• 四川省醫(yī)學(xué)科學(xué)院 四川省人民醫(yī)院消化內(nèi)科（成都，610072）;

【摘要】　 自身免疫性胰腺炎是一種以免疫介導(dǎo)、纖維炎癥改變?yōu)樘攸c(diǎn)的特殊類型慢性胰腺炎。此病的特點(diǎn)為血清中高IgG4水平，伴胰腺腫大和胰管不規(guī)則狹窄，同時(shí)碳酸酐酶抗體和抗乳鐵蛋白抗體的存在。病理學(xué)表現(xiàn)為導(dǎo)管周圍淋巴漿細(xì)胞浸潤(rùn)伴纖維化。實(shí)驗(yàn)室、組織學(xué)檢查、臨床表現(xiàn)均顯示與自身免疫有關(guān)。皮質(zhì)激素對(duì)其療效顯著。日本、韓國(guó)、美國(guó)相繼制定了自身免疫性胰腺炎的診斷標(biāo)準(zhǔn)，2008年提出了亞洲診斷標(biāo)準(zhǔn)。目前我國(guó)自身免疫性胰腺炎的病例報(bào)道不多，他國(guó)的診斷標(biāo)準(zhǔn)可作為我國(guó)自身免疫性胰腺炎診療的良好借鑒。

引用本文： 雷蕾,李良平. 自身免疫性胰腺炎診療進(jìn)展. 華西醫(yī)學(xué), 2011, 26(7): 1108-1111. doi: 復(fù)制

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1. 　Sarles H, Sarles JC, Muratore R, et al. Chronic inflammatory sclerosis of the pancreas-an autonomous pancreatic disease?[J]. Am J Dig Dis, 1961, 6(7): 688-698.
2. 　Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality.Proposal of the concept of autoimmune pancreatitis[J]. Dig Dis Sci, 1995, 40(7): 1561-1568.
3. 　Kamisawa T, Egawa N, Nakajima H, et al. Clinical difficulties in the differentiation of autoimmune panereatitis and pancreatic carcinoma[J].Am J Gastroenterol, 2003, 98(12): 2694-2699.
4. 　Zamboni G, Luttges J, Capelli P, et al, Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis:a study on 53 resection specimens and 9 biopsy specimens[J].Virchows Arch, 2004, 445(6): 552-563.
5. 　唐令詮, 馮昌寧, 蔣智敏. 原發(fā)性自身免疫性胰腺炎1例報(bào)道并文獻(xiàn)復(fù)習(xí)[J]. 胰腺病學(xué), 2004, 4(1): 41-42.
6. 　Takuma K, Kamisawa T, Igarashi Y. Autoimmune pancreatitis and IgG4-related sclerosing cholangitis[J]. Curr Opin Rheumatol, 2011, 23(1): 80-87.
7. 　Tomita H, Matsubayashi H, Sasaki K, et al. A case of autoimmune pancreatitis accompanied with Mikulicz’s disease[J]. Nippon Shokakibyo Gakkai Zasshi, 2010, 107(5): 775-783.
8. 　Kountouras J, Zavos C, Gavalas E, et al.Challenge in the pathogenesis of autoimmune pancreatitis:potentiaI role of helicobacter pylori infection via molecular mimicry[J]. Gastroenterology, 2007, 133(1): 368-369.
9. 　Ota M, Katsuyama Y, Hamano H, et al. Two Critical genes(HLA-DRB1 and ABCF1) in the HLA region are associated with the susceptibility to autoimmune pancreatitis[J].Immunogenetics, 2007, 59(1): 45-52.
10. 　Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic Autoimmune disease[J].Am J Gastroenterol, 2003, 98(12): 2811-2812.
11. 　Kamisawa T, Takuma K, Egawa N, et al. Autoimmune pancreatitis and IgG4-related sclerosing disease[J]. Nat Rev Gastroenterol Hepatol, 2010, 7(7): 401-409.
12. 　Okazaki K, Uchida K, Fukui T. Recent advances in autoimmune pancreatitis concept,diagnosis,and pathogenesis[J]. J Gastroenterol, 2008, 43(6): 409-418.
13. 　Finkelberg DL, Sahani D, Deshpande V, et al. Autoimmune pancreatitis[J]. N Engl J Med, 2006, 355(25): 2670-2676.
14. 　Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations In patients with sclerosing pancreatitis[J]. N EngI J Med, 2001, 344(10): 732-738.
