Gastrointestinal findings in patients with autoimmune pancreatitis
Gastrointestinal findings in patients with autoimmune pancreatitis
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DOI：
10.1055/s-2005-870369
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发表时间：
2005-11-01
期刊：
影响因子：
9.3
通讯作者：
Funata, N
中科院分区：
文献类型：
--
作者：
Kamisawa, T;Egawa, N;Funata, N
背景和研究目的：自身免疫性胰腺炎（AIP）是最近才被提出作为临床实体的一种疾病。其发病机制涉及自身免疫机制。尽管 AIP 患者的放射学检查结果已得到充分评估，但很少有研究关注这些患者的胃肠道检查结果。本研究的目的是探讨自身免疫性胰腺炎患者胃肠道的内镜和组织学表现。 患者和方法：回顾了 24 名 AIP 患者的胃 (n = 10)、十二指肠 (n = 18)、十二指肠大乳头 (n = 18) 和结肠 (n = 5) 的内镜表现。将这些结果与这些患者的胃粘膜（n = 13）、十二指肠粘膜（n = 9）、十二指肠大乳头（n = 3）和结肠粘膜（n = 3）的组织学检查结果进行比较。所有这些标本均使用抗 IgG4 抗体进行免疫组织化学研究。结果：内窥镜检查中，4 名患者的胃部和 2 名患者的结肠中观察到微苍白、粘膜增厚、可见血管模式消失的病灶。五名患者的十二指肠乳头有轻微或中度肿胀。在胃和结肠粘膜固有层以及十二指肠大乳头中观察到轻度至中度淋巴浆细胞浸润。在 7 名患者的胃固有层、2 名患者的结肠和 3 名患者的十二指肠大乳头中观察到 IgG4 阳性浆细胞的严重浸润（每个高倍视野 > 10 个细胞）；结论：虽然自身免疫性胰腺炎患者的胃或结肠内镜下没有发现特异性的发现，但在某些病例中观察到轻微的头顶病灶，粘膜增厚，可见血管模式消失。内窥镜检查中看到的这种模糊变化似乎是由于胃或结肠粘膜固有层中 IgG4 阳性浆细胞（与 CD4 或 CD8 阳性 T 淋巴细胞相关）大量浸润所致。
Background and Study Aims: Autoimmune pancreatitis (AIP) is a condition that has been proposed as a clinical entity only fairly recently. Its pathogenesis involves autoimmune mechanisms. Although the radiological findings in patients with AIP have been well evaluated, few studies have focused on the gastrointestinal findings in these patients. The aim of this study was to explore the endoscopic and histological findings in the gastrointestinal tract in patients with autoimmune pancreatitis.Patients and Methods: The endoscopic findings in the stomach (n = 10), the duodenum (n = 18), the major duodenal papilla (n = 18), and the colon (n = 5) in 24 patients with AIP were reviewed. These were compared with the results of histological examination of gastric mucosa (n = 13), duodenal mucosa (n = 9), the major duodenal papilla, (n = 3), and colonic mucosa (n = 3) in these patients. All these specimens were subjected to immunohistochemical study using anti-IgG4 antibody.Results: Foci of slightly pale, thickened mucosa with loss of visible vascular pattern were observed in the stomach in four patients and in the colon in two patients on endoscopy. Slight or moderate swelling of the major duodenal papilla was detected in five patients. Slight to moderate lymphoplasmacytic infiltration was observed in the lamina propria of the gastric and colonic mucosa, and of the major duodenal papilla. Heavy infiltration with IgG4-positive plasma cells (> 10 cells per high-power field) was observed in the lamina propria of the stomach in seven patients, of the colon in two patients, and of the major duodenal papilla in three patients; this was not observed in the control patients, who had other diseases.Conclusions: Although there were no specific endoscopic findings in the stomach or colon in patients with autoimmune pancreatitis, foci of slightly pate, thickened mucosa with loss of visible vascular pattern were observed in some cases. This indistinct change seen on endoscopy appears to be due to heavy infiltration with IgG4-positive plasma cells, associated with CD4- or CD8-positive T lymphocytes, in the lamina propria of the gastric or colonic mucosa.