一例IgG4相关性胰腺炎患者的循证诊断与治疗

    Evidence-Based Diagnosis and Treatment of a Patient With IgG4-Related Pancreatitis

    • 摘要: 目的 检索当前的最佳证据,为一例疑似免疫球蛋白G4(immunoglobulin G4,IgG4)相关性胰腺炎患者的进一步诊断与治疗提供最有力的证据。 方法 计算机检索Embase数据库(1995-2019)、Medline数据库、Cochrane Library(Central数据库)(1995-2019)、UptoDate数据库、万方数据库(1995-2019)、中国知网CNKI(1995-2019)等,查找有关IgG4相关性胰腺炎的系统评价、临床指南、横断面研究、病案报道、文献综述、专家建议等,并对检索到的文献证据进行评价分级。 结果 检索证据表明,局灶型IgG4相关性胰腺炎极易误诊为胰头癌,二者的鉴别有赖于胰腺穿刺活检;由于胰腺癌的治疗首选外科手术切除,而IgG4相关性胰腺炎首选糖皮质激素治疗,因此对胰腺癌患者的术前或疑似IgG4相关性胰腺炎患者进行胰腺穿刺活检显得尤为重要。 结论 胰腺穿刺活检及血清免疫学检查对于诊断IgG4相关性胰腺炎的特异性和敏感性都比较高,糖皮质激素是治疗IgG4相关性胰腺炎的特异性药物。

       

      Abstract: Objective To search the best evidence so far, and to provide the most powerful evidence for the diagnosis and treatment of a suspected immunoglobulin G4-related autoimmune pancreatitis(IgG4-RAIP) in our hospital. Methods Searching for systematic evaluation, clinical guidelines, cross-sectional studies, medical record reports, literature review, expert recommendations, etc from Embase database (1995-2019), Medline database, Cochrane Library (Central database) (1995-2019), Uptodate database, Wanfang database (1995-2019), China knowledge net CNKI (1995-2019); evaluating and grading the literature evidences. Results The retrieved evidences show that focal IgG4-related pancreatitis is easily misdiagnosed as pancreatic head cancer, and the differentiation between them depends on pancreas biopsy. Since surgical resection is the first choice for the treatment of pancreatic cancer and glucocorticoid therapy is the first choice for IgG4-related pancreatitis, it is particularly important to perform pancreatic biopsy in patients with pancreatic cancer before operation or in patients with suspected IgG4-related pancreatitis. Conclusions Pancreas biopsy and serum immunological examination have high specificity and sensitivity in the diagnosis of IgG4-related pancreatitis. Glucocorticoid is a specific drug for the treatment of IgG4-related pancreatitis.

       

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