内镜逆行胰胆管造影术下胆管引流治疗自身免疫性胰腺炎合并梗阻性黄疸的疗效及预后研究

Efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography in autoimmune pancreatitis with obstructive jaundice

摘要:

目的 探讨类固醇激素治疗前行内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）下胆管引流治疗自身免疫性胰腺炎（autoimmune pancreatitis， AIP）合并梗阻性黄疸的疗效及预后。方法 回顾性分析2010年至2023年在海军军医大学第一附属医院因AIP合并梗阻性黄疸接受类固醇激素治疗患者的临床资料，根据患者在激素治疗前是否行ERCP下胆管引流分为引流组与激素组，比较两组患者短期疗效、远期疗效、住院费用，并统计ERCP下胆管引流术后并发症发生情况。结果 本研究共纳入69例患者，引流组32例，年龄（62.78±11.21）岁，住院时间为（10.38±4.56）d，住院费用为（34 816.57±11 688.85）元；激素组37例，年龄（55.41±2.15）岁，住院时间为（8.95±4.99）d，住院费用为（16 518.50±6 544.37）元。两组患者住院时间差异无统计学意义（t=1.2，P=0.219），引流组住院费用显著高于激素组（t=7.0，P<0.001）。引流组ERCP后并发症发生率为25.00% （8/32）。引流组治疗后1个月总胆红素［118.5（76.2，309.3） μmol/L比48.7（30.5，148.4） μmol/L，U=1 728.5，P<0.001］、直接胆红素水平［84.5（47.7，236.3） μmol/L比37.7（18.3，105.7） μmol/L，U=1 588.5，P=0.001］高于激素组，丙氨酸氨基转移酶水平低于激素组［74.0（46.5，110.5）U/L比143.0（51.0，253.5）U/L，U=769.0，P=0.006］。治疗后4个月及12个月随访两组患者的总胆红素、直接胆红素、丙氨酸氨基转移酶水平差异无统计学意义（P>0.05）。引流组患者中28.1%（9/32）复发，激素组患者中21.6%（8/37）复发，两组复发率差异无统计学意义（χ2=0.4，P=0.266）。结论 ERCP下胆管引流治疗AIP合并梗阻性黄疸的远期疗效及复发率并无明显增益，反而增加患者发生术后并发症的风险及医疗费用，确诊AIP合并梗阻性黄疸患者单纯使用激素治疗是安全可行的。【关键词】自身免疫性胰腺炎；内镜逆行胰胆管造影术；梗阻性黄疸；预后。

Abstract:

Objective To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice. Methods A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups. Results A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups (P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups (χ²=0.4, P=0.266). Conclusion ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.