自身免疫性胰腺炎11例临床分析

目的 回顾性分析自身免疫性胰腺炎(AIP)的实验室、病理学及影像学表现,以便早期诊断AIP并进行治疗.方法 选取2007年6月至2009年6月我院收治、诊断明确及资料完整的AIP患者11例.所有患者均检测血常规、肿瘤指标、血淀粉酶、自身抗体等指标,并行腹部CT和B超检查.结果 实验室检查:血淀粉酶和肝酶增高5例,高胆红素血症4例,高球蛋白血症3例;肿瘤指标:6例患者CA199升高,平均值为78.4 U/ml;影像学检查:11例患者均有胰腺肿大.4例患者给予药物治疗,3个月后复查胰腺体积恢复正常,胰管及胆管未见狭窄或扩张;7例患者术后病理证实胰腺内大量纤维组织增生,淋巴细胞、浆细胞浸润,并见淋巴滤泡形成,其中2例术后6～12个月确诊为干燥综合征和类风湿关节炎,予糖皮质激素及免疫抑制剂治疗后症状消失.结论 AIP是一种特殊类型的慢性胰腺炎,具有特征性的实验室、影像学及组织学特点.如诊断明确,糖皮质激素及免疫抑制剂治疗有效.

Clinical analysis of autoimmune pancreatitis: a report of 11 cases

Objective To summarize the laboratory, pathologic and imaging characteristics of patients with autoimmune pancreatitis (AIP) retrospectively for early diagnosis and treatment. Methods Eleven AIP patients were selected in our hospital from 2007 to 2009. Laboratory parameters including complete blood count, tumor markers, hemodiastase and autoantibodies were tested. Abdominal ultrasonography and computerized tomography (CT) scanning were also performed. Results Five patients had elevated hemodiastase and liver enzymes, four patients had hyperbilirubinemia and three patients had hyperglobulinemia. Increased serum CA199 levels (mean 78.4 U/ml) were found in six patients. All of the 11 patients had enlarged pancreas on imaging. Four cases were treated with three months of drug therapy. After the treatment, the pancreas volumereturned to normal size, pancreatic duct and bile duct became normal in size. Seven cases received surgical operation. Pathology examination showed fibrous tissue and folliculus lymphaticus formation in the pancreas,with a large number of lymphocytes and plasma cells infiltration. Two of seven cases were diagnosed with Sj(o)gren's syndrome and rheumatoid arthritis after being followed-up for six to twelve months post-operation.Their symptoms relieved after corticosteroid and immunosuppressive therapy. Conclusion AIP is a special type of chronic pancreatitiswith characteristic laboratory, imaging and histological features. Glucocorticoid and immunosuppressive agents therapy are effective for AIP.