제3형 자가면역성 췌장염은 면역관문억제제 치료와 관련된 새로운 형태의 췌장염으로 CD8+ T세포 중심의 면역 반응이 병태생리의 핵심이다. 환자의 약 2/3는 무증상이지만 일부는 상복부 통증 등 전형적인 증상을 보이며 진단은 면역관문 억제제 치료력, 효소 상승, 영상 소견 및 다른 원인의 배제로 이루어진다. 치료는 증상과 중증도에 따라 보존적 치료부터 스테로이드까지 다양하나 스테로이드의 장기 효과는 불확실하다. 1년 이내 췌장 위축이 절반 이상에서 발생하며 내분비·외분비 기능 저하로 이어질 수 있다.

Autoimmune pancreatitis (AIP) has traditionally been classified into two subtypes: type 1, associated with immunoglobulin G4-related disease and type 2, characterized by idiopathic duct-centric pancreatitis. The emergence of immune checkpoint inhibitors (ICIs) in cancer treatment has introduced a new entity, type 3 AIP, representing ICI-induced pancreatic autoimmunity. This review examines the pathophysiology, clinical features, diagnosis, treatment, and outcomes of type 3 AIP. The condition affects 0.6-4% of patients receiving ICI therapy, with higher incidence in combination therapy compared to monotherapy. Pathophysiologically, activated CD8+ T-cells appear to be the primary mediators of pancreatic injury. Twothirds of patients are asymptomatic with only elevated pancreatic enzymes, while symptomatic cases typically present with epigastric pain radiating to the back. Diagnosis requires establishing temporal association with ICI therapy, elevated pancreatic enzymes, characteristic imaging findings, and exclusion of other etiologies. Management depends on disease severity, ranging from monitoring with continued ICI therapy in asymptomatic patients to temporary or permanent discontinuation in more severe cases. The efficacy of steroid therapy remains controversial, with limited evidence supporting its role in preventing long-term complications. Over 50% of patients develop pancreatic atrophy within 1 year, leading to potential endocrine and exocrine insufficiency requiring long-term pancreatic enzyme supplementation and diabetic management. As ICI use expands across oncology, greater awareness of type 3 AIP among clinicians and the development of evidence-based management protocols are essential to improve patient outcomes and quality of life.

서 론
본 론
    1. 병태생리
    2. 역학 및 위험인자
    3. 임상 양상
    4. 진단
    5. 치료
    6. 장기 예후
결 론
요 약
ORCID
REFERENCES

• 이윤찬(울산대학교 의과대학 서울아산병원 소화기내과) | Yoonchan Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea)
• 송태준(울산대학교 의과대학 서울아산병원 소화기내과) | Tae Jun Song (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea) Corresponding author
• 서동완(울산대학교 의과대학 서울아산병원 소화기내과) | Dong-Wan Seo (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea)