自身免疫性胰腺炎一例

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一种由自身免疫介导的胰腺慢性疾病,影像学有其特征性表现。现将一例自身免疫性胰腺炎病例报告如下。1病例资料     

自身免疫性胰腺炎二例误诊原因分析并文献复习

目的提高临床对自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的认识,减少误诊误治。方法回顾性分析我院收治的2例AIP临床资料并复习相关文献。结果本组例1以腹痛、黄疸入院,例2以左上腹疼痛入院,均在外院行影像学检查而误诊为胰腺占位性病变,为进一步诊治入我院,入院后经相关影像学检查、血清免疫学检查及糖皮质激素试验性治疗后临床症状及影像学表现明显改善,临床确诊为AIP。2例均带药出院,至症状、胰腺影像学形态正常后停药,随访无复发。结论对AIP缺乏诊治经验是该病误诊原因之一,临床接诊此类患者对应综合分析其影像学表现、血清免疫学检查结果及糖皮质激素治疗效果,以及时对AIP作出正确诊断并治疗。     

IgG4相关自身免疫性胰腺炎的超声表现及特征分析

目的总结Ig G4相关自身免疫性胰腺炎(Ig G4-AIP)的超声表现及特征。方法回顾性分析2014年12月至2019年4月首都医科大学附属北京友谊医院收治的40例Ig G4-AIP患者的临床及影像学资料,观察胰腺大小、形态、回声,有无肿物及肿物的大小、形态、回声及血流情况,同时观察主胰管、肝内外胆管有无狭窄或扩张,胆管壁有无增厚,腮腺、颌下腺有无肿大或肿物,其中3例行超声造影检查,观察胰腺病灶的增强-消退过程。结果本组患者男女比例为5. 7︰1,50～79岁者占90%。临床表现以黄疸、腹痛为主。胰腺超声表现分为3型:节段型8例(20. 0%),胰腺大小、形态正常,局部回声不均匀,以回声减低为主;弥漫型17例(42. 5%),胰腺弥漫性肿大,回声不均匀减低;肿块型15例(37. 5%),胰腺局限性肿大,回声与周围胰腺类似或减低,"肿块"位于胰头10例,胰尾5例。3例肿块型病变行超声造影检查,2例动脉期呈高或等增强,延迟期呈等增强,1例动脉期及延迟期均呈低增强。本组合并Ig G4相关胆管炎29例(72. 5%),其中超声确诊胆管炎10例,表现为肝内和(或)肝外胆管管壁不均匀增厚;合并IgG4相关涎腺炎6例(15. 0%),表现为腮腺和(或)颌下腺回声弥漫不均匀,伴或不伴有纤维条索样高回声。结论 Ig G4-AIP超声表现以弥漫型及肿块型为主,超声检查在发现胰腺病变的同时,联合胆管、涎腺等多器官扫查可为临床提供更有价值的信息。     

自身免疫性胰腺炎患者血清lgG4水平的变化及临床意义

目的 探讨自身免疫性胰腺炎(AIP)患者血清免疫球蛋白G亚型4(IgG4)水平的变化及临床意义.方法 纳入2012年10月至2016年2月在浙江大学医学院附属第一医院就诊并进行血清IgG4检查的胰腺疾病患者232例,依据其最终临床诊断分为AIP组(45例)、慢性胰腺炎组(除外自身免疫性胰腺炎,54例)、急性胰腺炎组(77例)和胰腺癌组(56例),同时选择73例健康体检者作为对照组,比较各组人群血清IgG4水平之间的差异;以AIP作为疾病组绘制ROC曲线,计算IgG4用于AIP临床辅助诊断的最佳界值;同时对73例健康体检者IgG4水平进行分析,建立适合本实验室的血清IgG4参考范围.结果 ⑴AIP组IgG4水平(5.980±4.929g/L)明显高于慢性胰腺炎组(0.651±0.546g/L)、急性胰腺炎组(0.661±0.456g/L)、胰腺癌组(0.775±0.687g/L)和对照组(0.532±0.370g/L),差异有统计学意义(P均<0.001);慢性胰腺炎组、急性胰腺炎组、胰腺癌组和对照组IgG4水平之间均无明显差异(P均>0.05);⑵血清IgG4为1.535g/L时,IgG4用于AIP临床辅助诊断的曲线下面积最大,面积为0.936,此时的灵敏度为85.6%,特异性为94.2%;⑶针对73例健康体检者IgG4水平所建立的95%可信区间的上限为1.27g/L,99%可信区间的上限为1.64g/L.结论 AIP患者血清IgG4水平明显高于其他胰腺疾病患者和健康体检者,血清IgG4用于AIP的临床辅助诊断具有较高的灵敏度和特异性,基于本研究所纳入的健康体检者建立的参考区间与试剂说明书之间存在一定的差异,每个实验室应建立适合于本实验室的参考范围.     

IgG4相关性自身免疫性胰腺炎诊治研究进展

自身免疫性胰腺炎(AIP)是一种少见的慢性胰腺炎症,可以分为Ⅰ-AIP和Ⅱ-AIP 2种亚型。Ⅰ-AIP属于IgG4相关性疾病,血清IgG4水平的增高是其最为敏感和特异性的表现。AIP组织学表现为胰腺导管周围大量淋巴细胞及浆细胞浸润、致密的席纹状纤维化、闭塞性静脉炎及IgG4+浆细胞明显增多;影像学表现为胰管的不规则狭窄、胰腺弥漫性肿大、胰周可见囊状边缘及胰腺实质延迟强化;激素治疗有效,但容易复发。本文就IgG4相关性AIP(Ⅰ-AIP)的特征性自身抗体、临床表现、病理组织学特征、影像学特征、诊断标准、治疗6个方面的相关研究进展进行综述。 更多还原     

自身免疫性胰腺炎32例分析

目的探讨自身免疫性胰腺炎(AIP)临床诊治经验。方法对32例AIP患者诊治的临床资料进行回顾性分析。结果 32例AIP中B超、CT诊断为胰胆癌肿28例,占87.5%,其中24例行剖腹探查术,占75.0%,4例仅行B超引导下穿刺活检未行手术。结论 AIP是一种特殊类型的慢性胰腺炎,其影像学特征与胰胆癌相似,易被误诊。临床医师应加强对本病的认识。     

自身免疫性胰腺炎6例临床分析

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是与自身免疫有关的慢性胰腺炎症,其临床特点、治疗及预后与一般慢性胰腺炎均有不同之处。本文对我院近10年来诊治的6例AIP患者的临床特征进行回顾性分析。     

IgG4检测在自身免疫性胰腺炎和IgG4相关性胆管炎诊治中的应用进展

近年来,免疫球蛋白G-4亚型(IgG4)在自身免疫性胰腺炎(AIP)和IgG4相关性胆管炎(IAC)早期鉴别诊断、疗效监测、预测复发方面的研究逐步增多。研究认为,血清IgG4检测在AIP和IAC诊治中有较重要的价值,可作为AIP早期鉴别诊断、激素疗效评估、复发检测和预后判断的指标,也是IAC的辅助诊断、鉴别诊断的重要标志物。本文对有关文献作一综述。     

自身免疫性胰腺炎研究进展

自身免疫性胰腺炎是慢性胰腺炎的特殊类型,临床表现为梗阻性黄疸、腹痛、体质量减轻等,易误诊为胰腺癌而行手术治疗。不同地区或国家对免疫性胰腺炎的诊断标准尚未达成一致,提高自身免疫性胰腺炎诊疗水平是国内外研究热点。类固醇类药物治疗自身免疫性胰腺炎效果明显,可改善患者临床症状及预后。     

自身免疫性胰腺炎患者血清IgG4水平与腹部受累器官CT形态变化的关系

  目的  探讨自身免疫性胰腺炎(autoimmune pancreatitis, AIP)患者血清IgG4水平变化与腹部受累器官CT形态变化的关系。  方法  回顾性分析19例临床诊断为AIP且相关资料完整患者的血清IgG4水平、胰腺及腹部胰外受累器官CT形态变化, 并分别根据其变化趋势将患者区分为好转与无好转, 用Fisher确切概率法分析血清IgG4水平变化趋势、胰腺形态变化趋势与腹部胰外受累器官形态变化趋势三者之间的一致性。  结果  血清IgG4水平变化与胰腺形态变化趋势一致者13例, 不一致者6例, 一致性检验P=0.169;血清IgG4水平变化与腹部胰外受累器官形态变化趋势一致者15例, 不一致者4例, 一致性检验P=0.013;胰腺与腹部胰外受累器官形态变化趋势一致者15例, 不一致者4例, 一致性检验P=0.020。  结论  血清IgG4水平与腹部胰外受累器官形态变化趋势、胰腺与腹部胰外受累器官形态变化趋势一致性较好, 血清IgG4水平与胰腺形态变化趋势一致性差。     

