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目的总结Ig G4相关性胆管炎(IAC)的临床特点及诊治体会。方法收集2010—2015年郑州大学第五附属医院收治的23例患者临床资料,根据患者临床表现、实验室检查、免疫血清学检查、影像学、病理学及糖皮质激素治疗情况等各项指标进行回顾性分析。结果 23例IAC患者主要临床表现为黄疸(78.26%)、上腹部不适或疼痛(69.57%),可有乏力、纳差、体质量减轻、皮肤瘙痒伴随症状。实验室检查以总胆红素及碱性磷酸酶轻中度升高为主;免疫血清学以Ig G4水平升高为主要特征;经内镜逆行性胰胆管造影术(ERCP)及磁共振成像胆胰管造影(MRCP)检查以胆管下段狭窄多见;正规糖皮质激素治疗有效率为69.57%。结论 IAC缺乏特异性的临床表现,早期诊断困难误诊率高。应综合分析临床表现、血清学检查、影像学及病理学等检查结果明确诊断,减少不必要的手术治疗。
Objective To summarize the clinical features, diagnosis and treatment of IgA related cholangitis (IAC). Methods The clinical data of 23 patients admitted from the Fifth Affiliated Hospital of Zhengzhou University from 2010 to 2015 were collected and analyzed according to the clinical manifestations, laboratory tests, immunological serological tests, imaging, pathology and glucocorticoid therapy Retrospective analysis. Results The main clinical manifestations of 23 patients with IAC were jaundice (78.26%), upper abdominal discomfort or pain (69.57%), fatigue, anorexia, weight loss and pruritus accompanied by symptoms. Laboratory tests were mainly mild to moderate increase of total bilirubin and alkaline phosphatase. Immuno-serology was mainly characterized by elevated Ig G4 level. ERCP and MR imaging Cholecystectomy (MRCP) examination of common bile duct stenosis more common; regular glucocorticoid treatment efficiency was 69.57%. Conclusion IAC lack of specific clinical manifestations, early diagnosis of high misdiagnosis. Should be a comprehensive analysis of clinical manifestations, serological tests, imaging and pathology and other test results clear diagnosis and reduce unnecessary surgical treatment.