Clinical Significance of Extrapancreatic Lesions in Autoimmune Pancreatitis
Clinical Significance of Extrapancreatic Lesions in Autoimmune Pancreatitis
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DOI：
10.1097/mpa.0b013e3181bd64a1
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发表时间：
2010-01-01
期刊：
影响因子：
2.9
通讯作者：
Joh, Takashi
中科院分区：
文献类型：
--
作者：
Naitoh, Itaru;Nakazawa, Takahiro;Joh, Takashi
目的：探讨自身免疫性胰腺炎(AIP)胰外病变的发生率及临床意义。方法：回顾分析自身免疫性胰腺炎患者病程中胰外病变的发生率及临床特点。结果：95%(61/)的患者在临床过程中发生胰外病变。硬化性胆管炎、硬化性涎腺炎、腹膜后纤维化、纵隔或肺门淋巴结肿大的发生率分别为84%(54/)、23%(15/)、16%(10/)、77%(27/35)。硬化性涎腺炎和胰外胆管硬化性胆管炎患者血清免疫球蛋白G浓度显著高于无硬化性涎腺炎和胰外胆管硬化性胆管炎患者(P=0.005和P=0.016)。单因素分析显示，硬化性涎腺炎(P=0.005)、弥漫性胰管改变(P=0.028)和临床血清免疫球蛋白G浓度升高(P=0.030)是预测复发的显著因素。多因素分析显示弥漫性胰管病变(P=0.005)和硬化性涎腺炎(P=0.012)是AIP复发的独立预测因素。临床上出现的硬化性涎腺炎是AIP复发的重要预测因素。
Objectives: To clarify the frequency and clinical significance of extrapancreatic lesions in autoimmune pancreatitis (AIP).Methods: The frequency and clinical characteristics of extrapancreatic lesions during the clinical course of AIP were investigated retrospectively in 64 patients with AIP. The predictive factors for relapse of AIP at clinical onset were also examined.Results: Extrapancreatic lesions occurred in 95% (61/64) during the clinical course of AIP. The frequencies of sclerosing cholangitis, sclerosing sialadenitis, retroperitoneal fibrosis, and mediastinal or hilar lymphadenopathy were 84% (54/64), 23% (15/64), 16% (10/64), and 77% (27/35), respectively. Patients with sclerosing sialadenitis or extrapancreatic bile duct sclerosing cholangitis had a significantly higher serum immunoglobulin G concentration than those without (P = 0.005 and P = 0.016, respectively). Univariate analysis revealed that sclerosing sialadenitis (P = 0.005), diffuse pancreatic ductal changes (P = 0.028), and a high serum immunoglobulin G concentration (P = 0.030) at clinical onset of AIP were significant predictive factors for relapse. Multivariate analysis revealed that diffuse pancreatic ductal changes (P = 0.005) and sclerosing sialadenitis (P = 0.012) were significant independent predictive factors for relapse of AIP.Conclusions: The frequency of extrapancreatic lesions with AIP during the clinical course was high. The presence of sclerosing sialadenitis at clinical onset is a significant predictive factor for relapse of AIP.