15. 　Ghazale A, Chari ST, Smyrk TC, et al. Value of serum IgG in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer[J].Am J Gastroentero1, 2007, 102(8): 1646-1653.
16. 　Frulloni L, Lunardi C, Simone R, et al. Identification of a novel antibody associated with autoimmune pancreatitis[J]. N Engl J Med, 2009, 361(22): 2135-2142.
17. 　Takahashi N, Fletcher JG, Fidler JL, et al. Dual-phase CT of autoimmune pancreatitis:a multireader study[J]. Am J Roentgenol, 2008, 190(2): 280-286.
18. 　Chang WI, Kim BJ, Lee JK, et al. The clinical and radiological characteristics of focal mass-forming autoimmune pancreatifis:comparison with chronic pancreatitis and pancreatic cancer[J].Pancreas, 2009, 38(4): 401-408.
19. 　Levy MJ, Reddy RP, Wiersema MJ, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice[J]. Gastrointest Endosc, 2005, 61(3): 467-472.
20. 　Levy MJ, Wiersema MJ, Chari ST. Chronic pancreatitis:focal pancreatitis or cancer? Is there a role for FNA/Biopsy? Autoimmune pancreatitis[J]. Endoscopy, 2006, 38(Suppl 1): S30-S35.
21. 　Aoki S, Nakazawa T, Ohara H, et al. Immunohistochemical study of autoimmune pancreatitis using anti-IgG4 antibody and patients’sera[J]. Hislopathology, 2005, 47(2): 147-158.
22. 　Chari ST, Kloeppel G, Zhang L, et al. Histopathologic and clinic subtypes of autoimmune pancreatitis: the Honolulu consensus document[J]. Pancreas, 2010, 10(6): 664-672.
23. 　Klöppel G, Detlefsen S, Chari ST, et al. Autoimmune pancreatitis: the clinicopathological characteristics of the subtype with granulocytic epithelial lesions[J]. J Gastroenterol, 2010, 45(8): 787-793.
24. 　KloppeI G, Sipos B, Zamboni G, et al. Autoimmune pancreatitis:histo-and immunopathological features[J]. J Gastroenterol, 2007, 42(Suppl 18): S28-S31.
25. 　Members of the Criteria Committee for Autoimmune pancreatitis of the Japan pancreas society. Diagnostic criteria for autoimmune pancreatitis by the Japan Pancreas Society[J].J Jpn Pan Soc, 2002, 17(6): 585-587.
26. 　Kim KP, Kim MH, Kim JC, et al. Diagnostic criteria for autoimmune chronic pancreatitis revisited[J]. World J Gastroenterol, 2006, 12(16): 2487-2496.
27. 　Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience[J]. Clin Gastroenterol Hepatol, 2006, 4(8): 1010-1016.
28. 　Otsuki M, Chung JB, Okazaki K, et al. Asian diagnostic criteria for autoimmune pancreatitis:consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis[J]. J Gastroenterol, 2008, 43(6): 403-408.
29. 　呂紅, 錢家鳴. 自身免疫性胰腺炎不同診斷標(biāo)準(zhǔn)的探討[J]. 胃腸病學(xué), 2009, 14 (1): 4-6.
30. 　Kamisawa T. Diagnostic criteria for autoimmune pancreatitis[J]. J Clin Gastroenterol, 2008, 42(4): 404-407.
31. 　Okazaki K, Kawa S, Kamisawa T, et al. Japanese clinical guidelines for autoimmune pancreatitis[J]. Pancreas, 2009, 38(8): 849-866.
32. 　Chari ST, Takahashi N, Levy MJ, et al. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer[J]. Clin Gastroenterol Hepatol, 2009, 7(10): 1097-1103.
33. 　Kamisawa T, Okamoto A, Wakabayashi T, et al. Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome[J]. Scand J Gastroenterol, 2008, 43(5): 609-613.
34. 　Kamisawa T, Shimosegawa T, Okazaki K, et al. Standard steroid treatment for autoimmune pancreatitis[J]. Gut, 2009, 58(11): 1504-1507.
35. 　Kamisawa T, Okazaki K, Kawa S, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: Ⅲ. Treatment and prognosis of AIP[J]. J Gastroenterol, 2010, 45(5): 471-477.
