目的:自身免疫性胰腺炎(AIP)是一种诊断挑战性的疾病,通常模拟胰腺恶性肿瘤。胰腺切除术被认为是胰腺导管腺癌(PDAC)的治愈性治疗。本荟萃分析旨在研究因癌症临床表现而接受胰腺切除术的患者中AIP的发生率。
方法:在三个数据库中进行了全面搜索,PubMed,Embase和Cochrane图书馆,使用术语“自身免疫性胰腺炎”和“胰腺切除术”,并通过手动检查所有检索到的文章中的参考列表进行补充。
结果:最终分析包括10篇文章。由于临床怀疑胰腺癌,进行了8917例胰腺切除术。AIP占140例(1.6%)。1型AIP占大多数病例,占94%(132例),而2型AIP在进一步分类后占剩余的6%(8例)。AIP占所有涉及不必要手术的良性疾病病例的近26%,在70%的病例中,男性的比例过高,而女性的比例为30%。AIP患者的平均年龄为59岁。47例(49%)AIP患者中有23例血清CA19-9水平升高,在1型AIP患者中检测到更高的水平(51%,43人中有22人)比2型AIP(25%,1of4)。1型AIP中IgG4水平的敏感性较低(43%,21/49名患者)。
结论:即使采用现代诊断方法,区分AIP和PDAC仍然具有挑战性,因此,在某些情况下可能导致不必要的外科手术。血清CA19-9水平不能用于区分AIP和PDAC。因此,必须进行工作以改进诊断方法并避免不必要的复杂手术。
OBJECTIVE: Autoimmune pancreatitis (AIP) is a diagnosis-challenging disease that often mimics pancreatic malignancy. Pancreatic resection is considered to be a curative treatment for pancreatic ductal adenocarcinoma (PDAC). This meta-analysis aims to study the incidence of AIP in patients who have undergone pancreatic resection for clinical manifestation of cancer.
METHODS: A comprehensive search was conducted in three databases, PubMed, Embase and the Cochrane Library, using the terms \'autoimmune pancreatitis\' and \'pancreatic resection\' and supplemented by manual checks of reference lists in all retrieved articles.
RESULTS: Ten articles were included in the final analysis. 8917 pancreatic resections were performed because of a clinical suspicion of pancreatic cancer. AIP accounted for 140 cases (1.6%). Type 1 AIP comprised the majority of cases, representing 94% (132 cases), while type 2 AIP made up the remaining 6% (eight cases) after further classification. AIP accounted for almost 26% of all cases of benign diseases involving unnecessary surgery and was overrepresented in males in 70% of cases compared to 30% in females. The mean age for AIP patients was 59 years. Serum CA 19 - 9 levels were elevated in 23 out of 47 (49%) AIP patients, where higher levels were detected more frequently in patients with type 1 AIP (51%, 22 out of 43) than in those with type 2 AIP (25%, 1 out of 4). The sensitivity of IgG4 levels in type 1 AIP was low (43%, 21/49 patients).
CONCLUSIONS: Even with modern diagnostic methods, distinguishing between AIP and PDAC can still be challenging, thus potentially resulting in unnecessary surgical procedures in some cases. Serum CA 19 - 9 levels are not useful in distinguishing between AIP and PDAC. Work must thus be done to improve diagnostic methods and avoid unnecessary complicated surgery.