From Pathogenesis, Clinical Manifestation, and Diagnosis to Treatment: An Overview on Autoimmune Pancreatitis.
From Pathogenesis, Clinical Manifestation, and Diagnosis to Treatment: An Overview on Autoimmune Pancreatitis.
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DOI：
10.1155/2017/3246459
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发表时间：
2017
影响因子：
2
通讯作者：
Tan S
中科院分区：
文献类型：
--
作者：
Cai O;Tan S
自身免疫性胰腺炎（AIP）是一种特殊类型的慢性胰腺炎，是由自身免疫介导的。2011年国际共识诊断标准（ICDC）提出了两种类型的AIP：I型与淋巴浆细胞硬化性胰腺炎（LPSP）的组织学模式相关，其特征在于血清IgG 4升高，而2型称为特发性导管中心性胰腺炎（IDCP），具有粒细胞上皮病变（GEL）和免疫球蛋白G4（IgG 4）阴性。其致病机制目前尚不清楚，可能与遗传因素、疾病特异性或相关抗原、先天性和获得性免疫有关。AIP最常见的临床表现是梗阻性黄疸和上腹部疼痛。根据ICDC 2011，可通过实质和导管成像、血清IgG 4浓度、胰腺组织学、胰腺外疾病和糖皮质激素反应性的组合进行诊断。由于临床和影像学与胰腺癌相似，在进行糖皮质激素治疗的经验性试验之前，应仔细进行一般检查以排除胰腺恶性肿瘤。糖皮质激素是AIP诱导缓解的最常用药物，但激素维持治疗和复发治疗仍存在争议。进一步的研究应确定更特异的AIP血清生物标志物，致病机制和复发的治疗。
Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis which is autoimmune mediated. The international consensus diagnostic criteria (ICDC) 2011 proposed two types of AIP: type I is associated with histological pattern of lymphoplasmacytic sclerosing pancreatitis (LPSP), characterized by serum IgG4 elevation, whereas type 2 is named idiopathic duct-centric pancreatitis (IDCP), with granulocytic epithelial lesion (GEL) and immunoglobulin G4 (IgG4) negative. The pathogenic mechanism is unclear now; based on genetic factors, disease specific or related antigens, innate and adaptive immunity may be involved. The most common clinical manifestations of AIP are obstructive jaundice and upper abdominal pain. The diagnosis can be made by a combination of parenchymal and ductal imaging, serum IgG4 concentrations, pancreatic histology, extrapancreatic disease, and glucocorticoid responsiveness according to ICDC 2011. Because of the clinical and imaging similarities with pancreatic cancer, general work-up should be done carefully to exclude pancreatic malignant tumor before empirical trial of glucocorticoid treatment. Glucocorticoid is the most common drug for AIP to induce remission, while there still exists controversy on steroid maintenance and treatment for relapse. Further studies should be done to identify more specific serum biomarkers for AIP, the pathogenic mechanisms, and the treatment for relapse.
影响因子：
4
作者：
Kamisawa T;Tabata T;Hara S;Kuruma S;Chiba K;Kanno A;Masamune A;Shimosegawa T
通讯作者：
Shimosegawa T