自身免疫性胰腺炎的激素治疗

马娟; 刘玉兰

doi:10.3969/j.issn.1001-5256.2018.08.002

自身免疫性胰腺炎的激素治疗

DOI: 10.3969/j.issn.1001-5256.2018.08.002

马娟,
刘玉兰

北京大学人民医院消化科

详细信息

中图分类号: R576
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出版历程
- 收稿日期: 2018-04-20
- 出版日期: 2018-08-20

Corticosteroid therapy for autoimmune pancreatitis

Ma Juan,
Liu YuLan

Department of Gastroenterology, People's Hospital, Peking University

摘要

摘要: 自身免疫性胰腺炎(AIP)是一种由自身免疫介导的特殊类型慢性胰腺炎,有其独特的影像学、血清学及组织病理特征。目前国际指南将AIP分为Ⅰ型和Ⅱ型。研究表明激素对AIP具有较好疗效,且指南将口服糖皮质激素作为无禁忌证患者的首选治疗方案。但是,目前关于初治激素的用量及复发后治疗方案的选择仍无一致的推荐。故综合目前的研究进展及指南推荐,从AIP初治患者的选择及治疗、复发患者的治疗方面阐述目前关于AIP治疗方案的选择。
- 胰腺炎 /
- 自身免疫疾病 /
- 糖皮质激素类 /
- 治疗学
Abstract: Autoimmune pancreatitis ( AIP) is a special type of autoimmune-mediated chronic pancreatitis and has unique imaging, serological, and histopathological features. According to current international guidelines, AIP is classified into type I and type II. Studies have shown that glucocorticoids have a good clinical effect in the treatment AIP, and the guidelines recommend oral glucocorticoids as the preferred treatment regimen for patients without contraindications. However, no consensus has been reached on initial dosage of glucocorticoids and treatment regimens after recurrence. Therefore, with reference to recent research advances and recommendations in guidelines, this article elaborates on the selection of treatment regimens for AIP from the aspects of the selection and treatment of previously untreated AIP patients and the treatment of patients with recurrence.
- pancreatitis /
- autoimmune diseases /
- glucocorticoids /
- therapeutics

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参考文献(32)

[1]OKAZAKI K, KAWA S, KAMISAWA T, et al.Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013I.Concept and diagnosis of autoimmune pancreatitis[J].J Gastroenterol, 2014, 49 (4) :567-588.

[2]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.

[3] SHIMOSEGAWA T, CHARI ST, FRULLONI L, et al.International consensus diagnostic criteria for autoimmune pancreatitis:Guidelines of the International Association of Pancreatology[J].Pancreas, 2011, 40 (3) :352-358.

[4] Editorial Board of Chinese Journal of Pancreatology.Chinese guidelines for the diagnosis and treatment of autoimmune pancreatitis (draft 2012, Shanghai) [J].Chin J Pancreatol, 2012, 12 (6) :410-418. (in Chinese) 《中华胰腺病杂志》编委会.我国自身免疫性胰腺炎共识意见 (草案2012, 上海) [J].中华胰腺病杂志, 2012, 12 (6) :410-418.

[5]SUGUMAR A, CHARI ST.Diagnosis and treatment of autoimmune pancreatitis[J].Curr Opin Gastroenterol, 2010, 26 (5) :513-518.

[6]KUBOTA K, IIDA H, FUJISAWA T, et al.Clinical factors predictive of spontaneous remission or relapse in cases of autoimmune pancreatitis[J].Gastrointest Endosc, 2007, 66 (6) :1142-1151.

[7]KAMISAWA T, OKAZAKI K, KAWA S, et al.Amendment of the Japanese consensus guidelines for autoimmune pancreatitis, 2013.III.Treatment and prognosis of autoimmune pancreatitis[J].J Gastroenterol, 2014, 49 (6) :961-970.

[8]KHOSROSHAHI A, WALLACE ZS, CROWE JL, et al.International consensus guidance statement on the management and treatment of Ig G4-related disease[J].Arthritis Rheumatol, 2015, 67 (7) :1688-1699.

[9] KAMISAWA T, SHIMOSEGAWA T, OKAZAKI K, et al.Standard steroid treatment for autoimmune pancreatitis[J].Gut, 2009, 58 (11) :1504-1507.

[10]HART PA, ZEN Y, CHARI ST.Recent advances in autoimmune pancreatitis[J].Gastroenterology, 2015, 149 (1) :39-51.

