儿童危重症死亡病例胰腺组织损伤临床病理分析

目的观察分析儿童危重症死亡病例胰腺组织损伤的临床病理学特征。方法回顾因危重症死亡且行尸体解剖病例的尸体解剖与临床资料。观察所有病例的胰腺组织学特征,并进行病理学分级评分。依据临床资料,分析胰腺损伤与脓毒症、休克、缺氧等因素的相关性。结果共收集儿童危重症死亡病例44例,27例(61.4%)观察到不同程度的胰腺组织损伤,其中25例(92.6%)观察到淋巴单核细胞浸润。依据临床资料,44例患儿中,24例脓毒症患儿,18例(75%)胰腺组织损伤,病理学评分为4.48±1.69;另20例非脓毒症患儿,9例(45%)胰腺组织损伤,病理学评分为3.07±1.24;两组患儿的胰腺损伤发生率及病理学评分差异均有统计学意义(P均<0.05)。44例患儿中,19例休克患儿,15例(78.9%)胰腺组织损伤;25例无休克患儿,12例(48%)胰腺组织损伤;两组患儿的胰腺组织损伤发生率差异有统计学意义(P<0.05)。44例患儿中12例缺氧患儿,7例(58.3%)胰腺组织损伤;另32例无缺氧患儿,20例(62.5%)胰腺组织损伤;两组患儿的胰腺损伤发生率比较差异无统计学意义(P>0.05)。结论儿童危重症死亡病例存在程度不同的胰腺组织损伤,炎症改变是胰腺组织损伤的主要病变;脓毒症、休克容易造成胰腺损伤,缺氧与胰腺损伤无明显相关。

Pathological characteristic of pancreatic tissue injury in pediatric death cases with critical illness

Objective To observe the pathological characteristic of pancreatic tissue injury in pediatric death cases with critical illness.Methods The clinical and anatomical data of pediatric death cases with critical illness were retrospectively reviewed.The histopathological features of pancreatic were evaluated and scored in all cases.The relationships of pancreatic tissue injury with sepsis,shock,anoxia were analyzed according to clinical records.Results A total of 44 pediatric death cases with critical illness were collected.Among them,27 cases(61.4%)were found pancreatic injury,mainly lymphocyte infiltration in 25 cases(92.6%).According to clinical records,18 cases(75.0%)had pancreatic tissue injury in 24 sepsis cases and their mean pathological score was 4.48 ± 1.69;9 cases(45.0%)had pancreatic tissue injury in 20 non-sepsis cases and their mean pathological score was 3.07 ± 1.24.Both the incidence of pancreatic injury and pathological scores between sepsis and non-sepsis cases were significantly difference(P all < 0.05).Fifteen cases(78.9%)had pancreatic tissue injury in 19 shock cases,and 12 cases(48%)had pancreatic tissue injury in 25 non-shock cases.The incidence of pancreatic tissue injury between shock and non-shock cases was significantly different(P < 0.05).Seven cases(58.3%)had pancreatic tissue injury in 12 anoxia cases,and 20 cases had pancreatic tissue injury in 32 non-anoxia cases.The incidence of pancreatic tissue injury between anoxia and non-anoxia cases was not significantly different(P > 0.05).Conclusions There were different-degree of pancreatic tissue injury in pediatric death cases with critical illness,which primary change was inflammatory.Sepsis and shock cause pancreatic tissue injury,and anoxia were not associated with pancreatic tissue injury.