自身免疫性胰腺炎的发病机制

自身免疫性胰腺炎（AIP）是一种特殊类型的,由自身免疫介导的,以胰腺肿大和胰管不规则狭窄为特征的慢性胰腺炎。其作为一个独立的临床疾病目前已成为共识,但确切的发病机制尚不清楚。此文对AIP的发病机制研究进行综述,以求更好地认识、研究AIP,从而找出更好的诊治方法。     

自身免疫性胰腺炎

自身免疫性胰腺炎 (AIP)是由自身免疫介导的一种慢性胰腺炎。AIP这一命名首先是由Sarles等[1] 提出 ,1995年Yoshida等[2 ] 对其定义加以补充、完善 ,其诊断标准是 1997年由Ito等[3 ] 明确提出 ,并且在 2 1世纪慢性胰腺炎分类系统中[4] AIP已作为慢性胰腺炎的一种独立分型单独存在。一、病因及发病机制2 0世纪 6 0年代人们认为AIP是必须与其他自身免疫性疾病相伴发生的 ,如Sj gren综合征、原发性胆汁性肝硬化、原发性硬化性胆管炎、炎症性肠病等。直至 1995年Yoshida等[2 ] 才提出无其他自身免疫疾病相伴的AIP概念。但二者的临床特征…     

踝臂指数的临床应用

踝臂指数（踝动脉与肱动脉收缩压的比值）是诊断外周动脉疾病的一种简单、非侵入性、可靠的方法。大量研究表明,低踝臂指数不仅是心脑血管病发病和死亡的独立预测因素,为系统性动脉硬化的重要指标。现着重阐述踝臂指数异常（〈0．9）与外周动脉病、心血管疾病、脑血管疾病、慢性肾功能衰竭等多种疾病之间的关系,旨在分析踝臂指数的临床应用价值,明确动脉粥样硬化为全身性疾病,以期在临床工作中更好地防治动脉粥样硬化性疾病。     

急性间质性肺炎

急性间质性肺炎(AIP)是80年代中期提出的间质性肺疾病中一个新的分类,其病理特点和临床表现与慢性型的特发性肺纤维化(IPF)不同,与成人呼吸窘迫综合征(ARDS)相似,但病因不明。本文就近十余年的文献资料对AIP的病理、临床、诊治等方面作一介绍。     

自身免疫性胰腺炎1例报告

<正>自身免疫性胰腺炎(AIP)是与自身免疫损伤相关的慢性胰腺炎症,随着研究的深入,其作为一个全新的临床疾病独立分型受到越来越多的关注,因其免疫球蛋白(Ig)G4水平显著升高,又称为IgG4相关性胰腺炎[1]。目前关于AIP确切的发病机制尚不清楚,有研究报道辅助性T细胞(helper T cell,Th)1、Th2、抗原递呈细胞(APC)、调节性T细胞(Treg)以及多种细胞     

035 急性间质性肺炎

急性间质性肺炎(AIP)是80年代中期提出的间质性肺疾病中一个新的分类,其病理特点和临床表现与慢性型的特发性肺纤维化(IPF)不同,与成人呼吸窘迫综合征(ARDS)相似,但病因不明.本文就近十余年的文献资料对AIP的病理、临床、诊治等方面作一介绍.     

自身免疫性胰腺炎的诊断和治疗进展

自身免疫性胰腺炎（AIP）是最近认定的一种临床病理疾病，首先由Sarles在1961年描述为“慢性胰腺硬化性炎症”，可能病因是自身免疫，伴随高球蛋白血症。这一疾病在最近20年逐渐引起临床重视，1995年，Yoshita提出“AIP”的概念，但直到最近才在科学文献中被广泛接受。因为可能伴有胆道系统的病变，也有人提出“自身免疫性胰腺胆管炎”的概念。该病病因、发病机理和临床表现尚不明确，国际上也缺乏统一诊断标准，分别有4个研究小组提出了自己的诊断标准。现将AIP诊治进展综述如下。     

自身免疫性胰腺炎的诊治进展

胆道疾病和酗酒是慢性胰腺炎常见的病因,但仍有30%～40%的慢性胰腺炎患者病因不明.Sarles等首先报道伴有高丙种球蛋白血症的胰腺炎后,自身免疫性胰腺炎(AIP)作为一种特殊类型的慢性胰腺炎逐渐被人们所认识.     

