高与低的初始类固醇剂量在自身免疫性胰腺炎:多中心对效率和糖尿病恶化的队列研究
Yuhei Iwasa1, Takuji Iwashita2,3, Keisuke Iwata1
1Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan.
Diagnostics (Basel, Switzerland)
|November 13, 2025
概括
对自身免疫性胰腺炎 (AIP) 的较低初始类固醇剂量显示出与高剂量相似的疗效,但显著降低了糖尿病恶化. 这表明低剂量类固醇方法可能是AIP管理的首选.
科学领域:
- 胃肠病学 胃肠病学
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
背景情况:
- 类固醇治疗是自身免疫性胰腺炎 (AIP) 的首要治疗方法,达到高反应率.
- 然而,类固醇使用与不良事件有关,特别是糖尿病 (DM) 的发展或恶化.
- 对AIP的最佳初始类固醇剂量尚不清楚,高剂量可能会加剧DM.
研究的目的:
- 研究初始类固醇剂量对AIP患者治疗疗效的影响.
- 评估不同初始类固醇剂量对糖尿病恶化的影响.
- 在接受类固醇治疗的AIP患者中识别与DM恶化相关的风险因素.
主要方法:
- 一项追溯性研究涉及81名接受类固醇治疗的AIP患者.
- 患者被分为高剂量 (HD;>0.4 mg/kg) 和低剂量 (LD;≤0.4 mg/kg) 初始类固醇组.
- 两组之间的治疗反应率,胰腺体体积变化,复发率和DM恶化的比较.
主要成果:
- 在HD和LD组中,治疗反应率均高 (100%).
- 没有观察到HD和LD组之间的复发率有显著差异 (29%对26%).
- 一年后,糖尿病恶化在HD组 (50%) 发生的频率明显高于LD组 (16%) (p=0.007).
结论:
- 与低剂量治疗相比,初始高剂量类固醇治疗AIP并没有提高治疗疗效或降低复发率.
- 从高剂量类固醇治疗开始是AIP患者DM恶化的重要危险因素.
- 较低的初始类固醇剂量可能是管理AIP的更安全的策略,特别是在患有或患有糖尿病的患者中.
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