36. 　Finkelberg DL, Sahani D, Deshpande V, et al. Autoimmune pancreatitis[J]. N Engl J Med, 2006, 355(25): 2670-2676.
37. 　Ito T, Nishimori I, Inoue N, et al. Treatment for autoimmune pancreatitis:consensus on the treatment for patients with autoimmune pancreatitis in Japan[J]. J Gastroenterol, 2007, 42 (Suppl 18): S50-S58.
38. 　劉厚鈺. 提高對(duì)自身免疫性胰腺炎的診斷水平[J]. 胃腸病學(xué), 2009, 14 (1): 2-3.
  1. 1. 　Sarles H, Sarles JC, Muratore R, et al. Chronic inflammatory sclerosis of the pancreas-an autonomous pancreatic disease?[J]. Am J Dig Dis, 1961, 6(7): 688-698.
  2. 2. 　Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality.Proposal of the concept of autoimmune pancreatitis[J]. Dig Dis Sci, 1995, 40(7): 1561-1568.
  3. 3. 　Kamisawa T, Egawa N, Nakajima H, et al. Clinical difficulties in the differentiation of autoimmune panereatitis and pancreatic carcinoma[J].Am J Gastroenterol, 2003, 98(12): 2694-2699.
  4. 4. 　Zamboni G, Luttges J, Capelli P, et al, Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis:a study on 53 resection specimens and 9 biopsy specimens[J].Virchows Arch, 2004, 445(6): 552-563.
  5. 5. 　唐令詮, 馮昌寧, 蔣智敏. 原發(fā)性自身免疫性胰腺炎1例報(bào)道并文獻(xiàn)復(fù)習(xí)[J]. 胰腺病學(xué), 2004, 4(1): 41-42.
  6. 6. 　Takuma K, Kamisawa T, Igarashi Y. Autoimmune pancreatitis and IgG4-related sclerosing cholangitis[J]. Curr Opin Rheumatol, 2011, 23(1): 80-87.
  7. 7. 　Tomita H, Matsubayashi H, Sasaki K, et al. A case of autoimmune pancreatitis accompanied with Mikulicz’s disease[J]. Nippon Shokakibyo Gakkai Zasshi, 2010, 107(5): 775-783.
  8. 8. 　Kountouras J, Zavos C, Gavalas E, et al.Challenge in the pathogenesis of autoimmune pancreatitis:potentiaI role of helicobacter pylori infection via molecular mimicry[J]. Gastroenterology, 2007, 133(1): 368-369.
  9. 9. 　Ota M, Katsuyama Y, Hamano H, et al. Two Critical genes(HLA-DRB1 and ABCF1) in the HLA region are associated with the susceptibility to autoimmune pancreatitis[J].Immunogenetics, 2007, 59(1): 45-52.
  10. 10. 　Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic Autoimmune disease[J].Am J Gastroenterol, 2003, 98(12): 2811-2812.
  11. 11. 　Kamisawa T, Takuma K, Egawa N, et al. Autoimmune pancreatitis and IgG4-related sclerosing disease[J]. Nat Rev Gastroenterol Hepatol, 2010, 7(7): 401-409.
  12. 12. 　Okazaki K, Uchida K, Fukui T. Recent advances in autoimmune pancreatitis concept,diagnosis,and pathogenesis[J]. J Gastroenterol, 2008, 43(6): 409-418.
  13. 13. 　Finkelberg DL, Sahani D, Deshpande V, et al. Autoimmune pancreatitis[J]. N Engl J Med, 2006, 355(25): 2670-2676.
  14. 14. 　Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations In patients with sclerosing pancreatitis[J]. N EngI J Med, 2001, 344(10): 732-738.
  15. 15. 　Ghazale A, Chari ST, Smyrk TC, et al. Value of serum IgG in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer[J].Am J Gastroentero1, 2007, 102(8): 1646-1653.
  16. 16. 　Frulloni L, Lunardi C, Simone R, et al. Identification of a novel antibody associated with autoimmune pancreatitis[J]. N Engl J Med, 2009, 361(22): 2135-2142.
  17. 17. 　Takahashi N, Fletcher JG, Fidler JL, et al. Dual-phase CT of autoimmune pancreatitis:a multireader study[J]. Am J Roentgenol, 2008, 190(2): 280-286.
