Pāniretī Autoimmune

Ko te pancreatitis autoimmune he mumura kei roto i te pancreas. I pea he mate nā te whakaeke a te pūnaha ārai mate i te pancreas. Ka kiia hoki te pancreatitis autoimmune ko te AIP. E rua ngā momo o te AIP e mohiotia ana inaianei, te momo 1 me te momo 2.

Ko te AIP momo 1 e kiia ana ko te mate e hono ana ki te IgG4 (IgG4-RD). I te nuinga o te wā ka pā tēnei momo ki ngā tūpuna maha, tae atu ki te pancreas, ngā ngongo bile kei roto i te ate, ngā whekau waha, ngā whatukuhu me ngā ngongo lymph.

Ka kitea te AIP momo 2 kei te pā noa ki te pancreas, ahakoa tata ki te toru o ngā tāngata he AIP momo 2 kei a rātou te mate pūngāwerewere o te kopu.

Ka taea te whakatau he kōrearea pancreatic te AIP momo 1. He rite ngā tohu o ngā āhuatanga e rua, engari he rerekē rawa ngā rongoā, no reira he mea tino nui kia wehewehea tetahi mai i tetahi.

Ko te pancreatitis autoimmune, e kiia ana hoki ko te AIP, he uaua te whakatau. I te nuinga o te wā, kāore e puta he tohu. Ko ngā tohu o te momo 1 AIP he rite ki ngā tohu o te mate pukupuku pancreatic. Ko ngā tohu o te mate pukupuku pancreatic ka uru ki: mimi pouri. Pupū ma, māwhero rānei e rere ana i roto i te wharepaku. Kiri me ngā kanohi kōwhai, e kiia nei ko te jaundice. Nga mamae i roto i tou puku o runga, i waenganui ranei o tou tuara. Ngakau ruaki. Whakawai ranei te ngenge rawa. Ngakau kai iti ranei te ngakau makona. Te ngaro o te taumaha kaore he take e mohiotia ana. Ko te tohu tino noa o te momo 1 AIP ko te jaundice kaore he mamae. E 80% te tokomaha o te hunga he momo 1 AIP kei a rātou te jaundice kaore he mamae. Na te aukati o ngā ngongo bile i puta mai ai tenei. Ko te hunga he momo 2 AIP ka taea te whakahoki ano i ngā wāhanga o te pancreatitis koi. Ko te mamae i te puku o runga, he tohu noa o te mate pukupuku pancreatic, i te nuinga o te wā kaore i roto i te pancreatitis autoimmune. Ko ngā rerekētanga i waenga i te momo 1 me te momo 2 AIP: I roto i te momo 1 AIP, ka pā pea te mate ki ētahi atu okana hei tāpiri ki te pancreas. Ko te momo 2 AIP e pā ana ki te pancreas anake. E hono ana hoki te mate momo 2 ki tētahi atu āhuatanga autoimmune e kiia nei ko te mate pūkahukahu mumura. Ko te momo 1 AIP e pā ana ki ngā tāne i te ono ki te whitu tekau o te ora. Ko te momo 2 AIP e pā ana ki ngā tāne me ngā wāhine, ā, he iti ake te tau o te tīmatanga i te momo 1 AIP. Ko te momo 1 AIP he tino tūpono ki te hoki mai i muri i te mutu o te maimoatanga. I te nuinga o te wā, kāore te pancreatitis autoimmune e puta he tohu. Engari, tirohia tētahi kaimahi hauora, ki te pēhea rānei te ngaro o te taumaha kaore i te whakamārama, te mamae o te puku, te jaundice, tetahi atu rānei tohu e whakararuraru ana i a koe.

Ko te mate pāngia autoimmune e kore e tino whakaatu i ngā tohu. Engari, tirohia tētahi kaimahi hauora, ki te pēhea rānei te ngaro o te taumaha kaore i te marama, te mamae o te kopu, te mate kōkino, tetahi atu rānei tohu e awangawanga ana koe.

Karekau ngā tohunga e te mohio ki te take o te pancreatitis autoimmune, engari e whakaarohia ana he mate nā te whakaeke a te pūnaha ārai mate o te tinana i ngā kiko hauora o te tinana. E mohiotia ana tenei ko te mate ārai mate.

