臨牀消化器内科 Vol.25 No.9(2)


特集名 自己免疫性膵炎
題名 臨床診断基準―海外との比較も含めて
発刊年月 2010年 08月
著者 岡崎 和一 関西医科大学内科学第三講座（消化器肝臓内科）
著者 楠田 武生 関西医科大学内科学第三講座（消化器肝臓内科）
著者 富山 尚 関西医科大学内科学第三講座（消化器肝臓内科）
著者 内田 一茂 関西医科大学内科学第三講座（消化器肝臓内科）
【 要旨 】 自己免疫性膵炎（AIP）の診断に関して，わが国と海外の診断基準を比較し，現状と問題点について述べた．わが国の「自己免疫性膵炎臨床診断基準2006」(厚生労働省難治性膵疾患調査研究班，日本膵臓学会)は，①高IgG4血症や病理学的にリンパ球とIgG4陽性形質細胞浸潤を特徴とするlymphoplasmacytic sclerosing pancreatitis（LPSP）を呈する，②膵臓病の専門家や消化器病の専門医だけでなく，一般医家をも対象にする，③本症ともっとも鑑別すべき膵癌や胆管癌などの悪性疾患をできるだけ排除する，④IgG4関連疾患の膵病変と考えられるが，各臓器病変の診断法が確立されていないことより，膵病変から診断する，⑤ステロイドの診断的治療は避ける，などのミニマムコンセンサスの立場である．海外(韓国，米国，イタリア)からは，ステロイドの効果や膵外病変を含む，より広範囲な立場をとる診断基準が提唱されており，とくに欧米ではLPSPに加え白血球病変による膵炎もAIPとしており，今後，国際的コンセンサスが必要である．
Theme Autoimmune Pancreatitis
Title Clinical Diagnostic Criteria for Autoimmune Pancreatitis
Author Kazuichi Okazaki Department of Gastroenterology and Hepatology, Kansai Medical University
Author Takeo Kusuda Department of Gastroenterology and Hepatology, Kansai Medical University
Author Takashi Tomiyama Department of Gastroenterology and Hepatology, Kansai Medical University
Author Kazushige Uchida Department of Gastroenterology and Hepatology, Kansai Medical University
[ Summary ] We compare the Japanese clinical diagnostic criteria used in 2006 with those in Korea and the United States and discuss current and possible future issues related to diagnosis of AIP. The basis of the Japanese criteria is practical usage to differentiate AIP from pancreatic or biliary malignancy, but not to differentiate it from systemic disorders. Therefore, that is the primary use for standard AIP but not for screening AIP. For pancreatic imaging, typical pancreatograms with CTs or MRIs are required according to the Japanese and Korean criteria, but not according to the Mayo criteria. ERCP is mandatory in the Japanese criteria, but MRCP is also available in the Korean and Mayo criteria. The presence of autoantibodies in addition to high serum IgG4 levels in blood tests are components of the criteria in Korea and Japan, but not the Mayo criteria. Irrespective of laboratory or radiological data, only LPSP is definitive for diagnosis of AIP according to the Mayo criteria, but not according to the Japanese or Korean criteria. The Mayo and Korean criteria define dense infiltration of IgG4 positive plasma cells observed in the pancreatic specimens as being useful for diagnosis when LPSP is not confirmed. Extra-pancreatic lesions are included in the Korean and Mayo criteria but not in the Japanese. Trials of steroidal treatment for the pancreas and/or extra-pancreatic lesions are a component of the Korean and Mayo criteria, but not the Japanese. However, pancreatic malignancy may accompany AIP. Although steroid trials may indicate increased diagnostic sensitivity for AIP, the efficacy of steroids should be carefully evaluated. Overly simple therapeutic diagnoses are not recommended in Japan at this time.
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