Corticosteroids prevent the progression of autoimmune pancreatitis to chronic pancreatitis
Corticosteroids prevent the progression of autoimmune pancreatitis to chronic pancreatitis
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DOI：
10.1016/j.pan.2020.07.408
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发表时间：
2020-09-01
期刊：
影响因子：
3.6
通讯作者：
Kawa, Shigeyuki
中科院分区：
文献类型：
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作者：
Kuraishi, Yasuhiro;Uehara, Takeshi;Kawa, Shigeyuki
背景/目标：自身免疫性胰腺炎（AIP）患者有时会进展为慢性胰腺炎（CP）。我们评估了皮质类固醇预防 CP 进展的能力。方法：我们将明确发现 CP（主胰管结石 [MPD] 或多发性胰腺钙化）的患者定义为患有严重钙化 (SC)。共有 145 名 AIP 患者入组。我们测量了 AIP 诊断和 SC 发展之间的持续时间，并回顾性比较了使用和不使用类固醇的患者到 SC 发展的时间。对与 SC 相关的因素进行了多变量分析。结果：19 名 (13%) 患者进展为 SC。由于 95 名患者出现胰头肿胀，并且仅在这些患者中发现 SC，因此我们的分析主要集中在这些高危人群。在仅限于胰头肿胀患者的 Kaplan-Meier 分析中，使用类固醇的患者 SC 发生率显着低于未使用类固醇的患者（风险比 [HR] 0.18，95% 置信区间 [CI] 0.07-0.52；p < 0.001）。对胰头肿胀患者的多变量测试证实，类固醇治疗与较低的 SC 发生率显着相关（HR 0.11，95% CI 0.03-0.34；p < 0.001），而 AIP 诊断时 MPD 扩张与较高的 SC 发生率相关（HR 4.02，95% CI 1.43-11.7；p = 0.009）。结论：皮质类固醇似乎可以预防 AIP 患者进展为 CP，尤其是胰头肿胀的患者。诊断时同时存在胰头肿胀和 MPD 扩张的患者进展为 CP 的发生率较高。建议对这些高危病例进行类固醇治疗。 (C) 2020 年 IAP 和 EPC。由 Elsevier B.V. 出版。保留所有权利。
Background/objectives: Patients with autoimmune pancreatitis (AIP) sometimes progress to chronic pancreatitis (CP). We evaluated the ability of corticosteroids to prevent the progression to CP.Methods: We defined patients with definitive findings of CP (stones in the main pancreatic duct [MPD] or multiple pancreatic calcifications) as having severe calcification (SC). A total of 145 AIP patients were enrolled. We measured the duration between AIP diagnosis and SC development and retrospectively compared the time to SC development between patients with and without steroids. Multivariate analysis for factors associated with SC were performed.Results: Nineteen (13%) patients progressed to SC. Since 95 patients had pancreatic head swelling and SC was found in these patients only, our analysis focused mainly on these at-risk populations. In Kaplan-Meier analysis limited to patients with pancreatic head swelling, the incidence of SC was significantly lower in patients with steroids than in those without (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.07-0.52; p < 0.001). Multivariate testing of patients with pancreatic head swelling confirmed that steroid therapy was significantly associated with a lower incidence of SC (HR 0.11, 95% CI 0.03-0.34; p < 0.001), while MPD dilation at AIP diagnosis was related to a higher incidence of SC (HR 4.02, 95% CI 1.43-11.7; p = 0.009).Conclusions: Corticosteroids appeared to prevent progression to CP in AIP patients, especially in those with pancreatic head swelling. Patients with both pancreatic head swelling and MPD dilation at diagnosis have a higher incidence of progression to CP. Steroid therapy is suggested for these high-risk cases. (C) 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.