脉搏波传导速度评价动脉粥样硬化性疾病的应用进展

动脉粥样硬化是导致各种心脑血管事件的主要因素,也是糖尿病、高血压、高脂血症等慢性疾病最主要的致病机制,早诊断早治疗是延缓及控制动脉粥样硬化性疾病的重要措施。脉搏波传导速度作为一种有效评估动脉粥样硬化的手段,因其无创、经济、操作简单等优点,近年在临床使用广泛。该文主要从脉搏波传导速度测定原理及应用两大方面作一综述。     

踝/臂血压指数与动脉粥样硬化的关系

现着重阐述踝/臂血压指数(AB I)异常(AB I<0.9)与外周动脉病、心血管疾病、脑血管疾病、糖尿病等多种疾病之间的关系,旨在分析AB I的临床应用价值,明确动脉粥样硬化为全身性疾病,以期在临床工作中更好地防治动脉粥样硬化疾病。     

血浆致动脉硬化指数在心血管疾病中的应用进展

心血管疾病(CVD)是一种严重威胁人类健康的疾病,如何较早发现并预防心血管事件的发生,是我们急需解决的问题。血浆致动脉硬化指数(AIP)是最近几年提出的CVD的独立预测指标,由血浆甘油三酯(TG)和高密度脂蛋白胆固醇(HDLC)比值的对数转换得出,即log[TG/HDLC]。相比既往单一指标而言,AIP更能综合反映血脂代谢水平,对于疾病的临床诊断及治疗监测意义重大。现就AIP在CVD中的应用进展予以综述。     

Autoimmune pancreatitis

The purpose of this review is to provide a concise view of the existing knowledge of autoimmune pancreatitis (AIP) for practicing clinicians. AIP is a rare disease whose recognition and understanding are evolving. It is a type of chronic pancreatitis that often presents as obstructive jaundice, has a distinctive histology, and is exquisitely sensitive to steroid therapy. This form of chronic pancreatitis has a unique clinical, biochemical, and radiological profile. The term "AIP" encompasses two subtypes: types 1 and 2. Type 1 AIP is the pancreatic manifestation of a systemic fibro-inflammatory disease called immunoglobulin G4-associated systemic diseases. Type 2 AIP has been shown to be associated with inflammatory bowel disease. Existing criteria are geared towards the diagnosis of type 1 AIP. At present, pancreatic histology is a requirement for the definitive diagnosis of type 2 AIP. AIP can mimic most other pancreatic diseases in its presentation, but in clinical practice, it often has to be differentiated from pancreatic cancer. There are established criteria and algorithms not only to diagnose AIP, but also to differentiate it from pancreatic cancer. The utility of these algorithms and the approach to management are discussed here.     

自身免疫性胰腺炎两种亚型治疗的进展

自身免疫性胰腺炎（AIP）是由自身免疫介导的、以胰腺肿大及胰管不规则狭窄为特征的慢性胰腺炎，有着独特的临床、影像学和组织病理学特点。据其特点分为两个亚型。两种亚型的治疗、预后及复发率不同。     

Predictive value of the atherogenic index of plasma for chronic total occlusion before coronary angiography

BackgroundThe atherogenic index of plasma (AIP) is calculated by logarithmic transformation of the ratio of triglyceride (TG) and high‐density lipoprotein cholesterol (HDL‐C) concentrations. Although previous studies have demonstrated that the AIP is associated with coronary artery disease, its association with chronic total occlusion (CTO) requires elucidation.HypothesisWe hypothesized that the AIP would have diagnostic value in cases of CTO and could be used to predict adverse events.MethodsThis study involved 1131 inpatients who underwent coronary angiography. Data on demographic and clinical characteristics, coronary artery stenosis rated by the Gensini score, and clinical assessment by the Global Registry of Acute Coronary Events and thrombolysis in myocardial infarction (TIMI) scores were collected by cardiovascular doctors. Serum AIP values were evaluated by logarithmic transformation of the ratio of TG and HDL‐C concentrations. The correlations of AIP values with clinical parameters were assessed, and receiver‐operating characteristic curves were constructed for CTO diagnosis.ResultsOverall, 1131 inpatients were assigned to the CTO (n = 398) and control (n = 733) groups. Compared with the control group, the CTO group showed a significantly higher AIP (p < .05). The AIP was positively correlated with body mass index, the TIMI score, the Gensini score, and stent length and was effective for the diagnosis and risk assessment of patients with CTO. Multivariate logistic regression analyses revealed that the AIP was an independent risk factor for CTO. The findings suggest that the AIP could predict the presence of CTO and disease severity.     

