자가면역성 만성 췌장염 17예의 임상상 = Clinical Characteristics of 17 Cases of Autoimmune Chronic Pancreatitis

국문 초록 (Abstract)

목적: 자가면역성 췌장염은 만성 췌장염의 특이한 형태이다. 국내 보고는 매우 드물며 증례 수준이다. 이에 저자들은 단일 병원에서 경험한 17예의 자가면역성 췌장염의임상상을 분석하였다. 대상 및 방법: 2000년 7월부터 2003년 7월 사이에 서울아산병원에서 자가면역성 췌장염으로 진단된 17명의 임상적, 방사선, 조직학적 특징을 분석하였다. 결과: 환자들은 대부분 중년 이상(45~75세, 평균 59.1세)의 남자(M:F=15:2)들로 주소는 황달이나 비특이적 소화기 증상들이었다. 췌장효소치는 대부분 정상이거나 약간 상승되었고 간기능검사는 담즙정체성 간기능 이상 소견을 보였다. IgG 상승과 자가면역 항체의 검출은 각각 47%(8/17), 35% (6/17)에서 관찰되었다. 조직학적으로는 14명중 13명에서 림프구 및 형질세포의 침윤과 섬유화가 관찰되었고 1명에서는 호산구의 침윤이 보였다. 전체 환자 중15명의 환자에서 초음파나 CT에서 석회화나 췌석이 없는 췌장의 미만성 종대를 보였고 ERCP에서 불규칙적 협착을주 소견으로 하는 경화성 형태의 주췌관이 관찰되었다. 이 환자들에서 스테로이드 투여 후 상기 소견들이 모두 호전되었다. 나머지 2명의 환자는 ERCP에서 국소적 협착 및 그상류쪽 췌관의 확장이 보여 국소형의 자가면역성 췌장염으로 진단되었다. 동반된 질환으로는 당뇨가 13명에서 관찰되었고, 원발성 경화성 담도염과 쇼그렌 증후군이 각각 1명에서 나타났다. 결론: 자가면역성 췌장염에 대한 이해는 환자에게 필요 없는 개복 수술을 피할 수 있게 하고 스테로이드의 경구 복용만으로 만성 췌장염의 현저한 호전을 가져올 수 있다.

다국어 초록 (Multilingual Abstract)

Background/Aims: Autoimmune pancreatitis is a distinctive type of chronic pancreatitis with reversibility. We analyzed the largest number of patients with autoimmune pancreatitis among the studies carried out at a single institution in Korea. Methods: We retrospectively analyzed the clinical, radiologic, laboratory and histologic features in 17 patients who were diagnosed as autoimmune pancreatitis. Results: The patients were predominately elderly men who presented with jaundice or nonspecific gastrointestinal symptoms. In most of the patients, serum pancreatic enzymes were normal or mildly elevated with an accompanying cholestatic biochemical profile. Elevated IgG levels and detection of autoantibodies were observed in 47% (8/17) and 35% (6/17), respectively. Thirteen patients showed histologic findings of lymphoplasmacytic infiltration and fibrosis, and one patient showed predominant infiltration of eosinophils. Fifteen patients revealed radiologic images of diffuse swelling of pancreas and the sclerosing pattern on direct pancreatogram. All of the features improved in response to oral steroid therapy. Two cases showed focal narrowing with upstream duct dilatation and thus, they were diagnosed as focal type. Diabetes mellitus concurred in 13 cases and primary sclerosing cholangitis and Sjogren's syndrome were present in 1 case, respectively. Conclusions: The recognition of autoimmune pancreatitis allows patients to avoid unnecessary surgery and recover with the administration of oral steroid. (Korean J Gastroenterol 2004;43:112-119)

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 요약
• 참고문헌

참고문헌 (Reference)

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