Differences in Clinical Profile and Relapse Rate of Type 1 Versus Type 2 Autoimmune Pancreatitis
Differences in Clinical Profile and Relapse Rate of Type 1 Versus Type 2 Autoimmune Pancreatitis
复制标题
DOI：
10.1053/j.gastro.2010.03.054
复制
发表时间：
2010-07-01
期刊：
影响因子：
29.4
通讯作者：
Vege, Santhi S.
中科院分区：
文献类型：
--
作者：
Sah, Raghuwansh P.;Chari, Suresh T.;Vege, Santhi S.
背景与目的：自身免疫性胰腺炎（AIP）分为亚型1（淋巴浆细胞硬化性胰腺炎）和2（特发性导管中心性胰腺炎）。我们比较了1型和2型AIP的临床特征和长期结局。方法：我们比较了78例符合原始HISORt标准的1型AIP患者和19例经组织学证实的2型AIP患者的临床表现、复发和生命状态。研究结果：在就诊时，1型AIP患者比2型AIP患者年龄大（62 +/- 14 vs 48 +/- 19岁; P <0.0001），血清免疫球蛋白G4水平升高的患病率更高（47/59 [80%] vs 1/6 [17%]; P = 0.004）。1型患者比2型患者更可能有近端胆管、腹膜后、肾脏或唾液疾病（60%比0; P <0.0001）。炎症性肠病与1型和2型相关（6% vs 16%; P = 0.37）。在42个月和29个月的中位临床随访期间，分别有47%的1型患者和2型患者复发。在1型AIP中，近端胆管受累（风险比[HR]，2.12; P = 0.038）和弥漫性胰腺肿胀（HR，2.00; P = 0.049）可预测复发，而胰腺切除术可降低复发率（与皮质类固醇治疗组相比; HR，0.15; P = 0.0001）。中位随访期为58个月和89个月（分别为1型和2型）后，两组的5年生存率与年龄和性别匹配的美国人群相似。结论：1型和2型AIP具有不同的临床特征。1型AIP患者的复发率很高，但2型AIP患者不会复发。AIP不影响长期生存。
BACKGROUND & AIMS: Autoimmune pancreatitis (AIP) has been divided into subtypes 1 (lymphoplasmacytic sclerosing pancreatitis) and 2 (idiopathic duct centric pancreatitis). We compared clinical profiles and long-term outcomes of types 1 and 2 AIP. METHODS: We compared clinical presentation, relapse, and vital status of 78 patients with type 1 AIP who met the original HISORt criteria and 19 patients with histologically confirmed type 2 AIP. RESULTS: At presentation, patients with type 1 AIP were older than those with type 2 AIP (62 +/- 14 vs 48 +/- 19 years; P < .0001) and had a greater prevalence of increased serum levels of immunoglobulin G4 (47/59 [80%] vs 1/6 [17%]; P = .004). Patients with type 1 were more likely than those with type 2 to have proximal biliary, retroperitoneal, renal, or salivary disease (60% vs 0; P < .0001). Inflammatory bowel disease was associated with types 1 and 2 (6% vs 16%; P = .37). During median clinical follow-up periods of 42 and 29 months, respectively, 47% of patients with type 1 and none of those with type 2 experienced a relapse. In type 1 AIP, proximal biliary involvement (hazard ratio [HR], 2.12; P = .038) and diffuse pancreatic swelling (HR, 2.00; P = .049) were predictive of relapse, whereas pancreaticoduodenectomy reduced the relapse rate (vs the corticosteroid-treated group; HR, 0.15; P = .0001). After median follow-up periods of 58 and 89 months (types 1 and 2, respectively), the 5-year survival rates for both groups were similar to those of the age-and sex-matched US population. CONCLUSIONS: Types 1 and 2 AIP have distinct clinical profiles. Patients with type 1 AIP have a high relapse rate, but patients with type 2 AIP do not experience relapse. AIP does not affect long-term survival.