Diagnosis,treatment and long-term outcomes of autoimmune pancreatitis in Spain based on the International Consensus Diagnostic Criteria: A multi-centre study

ObjectivesAutoimmune pancreatitis (AIP) is a form of chronic pancreatitis that has been reported worldwide for the last two decades. The aim of this study is to analyse the clinical profile of patients from Spain with AIP, as well as treatments, relapses and long-term outcomes.MethodsData from 59 patients with suspected AIP that had been diagnosed in 15 institutions are retrospectively analysed. Subjects are classified according to the International Consensus Diagnostic Criteria (ICDC). Patients with type 1 AIP (AIP1) and type 2 AIP (AIP2) are compared. Kaplan–Meier methodology is used to estimate the overall survival without relapses.ResultsFifty-two patients met ICDC, 45 patients were AIP1 (86.5%). Common manifestations included abdominal pain (65.4%) and obstructive jaundice (51.9%). Diffuse enlargement of pancreas was present in 51.0%; other organ involvement was present in 61.5%. Serum IgG4 increased in 76.7% of AIP1 patients vs. 20.0% in AIP2 (p = 0.028). Tissue specimens were obtained in 76.9%. Initial successful treatment with steroids or surgery was achieved in 79.8% and 17.3%, respectively. Maintenance treatment was given in 59.6%. Relapses were present in 40.4% of AIP1, with a median of 483 days. Successful long-term remission was achieved in 86.4%.ConclusionsAIP1 is the most frequent form of AIP in Spain in our dataset. Regularly, ICDC allows AIP diagnosis without the need for surgery. Steroid and chirurgic treatments were effective and safe in most patients with AIP, although maintenance was required many times because of their tendency to relapse. Long-term serious consequences were uncommon.     

Association between autoimmune pancreatitis and malignancy

Chronic inflammatory diseases are often associated with malignancy, and this phenomenon occurs even in the field of gastroenterology. For example, chronic pancreatitis has been reported to be highly associated with the occurrence of pancreatic cancer. However, the association between autoimmune pancreatitis (AIP) and pancreatic cancer is still an unsolved problem. As AIP is associated with immunoglobulin G4-related disease, which causes a variety of inflammatory and fibrotic lesions, the association between AIP and total malignancies is also a matter of interest. Here, we discuss the association between AIP and malignancy. As for the association between AIP and pancreatic cancer, there is no conclusive evidence, although several reports have suggested that the relative risk of pancreatic cancer is high in AIP. Concerning the association between AIP and total malignancies, there are two reports from Japan. Neither report supported the idea that chronic inflammation in AIP caused the increased risk of total malignancies. However, one report proposed the possibility that AIP might develop as a paraneoplastic syndrome in some patients because many cancers occurred within 1 year of AIP diagnosis, and thereby concluded that patients with AIP were at high risk of having various cancers. The paraneoplastic syndrome hypothesis should be tested in future studies.     

Incidence of the focal type of autoimmune pancreatitis in chronic pancreatitis suspected to be pancreatic carcinoma: experience of a single tertiary cancer center

Objective. With an increase in autoimmune pancreatitis (AIP) being reported, the focal type of AIP, which shows localized narrowing of the main pancreatic duct and focal swelling of the pancreas, has recently been recognized. Therefore, cases of focal-type AIP subjected to surgical intervention for presumptive malignancy might previously have been diagnosed as mass-forming chronic pancreatitis. The aim of this study was to elucidate the incidence of focal-type AIP in resected chronic pancreatitis at a single tertiary cancer center. The clinical and radiological features of focal-type AIP were also evaluated. Material and methods. We re-evaluated 15 patients who underwent pancreatic resection with a presumed diagnosis of pancreatic ductal adenocarcinoma, and who in the past had been diagnosed pathologically as having chronic pancreatitis. Results. Seven of 15 patients showed AIP, and the other 8 patients were diagnosed as having mass-forming chronic pancreatitis not otherwise specified by pathological retrospective examination. In other words, nearly half of the cases of resected chronic pancreatitis that were suspected to be pancreatic carcinoma preoperatively showed focal-type AIP. Regarding the characteristic findings of focal-type AIP, narrowing of the pancreatic duct on endoscopic retrograde pancreatography (ERP) might be diagnostic. Conclusions. Focal-type AIP is not a rare clinical entity and might be buried in previously resected pancreatic specimens that in the past were diagnosed simply as mass-forming pancreatitis.     