E rua ngā momo o te AIP e puta ana ki te auau rerekē i ngā wāhanga rerekē o te ao. I te United States, tata ki te 80% o te hunga e pangia ana e te pancreatitis autoimmune, e kiia ana hoki ko te AIP, he momo 1.

Ko te hunga e pangia ana e te momo 1 AIP:

• He maha atu i te 60 tau te pakeke.
• He tane.

Ko te hunga e pangia ana e te momo 2 AIP:

• He maha tonu te tekau tau, rua rānei te iti i te hunga e pangia ana e te momo 1.
• He rite te tūponotanga kia wahine kia tane.
• He nui ake te tūponotanga kia pangia e te mate pūkahukahu mumura, pēnei i te mate ulcerative colitis.

Ka taea e te pancreatitis autoimmune te whakaeke i te maha o ngā raruraru.

• Te kore o te mahi a te pancreas exocrine. Ka pā pea te AIP ki te kaha o tō pancreas ki te hanga i ngā enzymes e tika ana. Ko ngā tohu pea ko te ruaki, te ngaro o te taumaha, te mate iwi i roto i te metabolism, me te kore o ngā huaora, me ngā kohuke.
• Te mate huka. Nō te mea ko te pancreas te kōpū e hanga ana i te insulin, ka pā pea te kino ki te pancreas ki te mate huka. Ka hiahia pea koe ki te rongoā mā te inu rongoā, mā te insulin rānei.
• Te whakaiti o te pancreas me te ngongo bile, e kiia nei ko te stricture.
• Ngā calcifications pūtau rānei o te pancreas.

Ka taea e ngā rongoā mō te pancreatitis autoimmune, pēnei i te whakamahinga roa o te steroid, te whakaeke i ngā raruraru. Heoi, ahakoa ēnei raruraru, he roa noa te oranga o te hunga e rongoātia ana mō te pancreatitis autoimmune.

Kāore he hononga kua whakatūria i waenganui i te AIP me te mate pukupuku pancreas.

Kaore he uauatanga

He uaua te whakatau i te pancreatitis autoimmune, na te mea he rite tonu ōna tohu ki te mate pukupuku pancreatic. Heoi, he tino nui te whakatau tika. Ka taea e te mate pukupuku kaore i te whakatau te whakaroa i te rongoā e tika ana, te kore ranei e whiwhi.

Ka nui ake te pancreas o te hunga e pangia ana e te AIP, engari ka taea hoki te pupū i roto i te pancreas. Hei tohu i te whakatau me te whakatau i te momo AIP, he mea tika nga whakamātautau toto me te whakaahua.

Kaore he whakamātautau kotahi, te āhuatanga ranei e taea ai te tautuhi i te pancreatitis autoimmune. Ko nga aratohu e taunakitia ana mo te whakatau i te whakamahi i te whakakotahitanga o te whakaahua, nga whakamātautau toto me nga hua biopsy.

Ka uru pea nga whakamātautau motuhake:

• Ngā whakamātautau whakaahua. Ko ngā whakamātautau o tō pancreas me ētahi atu whekau ka uru pea te CT, MRI, te ultrasound endoscopic (EUS) me te endoscopic retrograde cholangiopancreatography (ERCP).
• Ngā whakamātautau toto. Ka taea e koe te whakamātautau hei tirotiro i ngā taumata teitei o te immunoglobulin e kiia nei ko IgG4. Ko te IgG4 te mea e whakaputahia ana e tō pūnaha mate. Ko te hunga e pangia ana e te momo 1 AIP ka nui te IgG4 i roto i ō rātou toto. Ko te hunga e pangia ana e te momo 2 AIP kaore i te nuinga.

Heoi, kaore te whakamātautau pai e tino kī ana kei te pangia koe e te mate. He tokoiti te hunga kaore e pangia e te pancreatitis autoimmune, tae atu ki etahi e pangia ana e te mate pukupuku pancreatic, kei a rātou ano te taumata teitei o te IgG4 i roto i ō rātou toto.

• Biopsy core endoscopic. I roto i tēnei whakamātautau, ka akohia e tetahi kaimahi hauora e kiia nei ko te pathologist tētahi tauira o te kiko pancreatic i roto i te taiwhanga. Kei te AIP te ahua motuhake ka taea te kite ngāwari i raro i te microscope e tetahi pathologist tohunga. Ka whakauruhia he pūtau iti e kiia nei ko te endoscope i roto i te waha ki te kopu, e aratakihia ana e te ultrasound. Katahi ka tangohia he tauira o te kiko mai i te pancreas mā te whakamahi i te ngira motuhake.

