Short-term and long-term outcomes of autoimmune pancreatitis
Short-term and long-term outcomes of autoimmune pancreatitis
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DOI：
10.1097/meg.0b013e3283431e23
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发表时间：
2011-02-01
影响因子：
2.1
通讯作者：
Igarashi, Yoshinori
中科院分区：
文献类型：
--
作者：
Takuma, Kensuke;Kamisawa, Terumi;Igarashi, Yoshinori
目的探讨自身免疫性胰腺炎（AIP）患者接受不同治疗后的短期和长期临床病程，探讨类固醇治疗后AIP复发的预测因素。方法对50例AIP患者随访1年以上（中位40个月，范围12 ~ 173个月）的临床病程进行分析。患者根据初始治疗进行细分：手术治疗10例，支持治疗11例，类固醇治疗29例。结果在手术治疗的患者中，两例分别因进行性广泛淋巴结病和腹膜后纤维化而接受类固醇治疗。5例保守随访患者由于AIP累及胆管加重，随后给予类固醇治疗。类固醇治疗对所有患者均有效。胰腺内分泌和外分泌功能障碍和唾液腺功能障碍在类固醇治疗后分别有100,85%和75%的患者得到改善。最初接受类固醇治疗的5例AIP患者复发，肝门胆管狭窄和血清IgG4水平升高与复发显著相关。两名复发的AIP患者在2年和3年后发生胰腺结石。虽然有7例患者死亡，但没有患者死于aip相关疾病或发展为胰腺癌。结论大多数AIP患者在临床、形态学和功能方面具有良好的短期和长期预后。肝门胆管狭窄和血清IgG4水平升高是类固醇治疗后AIP复发的预测因素。由于一些患者在类固醇治疗期间或之后出现胰腺结石形成或恶性肿瘤，AIP患者应严格随访。[J] [J] .中华胃肠病杂志，2011,(3):1 - 2。
Objective To examine the short-term and long-term clinical courses of patients with autoimmune pancreatitis (AIP) who underwent different treatments and identify predictive factors for relapse of AIP after steroid therapy.Methods Clinical courses of 50 AIP patients followed up for more than 1 year (median 40 months, range: 12-173 months) were examined. Patients were subdivided according to initial treatments as follows: surgical procedures in 10 patients, supportive therapy in 11 patients, and steroid therapy in 29 patients.Results Of the surgically treated patients, two underwent steroid therapy later because of progressive extensive lymphadenopathy and retroperitoneal fibrosis, respectively. Five conservatively followed-up patients were later given steroid therapy because of exacerbation of AIP involving the bile duct. Steroid therapy was effective in all patients. Pancreatic endocrine and exocrine dysfunctions and salivary gland dysfunction improved after steroid therapy in 100, 85, and 75% of patients, respectively. AIP relapsed in five patients initially treated with steroid, and presence of hilar bile duct stenosis and elevated serum IgG4 levels were significantly associated with relapse. Two relapsed AIP patients developed a pancreatic stone 2 and 3 years later. Although seven patients died, no patient died of AIP-related diseases or developed pancreatic carcinoma.Conclusion Most AIP patients treated with steroid had good short-term and long-term outcomes clinically, morphologically, and functionally. Hilar bile duct stenosis and elevated serum IgG4 levels were predictors of AIP relapse after steroid therapy. As some patients developed pancreatic stone formation or a malignancy during or after steroid therapy, AIP patients should be rigorously followed up. Eur J Gastroenterol Hepatol 23:146-152 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.