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自身免疫性胰腺炎的治疗进展
Advances in treatment of autoimmune pancreatitis
文章发布日期:2013年06月07日  来源:  作者:李 骥,钱家鸣  点击次数:2255次  下载次数:592次

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【摘要】:自身免疫性胰腺炎(AIP)是自身免疫介导的一种慢性胰腺炎。其治疗尚缺乏统一标准。通过回顾近些年国内外关于AIP治疗的文献,总结了糖皮质激素治疗的适应证包括有明确的临床症状(黄疸、腹痛等),显著的影像学异常以及明确的胰腺外器官受累。初始糖皮质激素剂量多采用相当于泼尼松0.6 mg·kg-1·d-1或30~40 mg,1次/d,逐渐减量,小剂量维持数月甚至数年。糖皮质激素并不一定会对AIP并发的糖尿病造成负面影响。反复复发或合并胰腺外重要脏器受累的患者须接受免疫抑制剂治疗,利妥昔单抗或许会成为难治性AIP的治疗选择之一。尽管部分AIP患者从外科手术中获益,但鉴于术后的并发症等因素,仍不推荐手术治疗成为AIP的常规治疗手段。
【Abstract】:Autoimmune pancreatitis (AIP) is a type of chronic pancreatitis characterized by an autoimmune inflammatory process. Treatment protocols for AIP are still evolving. According to the articles about AIP treatment in recent years, the indications for steroid therapy include specific clinical manifestations (jaundice, abdominal pain, etc.), markedly abnormal imaging findings, and extrapancreatic organ involvement. The initial dose of steroid (prednisone) is usually 0.6 mg·kg-1·d-1 or 30-40 mg/d; after 3 weeks to 1 month of treatment with the initial dose, the dose is decreased by 5-10 mg every 1-2 weeks until it drops to 2.5-5 mg/d; this dose is maintained for 6 months to 3 years. No consensus has been reached on the adverse effect of steroid on diabetes mellitus complicating AIP. Immunosuppressive agents should be used for the patients with disease relapses or with important extrapancreatic organs involved. Rituximab might become one of the therapies for refractory AIP. Although some patients achieved remission after surgical treatment, surgery is still not recommended as a routine treatment protocol due to the complications after surgery.
【关键字】:胰腺炎,慢性;自身免疫疾病;糖皮质激素类;免疫抑制剂
【Key words】:pancreatitis, chronic; autoimmune diseases; glucocorticoids; immunosuppressive agents
【引证本文】:

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