[资料]激素治疗自身免疫性胰腺炎的形态学改变
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Scand J Gastroenterol. 2004 Nov;39(11):1154-8.
Morphological changes after steroid therapy in autoimmune pancreatitis.
Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A.
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 113-8677 Tokyo, Japan. kamisawa@cick.jp
BACKGROUND: Although many patients with autoimmune pancreatitis undergo steroid therapy, detailed evaluation of morphological changes in the pancreas and bile duct following therapy has not been performed in this disease. In this study serological and morphological changes occurring during steroid treatment of autoimmune pancreatitis are comparatively examined.
METHODS: Ten patients with autoimmune pancreatitis were treated with corticosteroids. Morphological findings were: pancreatic enlargement (n = 9), irregular narrowing of the main pancreatic duct (n = 10), and biliary stenosis (n = 9). An initial dose of prednisolone was 40-30 mg/day, and this was tapered by 5 mg every 1-2 weeks. All patients underwent ultrasound and serological testing 1-2 weeks after commencing medication, followed by weekly serological testing and by CT and endoscopic retrograde cholangiopancreatography after 1-2 months. Radiological and serological changes were compared.
RESULTS: All 10 patients were responsive to steroid therapy. Pancreatic size normalized within 1 month; however, irregularity of the pancreatic duct remained in 6 patients. Rigidity or lateral deformity of the bile duct remained in 3 patients and biliary stenosis persisted in 5. Four patients in whom elevated serum IgG4 failed to normalize also showed incomplete morphological improvement. Three patients with complete improvement of the pancreatic duct stopped medication, but recurrence of pancreatitis did not occur.
CONCLUSIONS: Although steroid therapy was morphologically and serologically effective in patients with autoimmune pancreatitis, cholangiopancreatographic abnormalities remained in many patients. Morphological improvement on cholangiopancreatography and normalization of serum IgG4 after steroid therapy appeared to be good indicators for discontinuing medication in patients with autoimmune pancreatitis.
激素治疗自身免疫性胰腺炎的形态学改变
背景 尽管许多自身免疫性胰腺炎患者使用激素治疗，但仍缺乏该病治疗后胆胰管形态学变化研究的详细研究。本研究比较了激素治疗自身免疫性胰腺炎期间血清学、形态学方面的变化。
方法 使用肾上腺皮质激素治疗自身免疫性胰腺炎患者10例，其形态学异常包括：胰腺增大（n=9）、主胰管不规则狭窄（n=10）、胆道狭窄（n=9）。强的松龙初始剂量为40-30mg/天，此后每1－2周减量5mg。每位患者均在治疗开始1－2周后进行超声及血清学检查。其后每周复查血清学及CT，1－2月后行地ERCP检查。比较放射学及血清学的改变。
结果 10名患者均对激素治疗有效。在1个月内胰腺大小恢复正常，然而在6名患者胰管不规则变化仍无改善，3名患者的胆管僵硬变形及5名患者的胆道狭窄仍持续存在。4名患者升高的IgG4水平不能恢复正常，其形态学改善也不完全。3名胰管完全改善的患者停止服药，而且胰腺炎未再复发。
结论 尽管激素治疗对自身免疫性胰腺炎的形态学及血清学改善在效，但在许多患者，胆胰管异常仍将保留。形态学及血清IgG4的恢复正常可能是自身免疫性胰腺炎停止药物治疗的很好指证。
此外，自身免疫性胰腺炎的影像学特点参见http://www.dxy.cn/bbs/post/view?bid=89&id=5367223&sty=1&tpg=1&age=0。
Morphological changes after steroid therapy in autoimmune pancreatitis.
Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A.
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 113-8677 Tokyo, Japan. kamisawa@cick.jp
BACKGROUND: Although many patients with autoimmune pancreatitis undergo steroid therapy, detailed evaluation of morphological changes in the pancreas and bile duct following therapy has not been performed in this disease. In this study serological and morphological changes occurring during steroid treatment of autoimmune pancreatitis are comparatively examined.
METHODS: Ten patients with autoimmune pancreatitis were treated with corticosteroids. Morphological findings were: pancreatic enlargement (n = 9), irregular narrowing of the main pancreatic duct (n = 10), and biliary stenosis (n = 9). An initial dose of prednisolone was 40-30 mg/day, and this was tapered by 5 mg every 1-2 weeks. All patients underwent ultrasound and serological testing 1-2 weeks after commencing medication, followed by weekly serological testing and by CT and endoscopic retrograde cholangiopancreatography after 1-2 months. Radiological and serological changes were compared.
RESULTS: All 10 patients were responsive to steroid therapy. Pancreatic size normalized within 1 month; however, irregularity of the pancreatic duct remained in 6 patients. Rigidity or lateral deformity of the bile duct remained in 3 patients and biliary stenosis persisted in 5. Four patients in whom elevated serum IgG4 failed to normalize also showed incomplete morphological improvement. Three patients with complete improvement of the pancreatic duct stopped medication, but recurrence of pancreatitis did not occur.
CONCLUSIONS: Although steroid therapy was morphologically and serologically effective in patients with autoimmune pancreatitis, cholangiopancreatographic abnormalities remained in many patients. Morphological improvement on cholangiopancreatography and normalization of serum IgG4 after steroid therapy appeared to be good indicators for discontinuing medication in patients with autoimmune pancreatitis.
背景 尽管许多自身免疫性胰腺炎患者使用激素治疗，但仍缺乏该病治疗后胆胰管形态学变化研究的详细研究。本研究比较了激素治疗自身免疫性胰腺炎期间血清学、形态学方面的变化。
方法 使用肾上腺皮质激素治疗自身免疫性胰腺炎患者10例，其形态学异常包括：胰腺增大（n=9）、主胰管不规则狭窄（n=10）、胆道狭窄（n=9）。强的松龙初始剂量为40-30mg/天，此后每1－2周减量5mg。每位患者均在治疗开始1－2周后进行超声及血清学检查。其后每周复查血清学及CT，1－2月后行地ERCP检查。比较放射学及血清学的改变。
结果 10名患者均对激素治疗有效。在1个月内胰腺大小恢复正常，然而在6名患者胰管不规则变化仍无改善，3名患者的胆管僵硬变形及5名患者的胆道狭窄仍持续存在。4名患者升高的IgG4水平不能恢复正常，其形态学改善也不完全。3名胰管完全改善的患者停止服药，而且胰腺炎未再复发。
结论 尽管激素治疗对自身免疫性胰腺炎的形态学及血清学改善在效，但在许多患者，胆胰管异常仍将保留。形态学及血清IgG4的恢复正常可能是自身免疫性胰腺炎停止药物治疗的很好指证。
此外，自身免疫性胰腺炎的影像学特点参见http://www.dxy.cn/bbs/post/view?bid=89&id=5367223&sty=1&tpg=1&age=0。
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