| Background: Autoimmune pancreatitis is a special type of immunemediated pancreatitis characterized by diffuse or focal enlargement of the pancreas on imaging,with lymphocytic plasma cell infiltration and striate fibrosis as the characteristic histological findings.The clinical symptoms are mostly obstructive jaundice and mild abdominal pain,and most patients respond well to glucocorticoid therapy.AIP is a rare disease with insidious onset,lack of specific clinical manifestations,and difficult diagnosis.It is easy to be misdiagnosed as pancreatic cancer,and unnecessary surgery is performed,causing a double blow to the patient’s body and mind.The epidemiological data,clinical diagnosis and treatment of AIP in my country are still incomplete,and the pathogenesis is still unclear.Therefore,summarize the clinical characteristics and diagnosis and treatment experience of 43 patients with AIP in Xiangya Hospital of Central South University,and compare and analyze the relevant laboratory indicators with the PC group,analyze the significance of the indicators with statistical differences in the identification of AIP and PC,improve the identification ability,and guide AIP diagnosis and treatment.Methods: A retrospective analysis of 43 patients with AIP diagnosed in Xiangya Hospital of Central South University during a 10-year period(January 01,2012 to January 01,2022)was performed.At a ratio of 1:1,43 patients with PC who were treated in the same period were randomly selected as the control group.The general data,clinical manifestations,serological indicators,imaging,histology and treatment methods of the two groups of patients were collected and compared and analyzed.Results: Among the 43 AIP patients,35 were male,with a male-tofemale ratio of 4.38:1;the average age was 56.07±11.24 years,and 16 patients had other organ involvement,accounting for 37.2%,most of which were bile duct involvement.The hemoglobin and serum CA19-9 in the AIP group were lower than those in the PC group,and the serum Ig G4 positive rate,globulin,alanine aminotransferase,and alkaline phosphatase were higher than those in the PC group.The areas under the ROC curve of serum Ig G4,hemoglobin,alkaline phosphatase and globulin in the differential diagnosis of AIP and PC were 0.939,0.681,0.764,and 0.783,respectively.Abdominal ultrasonography was performed in 25 patients,and 19 patients showed the presence of pancreatic lesions;34 patients underwent abdominal CT,of which 7 patients had typical imaging findings of "sausage-like" changes;abdominal MRI including MRCP 21 cases were examined,mainly manifested as pancreatic enlargement and stenosis of the pancreatic segment of the common bile duct;15 cases underwent EUS examination or puncture under EUS,showing diffuse hypoechoic changes or focal swelling of the pancreas;7 cases underwent ERCP examination or ERCP treatment,common bile duct pancreatic stenosis as the main performance.30 cases were treated with hormone alone,2 cases were treated with hormone combined with rituximab,and 1 cases was treated with hormone combined with immunosuppressant(azathioprine).Conclusion: 1.Jaundice is more common in AIP patients,and abdominal pain is more common in PC patients,but it is not specific.AIP patients may be accompanied by involvement of other organs.If necessary,the clinical manifestations of other organs or tissue biopsy can be combined to make a clear diagnosis.2.Serum Ig G4 is still the most valuable serological test for AIP,and CA19-9 is mainly elevated in the PC group;AIP patients may have elevated alkaline phosphatase,globulin and other serological indicators,and serum Ig G4 can be further combined for AIP and PC differential diagnosis and improve diagnostic performance. |
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