本文關(guān)鍵詞： 自身免疫性胰腺炎 胰腺癌 鑒別診斷 血清學(xué)　出處：《浙江大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：目的 自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一種特殊類型的慢性胰腺炎,在臨床上易被誤診為胰腺癌。本研究旨在總結(jié)AIP的臨床特點,并探索其與胰腺癌基于臨床表現(xiàn)、血清學(xué)、影像學(xué)和病理學(xué)等的鑒別診斷策略。 方法 回顧性分析浙江大學(xué)附屬第一醫(yī)院2009年11月至2014年4月間診治的AIP與胰腺癌患者資料,收集包括一般情況、臨床癥狀、血清學(xué)指標(biāo)、影像學(xué)、組織病理學(xué)、治療等在內(nèi)的數(shù)據(jù)進(jìn)行統(tǒng)計分析。AIP的診斷依據(jù)2010年國際胰腺病協(xié)會的國際共識,而胰腺癌均通過病理學(xué)檢查確診。 結(jié)果 (1)AIP與胰腺癌均以老年男性多發(fā),兩組性別差異不顯著,年齡以AIP組更年長。AIP患者最常見癥狀為腹痛、梗阻性黃疸和體重減輕,而胰腺癌為腹痛、腹脹和體重減輕,兩者臨床表現(xiàn)易混淆,AIP在門診誤診為胰腺占位者高達(dá)56%。 (2)胰腺外器官受累是AIP的特征性表現(xiàn),50%的AIP患者合并有胰腺外器官受累。 (3)AIP組以血清免疫球蛋白IgG、IgG4水平升高為特征表現(xiàn),其血清球蛋白、嗜酸性粒細(xì)胞、膽紅素、肝酶和膽酶顯著高于胰腺癌組(P0.05),而腫瘤標(biāo)志物Ca19-9、血紅蛋白水平顯著低于胰腺癌組(P0.05)。使用Ca19-9、球蛋白、血紅蛋白和嗜酸性粒細(xì)胞四項指標(biāo)聯(lián)合以區(qū)別診斷AIP和胰腺癌,靈敏度為84%,特異度為88%,診斷價值較高。 (4)B超和CT是AIP和胰腺癌最為常用影像學(xué)手段,MRCP及ERCP對胰膽管病變有較好的顯像效果。胰腺彌漫性腫大強烈提示AIP,但40%的AIP患者也表現(xiàn)為局灶性腫大,易與胰腺癌混淆。AIP的膽管近端狹窄及遠(yuǎn)端擴張較胰腺癌常見,而主胰管近端狹窄和遠(yuǎn)端擴張常提示胰腺癌。部分AIP病例可見胰腺周圍滲出或包膜樣改變。血管受累、淋巴結(jié)轉(zhuǎn)移及其他臟器的腫瘤轉(zhuǎn)移是胰腺癌的特征性表現(xiàn)。 (5)組織病理是診斷AIP和胰腺癌的有力證據(jù)。AIP的病理表現(xiàn)特征為淋巴漿細(xì)胞廣泛浸潤,席紋狀纖維化,并可見IgG4陽性漿細(xì)胞。病理學(xué)診斷胰腺癌則以找到腫瘤細(xì)胞為依據(jù)。 (6)糖皮質(zhì)激素治療對AIP效果良好,合并膽道狹窄以致黃疸的患者則在糖皮質(zhì)激素治療前行ERCP下膽道支架植入術(shù)和或經(jīng)內(nèi)鏡鼻膽管引流術(shù)減輕患者癥狀。12%的患者在1-2年內(nèi)因AIP復(fù)發(fā)而重新住院。胰腺癌患者則根據(jù)病情行手術(shù)根除或姑息治療。 結(jié)論 AIP和胰腺癌作為兩種獨立的疾病,其治療和預(yù)后完全不同。兩者流行病學(xué)及臨床表現(xiàn)相似,較易混淆。胰腺外器官受累、血清學(xué)、影像學(xué)及病理等特征有助于兩種疾病的鑒別診斷。
[Abstract]:Purpose Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis. The purpose of this study was to summarize the clinical features of AIP and to explore the differential diagnosis strategies between AIP and pancreatic cancer based on clinical manifestations, serology, imaging and pathology. Method The data of AIP and pancreatic cancer patients from November 2009 to April 2014 in the first affiliated Hospital of Zhejiang University were analyzed retrospectively. The data were collected including general situation, clinical symptoms and serological indexes. Imaging, histopathology, treatment and other data were statistically analyzed. The diagnosis of AIP was based on the international consensus of the International Pancreatic Association in 2010, while pancreatic cancer was diagnosed by pathological examination. Results There was no significant difference between the two groups. The most common symptoms of age were abdominal pain, obstructive jaundice and weight loss in the older. AIP patients in the AIP group. The clinical manifestations of pancreatic cancer were abdominal pain, abdominal distension and weight loss. AIP was misdiagnosed as pancreatic occupying in outpatient department as high as 56%. (2) Extrapancreatic organ involvement is a characteristic feature of AIP. 50% of AIP patients have extrapancreatic organ involvement. The serum immunoglobulin (IgG) IgG4 level was elevated in the AIP group with serum globulin, eosinophilic granulocyte and bilirubin. The levels of liver enzyme and bile enzyme were significantly higher than that of pancreatic carcinoma group (P 0.05), but the tumor marker Ca 19-9 and hemoglobin level were significantly lower than that of pancreatic cancer group (P 0.05). Hemoglobin and eosinophilic granulocyte were combined to distinguish AIP from pancreatic cancer. The sensitivity and specificity of hemoglobin and eosinophilic granulocyte were 84 and 88 respectively. B ultrasound and CT are the most commonly used imaging methods for AIP and pancreatic cancer. MRCP and ERCP have better imaging effect for pancreaticocholangiopathy. Diffuse pancreatic enlargement strongly suggests AIP. However, 40% of AIP patients also presented with focal enlargement, and the proximal stricture and distal dilatation of bile duct were more common than pancreatic cancer. The proximal stenosis and distal dilatation of the main pancreatic duct often suggest pancreatic cancer. In some cases of AIP, peripancreatic effusion or capsular changes can be seen. Lymph node metastasis and other organ metastasis are characteristic manifestations of pancreatic cancer. Histopathology is a powerful evidence for the diagnosis of AIP and pancreatic cancer. The pathological features of AIP are extensive infiltration of lymphoplasmacytes and siliform fibrosis. IgG4 positive plasma cells can be seen. Pathological diagnosis of pancreatic cancer is based on finding tumor cells. The effect of glucocorticoid therapy on AIP was good. Before glucocorticoid therapy, biliary stenting under ERCP and / or endoscopic nasobiliary drainage alleviated symptoms in patients with biliary stricture and jaundice. 12% of patients had AIP within 1-2 years before glucocorticoid therapy. Recurrence and readmission. Patients with pancreatic cancer receive surgical eradication or palliative treatment depending on their condition. Conclusion AIP and pancreatic cancer are two independent diseases, their treatment and prognosis are completely different. The epidemiology and clinical manifestations of the two diseases are similar and easy to be confused. The imaging and pathological features are helpful to the differential diagnosis of the two diseases.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R576;R735.9

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1 林細(xì)州;徐蓓蓓;陸曉峰;鄭亮;;自身免疫性胰腺炎36例臨床分析[J];實用醫(yī)學(xué)雜志;2015年05期

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本文編號：1493153