自身免疫性胰腺炎胆管损害的临床影像分析

目的总结并探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)胆管损害的临床影像学特点,提高对AIP的认识。方法回顾性分析中日友好医院2008年5月-2012年9月资料完整的AIP患者16例,总结临床及影像学改变,并将治疗前后相关资料进行对照分析。重点分析与胆管损害相关的临床、影像改变。结果 AIP患者以男性为主,年龄48~78岁,平均年龄(63.4±5.7)岁。13例(81.3%)患者以梗阻性黄疸就诊,伴有ALP、GGT、CA199升高。影像学检查发现13例(81.3%)胰腺弥漫性肿大,呈"腊肠样"外观,3例(18.8%)胰头局灶性肿大;所有患者均有胆总管及肝内胆管扩张,14例(87.5%)仅为胆总管下段(胰腺段)1处狭窄,2例(12.5%)为肝外胆管2处狭窄。在使用糖皮质激素治疗的14例患者中,经治疗3~6个月,所有患者胰腺大小均恢复正常,但是12例(85.7%)仍有胆总管下段均匀性或不均匀性狭窄。2例(12.5%)未使用糖皮质激素治疗的患者,随访1年后胰腺及胆管均恢复正常。结论 AIP多伴有胆管病变,并且以胆总管下段受累为主。AIP中的胆管损害和胰腺炎症可能是相互独立的病变,均为IgG4相关疾病一部分。

Clinical and imaging analysis of bile duct damage caused by autoimmune pancreatitis

Objective To advance our understanding of autoimmune pancreatitis （AIP） by characterizing the imaging features of AIP-caused damage to bile ducts.Methods Sixteen cases of AIP diagnosed and treated in China-Japan Friendship Hospital from May.2008 to Sep.2012 were retrospectively analyzed,and the clinical and imaging alterations before and after treatment were compared,with a focus on damage in bile ducts.Results AIP patients were primarily male with an average age of （63.4 ± 5.7） （48 ～78） years old.Thirteen （81.3％） patients presented themselves in the clinic due to obstructive jaundice,which was associated with ALP,GGT,and increase of CA199.Imaging analysis revealed 13 （81.3％） cases of diffusive enlargement of pancreas with ＂sausage-like＂ appearance,and 3 （18.8％） cases of focal enlargement on pancreatic heads.Dilation of common and intrahepatic bile ducts were observed in all patients.Fourteen （87.5％） patients exhibited stricture only at the lower part （close to pancreas） of the common bile duct,2 （12.5％） cases also showed stricture in intrahepatic bile duct.Fourteen patients were treated with glucocorticoid for 3 to 6 months.After treatment,the pancreas size was restored in all patients.However,12 （85.7％） patients still exhibited even or uneven stricture at the lower part of the common bile duct.For the two untreated patients,the pancreas size and bile ducts both recovered after one year.Conclusion AIP is usually associated with abnormality of bile ducts,with the lower part of common bile ducts most frequently affected.The damage of bile ducts and pancreatitis may be independent pathological processes in AIP,but both are related to IgG4 diseases.