Autoimmune pancreatitis today: clinical features and diagnostic strategies

Autoimmune pancreatitis (AIP) is a particular form of chronic pancreatitis recognized as clinical entity only in recent decades. Peculiar clinical, serological, histological and radiological features make it different from other types of pancreatitis. The diagnosis of AIP represents a challenge for the clinicians. Particularly in its focal form, it shows several features in common with pancreatic adenocarcinoma. Both of these conditions, in fact, are often associated with obstructive jaundice, cause increase of the volume of the pancreas and can share the radiologic appearance of a focal mass. The autoimmune pancreatitis instead of pancreatic cancer regresses promptly after treatment with oral corticosteroids. Because of the different management of the two diseases a correct differential diagnosis is imperative. From 5% to 21% of AIP cases are diagnosed in patients after pancreatic resection performed for suspected malignancy. Still not identified a specific serological marker of AIP which can allow a definitive diagnosis of the disease. Both the diagnosis of pancreatic cancer as AIP is paid on the basis of different clinical tests: the diagnosis of pancreatic cancer requires imaging studies, laboratory tests and biopsy of the pancreas, while the diagnosis of AIP requires confirmation of the diagnostic histological, serological and radiological criteria, the involvement of other organs and a positive response to treatment with corticosteroids. Recently, three different diagnostic strategies for AIP have been proposed.     

Pathophysiology of autoimmune pancreatitis

Autoimmune pancreatitis(AIP) is a recently discovered form of pancreatitis and represents one of the diseases of the pancreas which can be cured and healed medically. International consensus diagnostic criteria have been developed, and the clinical phenotypes associated with the histopathologic patterns of lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric pancreatitis should be referred to as type 1 and type 2AIP, respectively. Most importantly, in type 1 AIP, the pancreatic manifestations are associated with other extrapancreatic disorders, resembling an immunoglobulin G4(IgG4)-related disease. In addition, the pancreas o a patient with AIP is often infiltrated by various types of immune cells; the cluster of differentiation(CD) 4or CD8 T lymphocytes and IgG4-bearing plasma cells have been found in the pancreatic parenchyma and other involved organs in AIP and factors regulating T-cell function may influence the development of AIP From a genetic point of view, it has also been reported that DRB1*0405 and DQB1*0401 mutations are significantly more frequent in patients with AIP when compared to those with chronic calcifying pancreatitis, and that only DQB1*0302 had a significant association with the relapse of AIP. Finally, it has been found that thepolymorphic genes encoding cytotoxic T lymphocyteassociated antigen 4, a key negative regulator of the T-cell immune response, are associated with AIP in a Chinese population. Even if these data are not concordant, it is possible that physiological IgG4 responses are induced by prolonged antigen exposure and controlled by type 2 helper T cells. We reviewed the current concepts regarding the pathophysiology of this intriguing disease, focusing on the importance of the humoral and cellular immune responses.     

牙齿开髓治疗对老年心血管病患者心率、血压、心电图的影响

目的　探讨老年心血管病患者在心电监护下进行牙齿开髓治疗的安全性。　方法　对2 33例患急、慢性牙髓炎同时伴心血管疾病的老年患者 (患病组 )及 32例无心血管病史的老年患者(对照组 )牙齿开髓治疗全过程进行血压、心率、心电图的监测观察。　结果　患病组和对照组局麻时 ,血压分别平均升高 14 / 6、14 / 6mmHg(1mmHg =0 133kPa) ;心率平均加快 4 8、4 1次 /min。术中患病组及对照组血压分别平均升高 16 / 9、19/ 11mmHg ;心率加快 6 4、5 9次 /min。与术前相比 ,差异有显著性 (P <0 0 5 ) ;各组之间在术前、麻醉中、麻醉后 5min、术中、术后心率、血压的变化相比 ,差异无显著性 (P >0 0 5 )。部分老年心血管病患者术中出现心电图改变。　结论　老年心血管疾病患者在心电监护下进行开髓治疗是可行的。