The effect of steroid therapy on pancreatic exocrine function in autoimmune pancreatitis

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2024-06-01 DOI:10.1016/j.pan.2024.04.006

Nicolò de Pretis , Luigi Martinelli , Enrico Palmeri , Federico Caldart , Salvatore Crucillà , Alberto Zorzi , Alessandro Brillo , Stefano Francesco Crinò , Maria Cristina Conti Bellocchi , Laura Bernardoni , Giulia De Marchi , Antonio Amodio , Pietro Campagnola , Rachele Ciccocioppo , Armando Gabbrielli , Alessandro Marcon , Luca Frulloni

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引用次数: 0

Abstract

Background/objectives

Autoimmune pancreatitis (AIP) is a steroid-responsive inflammatory disease of the pancreas. Few studies investigated pancreatic exocrine function (PEF) in patients suffering from AIP and no definitive data are available on the effect of steroids in PEF recovery. Aim of the study is the evaluation of severe pancreatic insufficiency (sPEI) prevalence in AIP at clinical onset and after steroid treatment.

Methods

312 Patients with diagnosis of AIP between January 1st^, 2010 and December 31st^, 2020 were identified in our prospectively maintained register. Patients with a pre-steroid treatment dosage of fecal elastase-1 (FE-1) were included. Changes in PEF were evaluated in patients with available pre- and post-treatment FE (between 3 and 12 months after steroid).

Results

One-hundred-twenty-four patients were included, with a median FE-1 of 122 (Q1-Q3: 15–379) μg/g at baseline. Fifty-nine (47.6 %) had sPEI (FE-1<100 μg/g). Univariable analysis identified type 1 AIP, radiological involvement of the head of the pancreas (diffuse involvement of the pancreas or focal involvement of the head), weight loss, age and diabetes as associated with a greater risk of sPEI. However, at multivariable analysis, only the involvement of the head of the pancreas was identified as independent risk factor for sPEI. After steroids, mean FE-1 changed from 64 (15–340) to 202 (40–387) μg/g (P = 0.058) and head involvement was the only predictor of improvement of sPEI.

Conclusion

The inflammatory involvement of the head of the pancreas is associated with PEF severity, as well as PEF improvement after treatment with steroids in patients with AIP.

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类固醇疗法对自身免疫性胰腺炎患者胰腺外分泌功能的影响

背景/目的自身免疫性胰腺炎（AIP）是一种类固醇反应性胰腺炎症性疾病。很少有研究调查 AIP 患者的胰腺外分泌功能（PEF），也没有关于类固醇对 PEF 恢复效果的确切数据。本研究的目的是评估 AIP 患者在临床发病时和类固醇治疗后的重症胰腺功能不全（sPEI）发生率。在类固醇治疗前粪便弹性蛋白酶-1（FE-1）含量达标的患者也被纳入其中。结果共纳入 124 名患者，基线 FE-1 中位数为 122（Q1-Q3：15-379）微克/克。59人（47.6%）患有 sPEI（FE-1<100 μg/g）。单变量分析发现，1 型 AIP、胰头放射学受累（胰腺弥漫性受累或胰头局灶性受累）、体重减轻、年龄和糖尿病与发生 sPEI 的更大风险相关。然而，在多变量分析中，只有胰腺头部受累被确定为 sPEI 的独立风险因素。类固醇治疗后，平均 FE-1 从 64（15-340）微克/克变为 202（40-387）微克/克（P = 0.058），而胰头受累是预测 sPEI 改善的唯一因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.