Pulmonary involvement of autoimmune pancreatitis

Background  A wide variety of systemic lesions have been seen in patients with autoimmune pancreatitis. The pulmonary involvement of autoimmune pancreatitis was analysed to clarify the clinicopathological features of pulmonary lesions in comparison with pulmonary sarcoidosis.
Materials and methods  Nineteen patients had autoimmune pancreatitis and eight had pulmonary sarcoidosis. The symptoms, laboratory data, chest computed tomography, Gallium-67 scintigraphy, pulmonary function testing and bronchoscopy findings, including the histological IgG4-immunostaining and IgG subclasses in the bronchoalveolar lavage in autoimmune pancreatitis, were collected to compare them with pulmonary sarcoidosis.
Results  The serum total protein, IgG and IgG4 levels were found to be significantly elevated in comparison with pulmonary sarcoidosis. In autoimmune pancreatitis, 17 patients showed bilateral hilar lymphadenopathy, while eight showed pulmonary nodules on chest computed tomography. Eighteen of 19 patients on Gallium-67 scintigraphy showed accumulation spots in either the hilar or mediastinal lymph nodes. Six patients with pulmonary nodules demonstrated accumulation spots in the corresponding lesions on chest computed tomography. All eight patients with pulmonary sarcoidosis showed accumulation spots in either the hilar or mediastinal lymph nodes. Bronchoalveolar lavage IgG4 in autoimmune pancreatitis showed a significant increase in comparison with pulmonary sarcoidosis. The histological findings obtained by a transbronchial lung biopsy showed the infiltration of lymphocytes and plasma cells in the thickened interstitum and alveoli with IgG4-positive plasma cell infiltration in patients with autoimmune pancreatitis.
Conclusion  IgG4 in the bronchoalveolar lavage was seen at remarkably increased levels and IgG4-positive plasma cells were identified in the pulmonary lesions of patients with autoimmune pancreatitis.     

自身免疫性胰腺炎3例误诊分析

本文回顾性分析3例自身免疫性胰腺炎(autoimmune pancreatitis, AIP)误诊的影像学资料,旨在提高对AIP影像学表现的认识水平. 1 资料与方法 手术及随访证实的3例男性AIP患者,年龄35～71岁,平均48岁,持续或间歇性上腹胀痛不适、进行性皮肤巩膜黄染、体重下降.血总胆红素、直接胆红素升高,肿瘤相关化验检查正常.     

Nonfunctional pancreatic neuroendocrine tumours misdiagnosed as autoimmune pancreatitis: A case report and review of literature

BACKGROUNDNonfunctional pancreatic neuroendocrine tumours are difficult to diagnose in the early stage of disease due to a lack of clinical symptoms, but they can rarely manifest as autoimmune pancreatitis. Autoimmune pancreatitis is an uncommon disease that may cause recurrent acute pancreatitis and is therefore often regarded as a special type of chronic pancreatitis.CASE SUMMARYWe report a case of a 42-year-old female who had nonspecific upper abdominal pain for 4 years and radiological abnormalities of the pancreas that mimicked autoimmune pancreatitis. The symptoms and pancreatic imaging did not improve following 1 year of steroid therapy. Finally, pancreatic biopsy was performed through endoscopic ultrasonography-guided fine-needle aspiration biopsy, and nonfunctional pancreatic neuroendocrine tumours were ultimately diagnosed. Pancreatectomy has resolved her symptoms.CONCLUSIONTherefore, the differentiation of nonfunctional pancreatic neuroendocrine tumours from autoimmune pancreatitis is very important, although it is rare. We propose that endoscopic ultrasonography-guided fine-needle aspiration biopsy should be performed if imaging characteristics are equivocal or the diagnosis is in question.     

Highlighting the importance of early diagnosis in progressive multi-organ involvement of IgG4-related disease: A case report and review of literature

IgG4-related disease (IgG4-RD) is an increasingly recognized pathological entity that tends to involve multiple organs with an elevated level of serum IgG4, which is easily misdiagnosed owing to sharing common clinical features with a variety of other diseases. Here, we report an interesting IgG4-RD case of a woman with progressive multi-organ involvement for over 19 years, started with swollen eyelids, dry eye and mouth, and polydipsia and hydruria. Imaging diagnosis revealed diffuse enlargement of the parotid glands, enlargement of the head of the pancreas, pulmonary infection and interstitial lung. Serological tests showed a remarkable elevation of the serum IgG4, and cytological analysis further revealed a large amount of lymphoplasmacytic infiltration into the focal lobule, and IgG4-positive cell infiltration in bladder mucosa. Therapeutically, the patient responded well to steroid therapy, and thus, she was diagnosed as IgG4-RD suspicious. This report highlights the importance of an early diagnosis in this autoimmune disease and suggests that patients with a clinically unclear cause of inflammation, swelling and refractory glands, rhinitis, pancreatitis, hypophysitis, and/or interstitial pneumonia should be considered for IgG4-RD. The plasma IgG4 level and lymphoplasmacytic infiltration may be useful indexes for screening, and a low dose of steroid maintaining therapy may offer benefits for patients with IgG4-RD.     

