| Objective:To summarize the clinical characteristics and the experience of diagnosis and treatment of Autoimmune pancreatitis(AIP).Methods:The clinical data of 37 patients with AIP who were admitted to the Shengjing Hospital of China Medical University between July 2012 to January 2018 were collected.There were 31 men and 6 women among the 37 cases and the age ranged from 35 to 82 years.The median age was 59.The diagnosis and treatment of the disease were discussed according to the clinical symptoms,imaging manifestations,serological examination,hormone reactivity and histopathological features.Results:The main clinical symptoms were obstructive jaundice,abdominal pain,abnormal blood glucose and wasting.There were 35 patients did the serum Ig G4 tests,28 of them were higher than 4g/L,and 4 cases were 2-4g/L;Serum Ig G increased in 15 cases,Spearman correlation analysis was carried out on Ig G4 and Ig G levels,and it was concluded that the Ig G index was valuable for the diagnosis of AIP.CT examination showed that 20 cases showed biliary obstruction,14 cases showed diffuse swelling,and 12 cases showed pancreatic focal enlargement.In the examination of MR and MRCP,19 cases showed stenosis of the pancreatic duct and 6 cases showed pancreatic duct stenosis.In EUS examination,there were 12 cases showed diffused low echo of the pancreas,and pancreatic head tumor low echo change in 6 cases,pancreatic duct stricture in 2 cases,Lower bile duct stricture in 13 cases,bile duct wall thickening in 7 cases.There were 11 cases of pancreatic histopathology(10 cases of EUS-FNA,1 case of surgery puncture),except for 1 case that did not see the cellular components,and the rest were considered inflammatory lesions.One patient had a liver biopsy showed Ig G4 related disease involving the liver.A total of 32 patients were treated with glucocorticoid,of which 5 were treated with hormone combined immunosuppressive therapy,and 4 patients were treated with ERCP+ENBD before glucocorticoid therapy,all of which had better improvement.4 cases were fully recovered in imaging during the follow-up.There were 3 cases of recurrence,1 case was treated with high dose glucocorticoid therapy again,2 cases were treated with combined immunosuppressive agents,and all of them improved.In 1 patient,the glucocorticoid intolerance was treated with hormone combined with immunosuppressive agents.Conclusions:Autoimmune pancreatitis morbidity is low,the lack of specificity of clinical symptoms and diagnosis methods,because of its many aspects to a presentation like that of pancreatic cancer and bile duct carcinoma,is often misdiagnosed,leading to the unnecessary surgery,so in clinical practice,for patients with symptoms such as jaundice,abdominal pain,emaciation,besides considering the malignant diseases,also should consider the possibility of AIP;Prior to the diagnosis of AIP,attention should also be paid to the complete exclusion of malignant diseases.The recurrence rate of AIP is relatively high.For patients diagnosed with AIP,regular follow-up should be conducted.For patients with poor hormone response or hormone intolerance,they can be treated with immunosuppressive agents. |
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