自身免疫性胰腺炎.pptVIP

部分病人会因胰腺外分泌功能下降引发糖尿病。 类固醇治疗有利于提高胰腺内/外分泌功能失调。 影像学检查有利于观察激素治疗后胰腺形态变化 胰腺功能 激素治疗后 男，61岁，腹痛6月余 治疗后 治疗前 治疗与复发 胰腺癌，恶性淋巴瘤，浆细胞瘤和转移瘤 肿瘤：轮廓不均匀，增强后不均匀强化 AIP：均匀延迟强化，IgG升高；增强扫描胰周囊状低密度灶 慢性胰腺炎 酗酒史，急性胰腺炎反复发作； 胰管扩张，自身抗体（-） 胰腺结石，胰腺实质钙化，假性囊肿 鉴别诊断 AIP标准激素治疗 09年最新报道，日本17个中心共563例，459例接受激素治疗，缓解率达98%，显著高于不要激素治疗者（74%）。 维持激素治疗377例，复发率为23%，不维持治疗的复发率为34%； 推荐首剂为0.6mg/kg/day，维持治疗持续3-6个月，维持治疗可减少复发。 * CT scan shows isoattenuating enlargement (arrow) of head and uncinate process of pancreas. (b) Endoscopic US image shows focal hypoechoic mass in the head and uncinate process of pancreas * * CT scan shows the low attenuation rim (arrowheads) in the pancreas tail. B ERCP image shows multiple narrowings of the main pancreatic duct (arrowheads) involving all segments of the pancreas. * (a) Axial T1-weighted gradient-echo image with fat suppression shows diffuse enlargement of pancreatic parenchyma (arrows), which appears hypointense compared with liver and spleen, with loss of its normal lobular structure. (b) On axial T2-weighted half-Fourier single-shot turbo spin-echo image, pancreatic parenchyma (arrows) appears hyperintense compared with liver parenchyma and isointense to spleen.(c, d) On axial gadolinium chelate–enhanced fat-saturated volumetric interpolated breath-hold examination gradient-echo images, pancreatic parenchyma (arrows) appears hypointense on (c) late arterial phase image, with progressive accumulation and retention on (d) the delayed phase image. * A Transverse T2- weighted MR image shows diffuse enlargement of the pancreas (arrowheads). Note the high signal intensity of the pancreatic parenchyma compared with that of liver (L). B Contrast-enhanced MR image shows stronger enhancement of the pancreatic parenchyma (arrowheads) compared with the liver (L). E On contrastenhanced CT obtained 2 months after steroid therapy,enlargement of the pancreas has decreased. F On follow-up ERCP obtained 2 months after steroid therapy, narrowing of the pancreatic duct has decreased. * Recurrent AIP