Ko te wero ko te tiki i te tauira kiko nui hei ako, kaua ko etahi pūtau noa iho. Kaore tenei tukanga i te whānuitia, ā, kaore pea ngā hua e tino whakatau.

• Whakamātautau steroid. Ka whakautu te pancreatitis autoimmune ki ngā steroid; ka whakamahi etahi kaimahi hauora i tetahi kaupapa whakamātautau o tenei rongoā hei whakau i te whakatau. Heoi, me tupu tenei rautaki i raro i te aratohu tohunga. Me whakamahi iti noa iho, me mahi noa i te wā kei reira he mārama ka tautoko i te whakatau o te pancreatitis autoimmune. Ka inehia te whakautu ki ngā corticosteroids mā te CT me te whakapai ake i ngā taumata IgG4 serum.

Ngā whakamātautau toto. Ka taea e koe te whakamātautau hei tirotiro i ngā taumata teitei o te immunoglobulin e kiia nei ko IgG4. Ko te IgG4 te mea e whakaputahia ana e tō pūnaha mate. Ko te hunga e pangia ana e te momo 1 AIP ka nui te IgG4 i roto i ō rātou toto. Ko te hunga e pangia ana e te momo 2 AIP kaore i te nuinga.

Heoi, kaore te whakamātautau pai e tino kī ana kei te pangia koe e te mate. He tokoiti te hunga kaore e pangia e te pancreatitis autoimmune, tae atu ki etahi e pangia ana e te mate pukupuku pancreatic, kei a rātou ano te taumata teitei o te IgG4 i roto i ō rātou toto.

Biopsy core endoscopic. I roto i tēnei whakamātautau, ka akohia e tetahi kaimahi hauora e kiia nei ko te pathologist tētahi tauira o te kiko pancreatic i roto i te taiwhanga. Kei te AIP te ahua motuhake ka taea te kite ngāwari i raro i te microscope e tetahi pathologist tohunga. Ka whakauruhia he pūtau iti e kiia nei ko te endoscope i roto i te waha ki te kopu, e aratakihia ana e te ultrasound. Katahi ka tangohia he tauira o te kiko mai i te pancreas mā te whakamahi i te ngira motuhake.

Ko te wero ko te tiki i te tauira kiko nui hei ako, kaua ko etahi pūtau noa iho. Kaore tenei tukanga i te whānuitia, ā, kaore pea ngā hua e tino whakatau.

• Whakatārewatanga biliary. I mua i te tīmatanga o te rongoā, ka tāpiri pea ngā tākua rānau hauora ki tetahi pūtuki hei whakaheke i ngā kaukau biliary. Koinei te ingoa o te whakatārewatanga biliary, ā, ka mahia ki ngā tāngata e whai tohu ana i te mate kōtiti o te jaundice. Heoi, i te nuinga o te wā, ka pai ake te jaundice mā te whakamahinga anake o te rongoā steroid. I etahi wā, ka tūtohutia te whakaheketanga mena kaore i te tino mōhio te whakatau. Ka tangohia pea ngā tauira kiko me ngā pūtau mai i te kaukau bile i te wā e whakatārewatia ana te stent.
• Steroids. Ka pai ake ngā tohu o te mate huakōre autoimmune i muri i te whakamahinga poto o te prednisolone, te prednisone rānei. He tokomaha ngā tāngata e tere te whakautu, ā, he tino nui te whakautu. I etahi wā, ka ora ngā tāngata kaore he rongoā.
• Aroturuki i te whakauru o ētahi atu kōpū. Ko te momo 1 AIP i te nuinga o te wā e hono ana ki te whakauru o ētahi atu kōpū, tae atu ki ngā pūngāwerewere lymph nui me ngā whekau salivary, te whākāka o ngā kaukau bile, te mumura o te ate, me te mate whatukuhu. Ahakoa ka iti haere ēnei tohu, ka ngaro rānei katoa mā te rongoā steroid, ka whai tonu tō rōpū tiaki ki te aroturuki i a koe.

Kaore he uauatanga