欧洲1型自身免疫性胰腺炎:临床特征和对治疗的反应
Kasper A Overbeek1, Jakob L Poulsen2, Marco Lanzillotta3
1Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
概括
用皮质类固醇治疗自身免疫性胰腺炎 (AIP) 是有效的,达到高缓解率. 升高的IgG4水平可能需要对1型AIP患者进行更密切的监测.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 内分泌学 在内分泌学.
背景情况:
- 自身免疫性胰腺炎 (AIP) 是一种免疫媒介的胰腺疾病.
- 1型AIP的特点是独特的病理生理学和表现.
- 了解治疗有效性对于患者管理至关重要.
研究的目的:
- 在一个大型泛欧洲队列中描述1型AIP.
- 评估1型AIP目前治疗方案的有效性.
- 确定与缓解和复发相关的因素.
主要方法:
- 自2005年以来,对在42所欧洲大学医院诊断出1型或其他未指定的AIP的成年人进行了回顾性分析.
- 使用特定标准对1型AIP进行统一诊断.
- 不包括2型AIP和术后患者.
- 主要终点:完全缓解 (没有症状和AIP相关放射性异常的解决).
主要成果:
- 总共包括735名AIP患者 (69%男性,中位数年龄57岁,85%白人).
- 625名患者的皮质类固醇治疗导致79%的完全缓解率.
- 在95名未接受治疗的患者中,自发缓解的完整率为61%.
- 更高的皮质类固醇剂量或更长的初始持续时间并没有改善结果.
- 升高的IgG4水平与完全缓解的可能性降低有关 (OR,0.639;95% CI,0.427-0.955).
- 复发发生在30%的患者中,不论是类固醇缓解持续时间,诱导持续时间或累积剂量.
结论:
- 开始剂量为0.4毫克/公斤/天的皮质类固醇2周,然后是短暂的逐渐减少,似乎有效地诱导1型AIP的缓解.
- 患有1型AIP和IgG4水平升高的患者可能需要更密切的监测.
- 该研究没有发现支持更积极的治疗方案的证据.
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