105例小儿急性胰腺炎临床及预后特点分析

目的分析小儿急性胰腺炎(AP)的病因及临床特点。方法选取2013年1月-2018年12月西南医科大学附属医院收治的105例小儿AP患者为研究对象。根据严重程度分为轻型急性胰腺炎(MAP)(n=77),中度重型急性胰腺炎(MSAP)(n=25),重型急性胰腺炎(SAP)(n=3),对比分析MAP组与MSAP组间低年龄组(2~9岁)(n=36)与高年龄组(10~17岁)(n=69)及复发组(n=17)与非复发(n=88)的临床特征。从数据库随机抽取成人初发AP105例作为对照组,对比各组患者的基本资料、病因、实验室指标、病情严重程度、并发症、治疗结局。符合正态分布的计量资料2组间比较采用t检验,方差不齐时采用校正t检验;非正态分布数据及等级资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ^2检验,单向有序分类采用趋势χ^2检验,双向有序分类变量采用Goodman-KruskalGamma分析;对于累计风险的比较采用Kaplan-Meier法及log-rank检验。结果105例AP患儿中,主要病因包括特发性31例(29.5%)、胆源性27例(25.7%)、外伤20例(19.0%)、高脂性11例(10.5%)、病毒感染10例(9.5%)、药物6例(5.7%),其病因构成比与成人组存在明显差异(χ^2=99.282,P<0.001)。小儿组与成人组比较,其严重程度较成人组轻(Z=-2.325,P=0.020);小儿组胰腺坏死比成人组低(3.8%vs12.4%,χ^2=5.184,P=0.023)。小儿MAP组入院24h的CRP(Z=-6.406)、血脂肪酶(Z=-3.096)、WBC(Z=-2.762)、血糖(t=3.298)比MSAP组低(P值均<0.05);血钙高于MSAP组(t=3.43,P=0.001)。随访期间共有17例(16.2%)患儿再次发生AP,随着病情严重程度的增加,复发率增加(χ^2=6.503,P=0.011),急性复发性胰腺炎(ARP)以女性(82.4%)多见(χ^2=12.241,P<0.001),初次AP合并胰腺坏死复发率更高(χ^2=6.572,P=0.01),高脂血症是小儿ARP最常见的病因(χ^2=5.533,P=0.019),随着时间推移复发风险最高,病毒性和药物性的复发风险最低(P=0.028)。结论小儿AP病因以特发性与胆源性为主,病情相对成人较轻,预后较好。女性、初次AP合并胰腺坏死、高脂血症是ARP高危因素。

Clinical and prognostic features of children with acute pancreatitis:A retrospective analysis of 105 cases

Objective To investigate the etiology and clinical features of acute pancreatitis (AP) in children.Methods A total of 105 children with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to December 2018 were enrolled,and according to the severity of AP,they were divided into mild acute pancreatitis (MAP) group with 77 children,moderate-severe acute pancreatitis (MSAP) group with 25 children,and severe acute pancreatitis (SAP) group with 3 children,and a comparative analysis was performed for the MAP group and the MSAP group.According to age,the children were divided into young age group with 36 children aged 2-9 years and old age group with 69 children aged 10-17 years,and according to the presence or absence of recurrence,they were divided into recurrence group with 17 children and non-recurrence group with 88 children;a comparative analysis was also performed.A total of 105 adults with incipient AP were randomly selected from databases and were enrolled as control group,and the groups were compared in terms of general data,etiology,laboratory markers,disease severity,complications,and treatment outcome.The t -test was used for comparison of normally distributed continuous data between groups,and the corrected t -test was used in case of heterogeneity of variance;the Mann-Whitney U test was used for comparison of non-normally distributed data and ranked data between groups;the chi-square test was used for comparison of categorical data between groups;the trend chi-square test was used for unidirectional ordered categorical variables,and a Goodman-Kruskal Gamma analysis was used for bidirectional ordered categorical variables;the Kaplan-Meier method and the log-rank test were used for the comparison of cumulative risk.Results As for etiology,among the 105 children with AP,31 (29.5%) had idiopathic AP,27(25.7%) had biliary AP,20 (19.0%) had trauma,11(10.5%) had hyperlipidemic AP,10(9.5%) had viral infection,and 6(5.7%) had drug-induced AP,and there was a significant difference in the constituent ratio of etiology between the pediatric patients and the adult patients (χ^2=99.282,P <0.001).Compared with the adult patients,the pediatric patients had significantly lower severity ( Z=-2.325,P <0.02) and proportion of individuals with pancreatic necrosis (3.8% vs 12.4%,χ^2=5.184,P <0.023).Compared with the MSAP group at 24 hours after admission,the MAP group had significantly lower C-reactive protein,blood lipase,white blood cell count,and blood glucose ( Z =-6.406,-3.096,and -2.762,t =3.298,all P <0.05) and a significantly higher blood calcium level ( t =3.43,P =0.001).During follow-up,17 children (16.2%) developed AP again,and the recurrence rate increased with an increase in disease severity (χ^2=6.503,P =0.011).Recurrent AP was often observed in girls (82.4%)(χ^2=12.241,P<0.001 ),and the children with first-onset AP and pancreatic necrosis had a higher recurrence rate (χ^2=6.572,P=0.01 ).Hyperlipidemia was the most common cause of acute recurrent pancreatitis (ARP) in children (χ^2=5.533,P=0.019 ),and hyperlipidemic AP had the highest risk of recurrence over time,while viral and drug-induced AP had the lowest risk of recurrence ( P =0.028).Conclusion Idiopathic and biliary AP are the main causes of AP in children,and compared with adults,children tend to have milder disease conditions and a better prognosis.Female sex and first-onset AP with pancreatic necrosis and hyperlipidemia are high-risk factors for ARP.