen in 28 patients, who were defined as the stone-forming group. No stones were observed in 32 patients, who were defined as the non-stone-forming group. Nine patients who had stones at diagnosis but showed no change during the course of this study were excluded from our cohort. Univariate analysis revealed no significant differences in clinical or laboratory factors associated with AIP-specific inflammation between the two groups. However, pancreatic head swelling (P = 0.006) and narrowing of both Wirsung's and Santorini's ducts in the pancreatic head region (P = 0.010) were significantly more frequent in the stone-forming group. Furthermore, multivariate analysis identified Wirsung and Santorini duct narrowing at diagnosis as a significant independent risk factor for pancreatic stone formation (OR 4.4, P = 0.019).A primary risk factor for pancreatic stone formation in AIP was narrowing of both Wirsung's and Santorini's ducts, which most presumably led to pancreatic juice stasis and stone development.