Present state of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of autoimmune pancreatitis type 1

Autoimmune pancreatitis (AIP) is defined as pancreatitis caused by irregular narrowing of the pancreatic duct accompanied by pancreatic swelling, fibrosis and lymphocyte infiltration, events that are related to autoimmune mechanisms. The 2010 International Consensus Diagnostic Criteria for AIP defined pancreatitis as “type 1” when increased levels of serum IgG4 were present and other organs were involved; lymphoplasmacytic sclerosing pancreatitis was the main histological characteristic. Apart from surgery, endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is the only method for the histological diagnosis of AIP; however, this method is difficult. The use of larger-diameter FNA needles and trucut biopsy did not improve the diagnostic performance of EUS-FNA, but it has improved gradually. In this review, we look back at past efforts to improve the diagnostic performance of EUS-FNA and reveal the present state of EUS-FNA for the histological diagnosis of AIP type 1.     

血清IgG4和CA199联合检测在自身免疫性胰腺炎和胰腺癌鉴别诊断中的意义

目的研究血清IgG4在中国人自身免疫性胰腺炎（AIP）中的诊断价值．并探讨联合检测血清糖类抗原199（CA199）在AIP和胰腺癌鉴别诊断中的作用。方法750例慢性胰腺炎患者和30例胰腺癌患者血样采白2009年8月至2010年7月消化科门诊或住院患者;30名正常健康人血样取自血站和体检部。血清IgG4浓度采用速率散射比浊法测定,血清CA199浓度采用电化学免疫发光法测定。各组间血清IgCA和CA199浓度变化的差异采用非参数统计分析。结果750例慢性胰腺炎患者血清中有28例血清IgG4浓度高于正常参考值上限（〉2．0g／L）,其中11例（1．4％）患者经影像学和胰腺穿刺活检病理检查等确诊为AIP,其IgG4浓度中位数为11．10（4．12～37．20）g／L;胰腺癌患者IgG4浓度为0．51（0．06～1．12）g/L,正常对照组IgG4浓度为0．56（0．18～1．50）g／L。AIP患者组血清中的IgG4浓度明显高于正常参考值上限,且明显高于胰腺癌患者和正常对照组（P〈0．0001）。胰腺癌组血清IgG4水平均低于正常参考值上限,与正常对照组比较差异无统计学意义。所有确诊A1P患者血清CA199浓度7例患者轻、中度升高,余低于正常参考值上限（〈37U／L）,浓度中位数为41．48（0．60～136．40）U／L;然而胰腺癌组血清CA199浓度中位数为533．60（4．25～1000）U／L,明显高于AIP患者组（P〈0．01）。结论血清IgG4明显升高,用于辅助诊断AIP具有较高的特异性和敏感性,提示将IgG4水平纳入AIP的诊断标准对中国人也适用;在AIP和胰腺癌难以鉴别时,同时检测血清IgG4和CA199有助于临床对AIP和胰腺癌的鉴别诊断。     

自身免疫性胰腺炎的CT诊断

目的 探讨自身免疫性胰腺炎(ALP)的CT表现.方法 回顾性分析6例AIP患者的临床资料,5例行螺旋CT平扫 增强扫描,其中3例患者行CT延迟扫描,其中的1例患者与另1例患者行PET/CT检查;从胰腺形态、大小、强化形式、胰管、胆总管、胰周及腹膜后间隙分析CT表现.结果 66.7%(4/6例)AIP表现为胰腺弥漫增大,33.3%(2/6例)表现为胰腺局限性增大;66.7%(4/6例)可见"鞘膜"征;100%(5/5例)增强扫描呈门脉期和延迟期均匀强化;100%(6/6例)有主胰管狭窄;33.3%(2/6例)可见胆总管胰头段狭窄致低位胆道梗阻;33.3%(2/6例)伴淋巴结肿大.2例(100%)PET/CT提示病变摄取增高.结论 自身免疫性胰腺炎具有典型的CT表现,能够明确诊断,避免不必要的手术.动脉期、门脉期及延迟期增强CT扫描对其诊断具有重要价值.     

Acetaminophen-induced acute pancreatitis: A case report and literature review

Acute pancreatitis is rarely associated with drugs. Acetaminophen overdose is a well-known cause of hepatic toxicity, but drug-induced pancreatitis is rarely reported, especially after mild overdose. A 32-year-old woman presented with nausea and vomiting for 12 h, but no abdominal pain following an overdose of eight Tylenol tablets containing acetaminophen (325 mg acetaminophen per tablet). Laboratory results on admission showed abnormal amylase and lipase levels but completely normal liver function. Magnetic resonance cholangiopancreatography revealed mild swelling of the pancreas without fluid collection around the pancreas. The patient complained of severe abdominal pain five days after admission when attempting to drink water and liquids. Eight days after admission, fluid around the pancreas was observed by computed tomography. The patient was subsequently diagnosed with acetaminophen-induced acute pancreatitis after exclusion of common causes. Routine treatment for pancreatitis and N-acetylcysteine were administered to prevent disease progression. The patient was discharged in good condition.