Abstract：
OBJECTIVE: Autoimmune pancreatitis (AIP) is a steroid-responsive inflammatory disease of the pancreas. Few studies investigated pancreatic exocrine function (PEF) in patients suffering from AIP and no definitive data are available on the effect of steroids in PEF recovery. Aim of the study is the evaluation of severe pancreatic insufficiency (sPEI) prevalence in AIP at clinical onset and after steroid treatment.
METHODS: 312 Patients with diagnosis of AIP between January 1st, 2010 and December 31st, 2020 were identified in our prospectively maintained register. Patients with a pre-steroid treatment dosage of fecal elastase-1 (FE-1) were included. Changes in PEF were evaluated in patients with available pre- and post-treatment FE (between 3 and 12 months after steroid).
RESULTS: One-hundred-twenty-four patients were included, with a median FE-1 of 122 (Q1-Q3: 15-379) μg/g at baseline. Fifty-nine (47.6 %) had sPEI (FE-1<100 μg/g). Univariable analysis identified type 1 AIP, radiological involvement of the head of the pancreas (diffuse involvement of the pancreas or focal involvement of the head), weight loss, age and diabetes as associated with a greater risk of sPEI. However, at multivariable analysis, only the involvement of the head of the pancreas was identified as independent risk factor for sPEI. After steroids, mean FE-1 changed from 64 (15-340) to 202 (40-387) μg/g (P = 0.058) and head involvement was the only predictor of improvement of sPEI.
CONCLUSIONS: The inflammatory involvement of the head of the pancreas is associated with PEF severity, as well as PEF improvement after treatment with steroids in patients with AIP.
METHODS: 312 Patients with diagnosis of AIP between January 1st, 2010 and December 31st, 2020 were identified in our prospectively maintained register. Patients with a pre-steroid treatment dosage of fecal elastase-1 (FE-1) were included. Changes in PEF were evaluated in patients with available pre- and post-treatment FE (between 3 and 12 months after steroid).
RESULTS: One-hundred-twenty-four patients were included, with a median FE-1 of 122 (Q1-Q3: 15-379) μg/g at baseline. Fifty-nine (47.6 %) had sPEI (FE-1<100 μg/g). Univariable analysis identified type 1 AIP, radiological involvement of the head of the pancreas (diffuse involvement of the pancreas or focal involvement of the head), weight loss, age and diabetes as associated with a greater risk of sPEI. However, at multivariable analysis, only the involvement of the head of the pancreas was identified as independent risk factor for sPEI. After steroids, mean FE-1 changed from 64 (15-340) to 202 (40-387) μg/g (P = 0.058) and head involvement was the only predictor of improvement of sPEI.
CONCLUSIONS: The inflammatory involvement of the head of the pancreas is associated with PEF severity, as well as PEF improvement after treatment with steroids in patients with AIP.
摘要：
目的：自身免疫性胰腺炎（AIP）是一种类固醇反应性胰腺炎性疾病。很少有研究调查AIP患者的胰腺外分泌功能（PEF），并且没有关于类固醇在PEF恢复中的作用的确切数据。该研究的目的是评估AIP在临床发作和类固醇治疗后的严重胰腺功能不全（sPEI）患病率。
方法：312例1月1日之间诊断为AIP的患者，2010年12月31日,2020年在我们前瞻性维护的登记册中确定。包括接受类固醇治疗前剂量的粪便弹性蛋白酶-1（FE-1）的患者。在治疗前和治疗后（类固醇后3至12个月）可获得FE的患者中评估PEF的变化。
结果：纳入了一百二十四例患者，基线时FE-1中位数为122（Q1-Q3：15-379）μg/g。59(47.6%)具有sPEI(FE-1<100μg/g)。单变量分析确定类型1AIP，胰腺头部的放射学受累（胰腺的弥漫性受累或头部的局灶性受累），减肥,年龄和糖尿病与更高的sPEI风险相关。然而,在多变量分析中，只有胰头受累被确定为sPEI的独立危险因素.类固醇之后,平均FE-1从64（15-340）变为202（40-387）μg/g（P=0.058），头部受累是sPEI改善的唯一预测指标。
结论：胰头的炎症受累与PEF严重程度有关，以及AIP患者类固醇治疗后PEF的改善。
方法：312例1月1日之间诊断为AIP的患者，2010年12月31日,2020年在我们前瞻性维护的登记册中确定。包括接受类固醇治疗前剂量的粪便弹性蛋白酶-1（FE-1）的患者。在治疗前和治疗后（类固醇后3至12个月）可获得FE的患者中评估PEF的变化。
结果：纳入了一百二十四例患者，基线时FE-1中位数为122（Q1-Q3：15-379）μg/g。59(47.6%)具有sPEI(FE-1<100μg/g)。单变量分析确定类型1AIP，胰腺头部的放射学受累（胰腺的弥漫性受累或头部的局灶性受累），减肥,年龄和糖尿病与更高的sPEI风险相关。然而,在多变量分析中，只有胰头受累被确定为sPEI的独立危险因素.类固醇之后,平均FE-1从64（15-340）变为202（40-387）μg/g（P=0.058），头部受累是sPEI改善的唯一预测指标。
结论：胰头的炎症受累与PEF严重程度有关，以及AIP患者类固醇治疗后PEF的改善。