  18. 18. 　Chang WI, Kim BJ, Lee JK, et al. The clinical and radiological characteristics of focal mass-forming autoimmune pancreatifis:comparison with chronic pancreatitis and pancreatic cancer[J].Pancreas, 2009, 38(4): 401-408.
  19. 19. 　Levy MJ, Reddy RP, Wiersema MJ, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice[J]. Gastrointest Endosc, 2005, 61(3): 467-472.
  20. 20. 　Levy MJ, Wiersema MJ, Chari ST. Chronic pancreatitis:focal pancreatitis or cancer? Is there a role for FNA/Biopsy? Autoimmune pancreatitis[J]. Endoscopy, 2006, 38(Suppl 1): S30-S35.
  21. 21. 　Aoki S, Nakazawa T, Ohara H, et al. Immunohistochemical study of autoimmune pancreatitis using anti-IgG4 antibody and patients’sera[J]. Hislopathology, 2005, 47(2): 147-158.
  22. 22. 　Chari ST, Kloeppel G, Zhang L, et al. Histopathologic and clinic subtypes of autoimmune pancreatitis: the Honolulu consensus document[J]. Pancreas, 2010, 10(6): 664-672.
  23. 23. 　Klöppel G, Detlefsen S, Chari ST, et al. Autoimmune pancreatitis: the clinicopathological characteristics of the subtype with granulocytic epithelial lesions[J]. J Gastroenterol, 2010, 45(8): 787-793.
  24. 24. 　KloppeI G, Sipos B, Zamboni G, et al. Autoimmune pancreatitis:histo-and immunopathological features[J]. J Gastroenterol, 2007, 42(Suppl 18): S28-S31.
  25. 25. 　Members of the Criteria Committee for Autoimmune pancreatitis of the Japan pancreas society. Diagnostic criteria for autoimmune pancreatitis by the Japan Pancreas Society[J].J Jpn Pan Soc, 2002, 17(6): 585-587.
  26. 26. 　Kim KP, Kim MH, Kim JC, et al. Diagnostic criteria for autoimmune chronic pancreatitis revisited[J]. World J Gastroenterol, 2006, 12(16): 2487-2496.
  27. 27. 　Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience[J]. Clin Gastroenterol Hepatol, 2006, 4(8): 1010-1016.
  28. 28. 　Otsuki M, Chung JB, Okazaki K, et al. Asian diagnostic criteria for autoimmune pancreatitis:consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis[J]. J Gastroenterol, 2008, 43(6): 403-408.
  29. 29. 　呂紅, 錢家鳴. 自身免疫性胰腺炎不同診斷標(biāo)準(zhǔn)的探討[J]. 胃腸病學(xué), 2009, 14 (1): 4-6.
  30. 30. 　Kamisawa T. Diagnostic criteria for autoimmune pancreatitis[J]. J Clin Gastroenterol, 2008, 42(4): 404-407.
  31. 31. 　Okazaki K, Kawa S, Kamisawa T, et al. Japanese clinical guidelines for autoimmune pancreatitis[J]. Pancreas, 2009, 38(8): 849-866.
  32. 32. 　Chari ST, Takahashi N, Levy MJ, et al. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer[J]. Clin Gastroenterol Hepatol, 2009, 7(10): 1097-1103.
  33. 33. 　Kamisawa T, Okamoto A, Wakabayashi T, et al. Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome[J]. Scand J Gastroenterol, 2008, 43(5): 609-613.
  34. 34. 　Kamisawa T, Shimosegawa T, Okazaki K, et al. Standard steroid treatment for autoimmune pancreatitis[J]. Gut, 2009, 58(11): 1504-1507.
  35. 35. 　Kamisawa T, Okazaki K, Kawa S, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: Ⅲ. Treatment and prognosis of AIP[J]. J Gastroenterol, 2010, 45(5): 471-477.
  36. 36. 　Finkelberg DL, Sahani D, Deshpande V, et al. Autoimmune pancreatitis[J]. N Engl J Med, 2006, 355(25): 2670-2676.
  37. 37. 　Ito T, Nishimori I, Inoue N, et al. Treatment for autoimmune pancreatitis:consensus on the treatment for patients with autoimmune pancreatitis in Japan[J]. J Gastroenterol, 2007, 42 (Suppl 18): S50-S58.
  38. 38. 　劉厚鈺. 提高對(duì)自身免疫性胰腺炎的診斷水平[J]. 胃腸病學(xué), 2009, 14 (1): 2-3.