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投稿时间:2024-04-12 网络发布日期:2025-05-20
投稿时间:2024-04-12 网络发布日期:2025-05-20
中文摘要: 目的 探讨 IgG4相关性自身免疫性胰腺炎(AIP)的临床特征、诊断治疗过程及预后。方法 回顾性分析吉林省一汽总医院 2015年至 2023年收治的 9例 AIP炎患者的临床资料,综合分析患者临床表现、实验室检查、影像学检查以及诊治过程。结果 9例 AIP患者中男性 3例,女性 6例。有 6例患者出现不同程度的肝功能异常,以谷氨酰转肽酶及碱性磷酸酶升高为主,部分患者存在总胆红素及直接胆红素升高。 9例患者中有 3例糖类抗原 199略有升高, 9例患者血清 IgG4有不同程度升高,均大于正常高值的 2倍。影像学检查提示胰腺弥漫性增大 4例,呈腊肠样改变。胰头部局限性增大 2例,增强扫描呈轻度强化,强化程度始终低于正常胰腺组织。胰腺体部局限性增大 3例,增强扫描提示有不同程度强化。 9例患者均行激素治疗,治疗效果良好,通过门诊或入院随访至 2024年,结果 3例复发,再次予以激素治疗。结论 血清 IgG4相关性 AIP是一种自身免疫性疾病,局限性胰腺肿大病例易于误诊为胰腺癌,综合分析患者临床表现、实验室检查、影像学检查以及激素治疗效果,有助于提高该病的诊断率,内镜下胆管支架植入治疗可快速缓解因中重度黄疸所致不适。
Abstract:Objective To explore the diagnosis and treatment and prognosis of IgG4-related autoimmune pancreatitis (AIP) . Methods A retrospective analysis was conducted on the clinical data of 9 patients with AIP admitted to Jilin Province FAW General Hospital from 2015 to 2023. The clinical manifestations, laboratory tests, imagingexaminations, and diagnosis and treatment processes of the patients were comprehensively analyzed. Results There were 9 AIP patients, including 3 males and 6 females. Six patients showed different degrees of liver function abnormalities, mainly elevated glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP) , and some patients had elevated total bilirubin (TBIL) and direct bilirubin (DBIL) . Carbohgdrate antigen (CA) 199 was slightly elevated in 3 of the 9 patients, and serum IgG4 was elevated to different degrees in 9 patients, which was more than twice of the normal high value. Imaging examination suggested diffuse enlargement of the pancreas in 4 cases, presenting as a sausage.like change. Two cases showed localized enlargement of the caput pancreatis, with mild enhancement on contrast.enhanced scanning, and the degree of enhancement remained lower than that of normal pancreatic tissue. There were 3 cases of limited enlargement of the body part of the pancreas, and the enhancement scans suggesteddifferent degrees of enhancement. All 9 patients were treated with hormone therapy, with good therapeutic effects, and were followed up through outpatient or hospitalization until 2024, and there were 3 patients relapsed and were treated with hormone therapy again. Conclusion Serum IgG4 associated AIP is an autoimmune disease, and patients with localized pancreatic enlargement are prone to be misdiagnosed as pancreatic cancer. A comprehensive analysis of patients’clinical manifestations, laboratory examinations, imaging examinations, and hormone treatment effects will help to improve the diagnostic rate of this disease. Endoscopic biliary stent implantation can quickly alleviate discomfortcaused by moderate to severe jaundice.
keywords: IgG4 Autoimmune pancreatitis Biliary stent Endoscopic therapy Liver function Pancreatic enlargement Obstructive jaundice
文章编号: 中图分类号:R657.5+1 文献标志码:A
基金项目:吉林省科学技术厅科技发展计划项目(20210101202JC)
附件
Author Name | Affiliation |
WANG Zhonghui, SUN Tieliang, DAI Chunlei | Second General Surgery Department, Jilin Province FAW General Hospital, Changchun, Jilin 130011, China |
引用文本:
王中会,孙铁梁,戴春雷.IgG4相关性自身免疫性胰腺炎的诊断与治疗[J].中国临床研究,2025,38(5):715-718.
王中会,孙铁梁,戴春雷.IgG4相关性自身免疫性胰腺炎的诊断与治疗[J].中国临床研究,2025,38(5):715-718.