マウス肝炎ウイルスに対するマウスインターフェロンαとγ併用による抗ウイルス作用の相乗効果

取得学位 : 博士（医学）, 学位授与番号 : 医博乙第1595号, 学位授与年月日 : 平成16年9月1日, 学位授与大学 : 金沢大

Management of biliary stricture in patients with IgG4-related sclerosing cholangitis.

BACKGROUND:We aimed to determine the optimal approach with endoscopic biliary drainage (EBD) and corticosteroid (CS) for the treatment of IgG4-related sclerosing cholangitis (ISC). METHODS:To evaluate the safety of EBD for treatment of biliary stricture caused by ISC, we assessed the risk of stent dislodgement and sought to determine the most appropriate time for stent removal. We also assessed the safety of treatment with CS alone for patients with obstructive jaundice, and the rate of and risk factors for biliary tract complications. RESULTS:Sixty-nine patients with ISC treated with CS were enrolled. Twenty-eight patients (40.6%) were treated with EBD for biliary stricture before CS initiation. Intentional stent removal was performed in thirteen (46.4%) after confirming CS-induced improvement. Eleven of thirteen patients (84.6%) underwent stent removal within 1 month after CS initiation and all their stent removals were safely carried out without early (within two weeks) recurrence of obstructive jaundice. Ten of twenty-eight patients (35.7%) experienced spontaneous stent dislodgement after CS initiation, and seven (70%) of them developed stent dislodgement two weeks to two months after CS initiation. Among forty-one patients treated with CS alone without EBD, 10 patients had obstructive jaundice at the time of CS initiation and all of them achieved clinical improvement without biliary tract infection. During the follow-up, three patients (4.3%), all of whom had undergone EBD, developed bile-duct stones, while none of those treated with CS alone developed bile-duct stones (p = 0.032). Long-term biliary stenting was a risk factor for bile-duct stones. CONCLUSIONS:Biliary stent removal should be carried out within 2 weeks after CS initiation if biliary stricture improves to prevent stent dislodgement. Obstructive jaundice can be treated safely with CS alone in patients without infection. Clinicians should be aware of the possibility of bile-duct stones in patients treated with EBD

Prognosis of type 1 autoimmune pancreatitis after corticosteroid therapy-induced remission in terms of relapse and diabetes mellitus.

Relapse and diabetes mellitus (DM) are major problems for the prognosis of autoimmune pancreatitis (AIP). We examined the prognosis of type 1 AIP after corticosteroid therapy (CST)-induced remission in terms of relapse and DM.The study enrolled 82 patients diagnosed with type 1 AIP who achieved remission with CST. We retrospectively evaluated the relapse rate in terms of the administration period of CST, clinical factors associated with relapse, and the temporal change in glucose tolerance.During follow-up, 32 patients (39.0%) experienced relapse. There was no significant clinical factor that could predict relapse before beginning CST. AIP patients who ceased CST within 2 or 3 years experienced significantly earlier relapse than those who had the continuance of CST (p = 0.050 or p = 0.020). Of the 37 DM patients, 15 patients (40.5%) had pre-existing DM, 17 (45.9%) showed new-onset DM, and 5 (13.5%) developed CST-induced DM. Patients with new-onset DM were significantly more likely to show improvement (p = 0.008) than those with pre-existing DM.It was difficult to predict relapse of AIP based on clinical parameters before beginning CST. Relapse was likely to occur within 3 years after the beginning of CST and maintenance of CST for at least 3 years reduced the risk of relapse. The early initiation of CST for AIP with impaired glucose tolerance is desirable because pre-existing DM is refractory to CST

The period from initiation of corticosteroid therapy to relapse of AIP.

<p>Kaplan–Meier plots of the cumulative relapse rate of type 1 autoimmune pancreatitis grouped for various parameters. Patients who had an elevated serum IgG4 level of 550 mg/dL or more (<i>p</i> = 0.127) tended to experience early relapse. Serum IgG level of 1800 mg/dLor more (<i>p</i> = 0.724) and maintenance dose of 5 mg/day or more (<i>p</i> = 0.452) were not associated with early relapse. Grouped for administration period of CST, AIP patients who ceased CST within 2 or 3 years experienced significantly earlier relapse than those who had the continuance of CST (<i>p</i> = 0.050 or <i>p</i> = 0.020).</p

Clinical characteristics of the patients with or without relapse.

<p>Clinical characteristics of the patients with or without relapse.</p

The association between the presence of diabetes mellitus and the clinical characteristics of the type 1 autoimmune pancreatitis.

<p>The association between the presence of diabetes mellitus and the clinical characteristics of the type 1 autoimmune pancreatitis.</p