[11]ARAKI J, TSUJIMOTO F, OHTA T, et al.Natural course of autoimmune pancreatitis without steroid therapy showing hypoechoic masses in the uncinated process and tail of the pancreas on ultrasonography[J].J Ultrasound Med, 2006, 25 (8) :1063-1067.

[12]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 (Suppl18) :50-58.

[13]KANNO A, MASAMUNE A, OKAZAKI K, et al.Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2011[J].Pancreas, 2015, 44 (4) :535-539.

[14]BUIJS J, van HEERDE MJ, RAUWS EA, et al.Comparable efficacy of low-versus high-dose induction corticosteroid treatment in autoimmune pancreatitis[J].Pancreas, 2014, 43 (2) :261-267.

[15]TOMIYAMA T, UCHIDA K, MATSUSHITA M, et al.Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis[J].J Gastroenterol, 2011, 46 (5) :696-704.

[16]PARK DH, KIM MH, OH HB, et al.Substitution of aspartic acid at position 57 of the DQb1 affects relapse of autoimmune pancreatitis[J].Gastroenterology, 2008, 134 (2) :440-446.

[17]HAN PA, KAMISAWA T, BNLGGE WR, et al.Long-term outcomes of autoimmune pancreatitis:A multicenter, international analysis[J].Gut, 2013, 62 (12) :1771-1776.

[18]WAKABAYASHI T, KAWAURA Y, SATOMURA Y, et al.Longterm prognosis of duct-narrowing chronic pancreatitis:Strategy for steroid treatment[J].Pancreas, 2005, 30 (1) :31-39.

[19]MASAMUNE A, NISHIMORI I, KIKUTA K, et al.Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis[J].Gut, 2017, 66 (3) :487-494.

[20]GHAZALE A, CHARI ST, ZHANG L, et al.Immunoglobulin G4-associated cholangitis:Clinical profile and response to therapy[J].Gastroenterology, 2008, 134 (3) :706-715.

[21]LIU B, LI J, YAN LN, et al.Retrospective study of steroid therapy for patients with autoimmune pancreatitis in a Chinese population[J].World J Gastroenterol, 2013, 19 (4) :569-574.

[22]SAH RP, CHARI ST, PANNALA R, et al.Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis[J].Gastroenterology, 2010, 139 (1) :140-148.

[23]HUGGETT MT, CULVER EL, KUMAR M, et al.Type 1 autoimmune pancreatitis and Ig G4-related sclerosing cholangitis is associated with extrapancreatic organ failure, malignancy, and mortality in a prospective UK cohort[J].Am J Gastroenterol, 2014, 109 (10) :1675-1683.

[24]KAMISAWA T, OKAMOTO A.Prognosis of autoimmune pancreatitis[J].J Gastroenterol, 2007, 42 (Suppl 18) :s59-s62.

[25]KIM KP, KIM MH, SONG MH, et al.Autoimmune chronic pancreatitis[J].Am J Gastroenterol, 2004, 99 (8) :1605-1616.

[26]LOPEZ-SERRANO A, CRESPO J, PASCUAL I, et al.Diagnosis, treatment and long-term outcomes of autoimmune pancreatitis in Spain based on the International Consensus Diagnostic Criteria:A multi-centre study[J].Pancreatology, 2016, 16 (3) :382-390.

[27]SHIMIZU S, NAITOH I, NAKAZAWA T, et al.Correlation between long-term outcome and steroid therapy in type 1 autoimmune pancreatitis:Relapse, malignancy and side effect of steroid[J].Sca Ild J Gastroenterol, 2015, 50 (11) :1411-1418.

[28]HIMNO K, TADA M, ISAYAMA H, et al.Outcome of long-term maintenance steroid therapy cessation in patients with autoimmune pancreatitis:A prospective study[J].J Clin Gastroenterol, 2016, 50 (4) :331-337.

[29]RAINA A, YADAV D, KRASINSKAS AM, et al.Evaluation and management of autoimmune pancreatitis:Experience at a large US center[J].Am J Gastroenterol, 2009, 104 (9) :2295-2306.

[30]MENG Q, XIN L, LIU W, et al.Diagnosis and treatment of autoimmune pancreatitis in China:A systematic review[J].PLo S One, 2015, 10 (6) :e0130466.

[31]NISHINO T, TOKI F, OYAMA H, et al.Long-term outcome of autoimmune pancreatitis after oral prednisolone therapy[J].Intem Med, 2006, 45 (8) :497-501.

[32]MATSUSHITA M, YALLLASHINA M, IKEUM T, et al.Effective steroid pulse therapy for the biliary stenosis caused by autoimmune pancreatitis[J].Am J Gastroenterol, 2007, 102 (1) :220-221.

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