| 摘要: |
| 目的 探索自身免疫性胰腺炎（AIP）复发的危险因素，为其临床治疗提供新的参考。方法 收集2014－2021年海军军医大学第一附属医院收治的198例AIP患者的临床资料，其中1型AIP患者164例，2型AIP患者34例。根据AIP患者是否复发将其分为复发组（38例）与非复发组（160例），分析两组间的差异；进一步筛选有明确糖皮质激素维持治疗时间的患者，采用logistic回归模型及Spearman秩相关分析AIP复发的危险因素。结果 随访期间，19.19%（38/198）的AIP患者出现复发；1、3、5年的累积复发率分别为6.57%、9.09%、12.63%；1型AIP患者的复发率高于2型AIP患者［21.95%（36/164） vs 5.88%（2/34），P＝0.030］。在112例有明确糖皮质激素维持治疗时间的患者中，单因素logistic回归分析结果显示，血清低密度脂蛋白胆固醇水平（OR＝0.544，95% CI 0.321～0.924，P＝0.024）和糖皮质激素维持治疗时间（OR＝0.797，95% CI 0.704～0.902，P＜0.001）为AIP复发的潜在相关因素。进一步多因素logistic回归分析结果显示，糖皮质激素维持治疗时间与AIP复发独立关联（OR＝0.813，95% CI 0.713～0.926，P＝0.002）。Spearman秩相关分析显示，糖皮质激素维持治疗时间与AIP复发呈负相关（r＝－0.545，P＜0.001）。ROC曲线分析结果显示，糖皮质激素维持治疗时间对AIP复发有较好的预测价值，AUC值为0.873（95% CI 0.800～0.945，P＜0.001）。结论 长期维持规律的糖皮质激素治疗是AIP复发的独立保护因素，可显著减少AIP的复发。 |
| 关键词: 自身免疫性胰腺炎 复发 危险因素 保护因素 糖皮质激素类 |
| DOI：10.16781/j.CN31-2187/R.20240334 |
| 投稿时间：2024-05-16修订日期：2024-10-30 |
| 基金项目:国家自然科学基金（82370655）. |
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| Risk factors for recurrence of autoimmune pancreatitis |
| JIANG Mengruo,SUN Liqi,PENG Lisi,JIN Zhendong,LI Zhaoshen*,HUANG Haojie* |
(Department of Gastroenterology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To explore the risk factors for the recurrence of autoimmune pancreatitis (AIP), so as to provide a new reference for its clinical treatment. Methods The clinical data of 198 AIP patients admitted to The First Affiliated Hospital of Naval Medical University from 2014 to 2021 were collected, including 164 patients with type 1 AIP and 34 patients with type 2 AIP. Based on the recurrence status of AIP, the patients were categorized into recurrence group (38 cases) and non-recurrence group (160 cases), and differences between the 2 groups were analyzed. Patients with definite duration of glucocorticoid maintenance therapy were further screened, and logistic regression model and Spearman rank correlation analysis were used to analyze the risk factors of AIP recurrence. Results During the follow-up period, 19.19% (38/198) of AIP patients experienced a relapse. The 1-, 3-, and 5-year cumulative recurrence rates were 6.57%, 9.09%, and 12.63%, respectively, with type 1 AIP demonstrating a significantly higher recurrence rate than type 2 AIP (21.95% ［36/164］ vs 5.88% ［2/34］, P＝0.030). Univariate logistic regression analysis showed that serum low density lipoprotein-cholesterol level (odds ratio ［OR］ ＝0.544, 95% confidence interval ［CL］ 0.321-0.924, P＝0.024) and the duration of glucocorticoid maintenance therapy (OR＝0.797, 95% CI 0.704-0.902, P＜0.001) were the potential factors of AIP recurrence in 112 patients with definite data on the duration of glucocorticoid maintenance therapy. Multivariate logistic regression analysis showed that the duration of glucocorticoid maintenance therapy was independently associated with AIP recurrence (OR＝0.813, 95% CI 0.713-0.926, P＝0.002). Spearman rank correlation analysis further demonstrated a negative correlation between the duration of glucocorticoid maintenance therapy and AIP recurrence (r＝－0.545, P＜0.001). Additionally, receiver operating characteristic curve analysis indicated that the duration of glucocorticoid maintenance therapy had good predictive effect on AIP recurrence, with an area under curve value of 0.873 (95% CI 0.800-0.945, P＜0.001). Conclusion Long-term regular glucocorticoid therapy is an independent protective factor against AIP recurrence, and it can significantly reduce the recurrence of AIP. |
| Key words: autoimmune pancreatitis recurrence risk factors protective factors glucocorticoids |
