儿童急性胰腺炎临床特征与预后分析

Clinical characteristics and prognosis of acute pancreatitis in children

摘要:

目的 探讨儿童急性胰腺炎（acute pancreatitis, AP）的临床特征，提高对该病的认识。方法 回顾性选取2020年1月—2022年6月于郑州大学第一附属医院住院治疗的AP患儿为研究对象，统计其临床特征并归纳分析。结果 共纳入92例AP患儿，男女比例1∶1；平均发病年龄为（9±4）岁，青春期（34%，31/92）和学龄前期（33%，30/92）儿童多见，婴幼儿少见（7%，6/92）。病因从多至少依次是药物性（40%，37/92）、胆源性（18%，17/92）、饮食性（14%，13/92）、特发性（13%，12/92）、外伤（9%，8/92）和感染性（5%，5/92）。轻、中度重症和重度依次占68%（63/92）、21%（19/92）和11%（10/92）。62例（67%）完成腹部B超，阳性率为66%（41/62）；67例（73%）完成腹部CT，阳性率为90%（60/67）；20例（22%）完成磁共振胆胰管成像，阳性率为95%（19/20）。不同严重程度患儿的D-二聚体、降钙素原和淀粉酶水平差异有统计学意义（P<0.05）；不同病因患儿的白细胞计数、红细胞压积、尿素氮、白蛋白和血钙水平差异有统计学意义（P<0.05）。89例（97%）患儿预后较好。结论 儿童AP首要病因是药物性，以轻度为主。腹部CT在儿童AP诊断中的检查率和阳性率均较高，磁共振胆胰管成像的特异性最强；实验室检查指标有助于AP严重程度和病因判断。儿童AP预后较好。

Abstract:

Objective To study the clinical characteristics of acute pancreatitis (AP) in children.Methods A retrospective analysis was conducted on the children with AP who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022, and their clinical characteristics were summarized and analyzed.Results A total of 92 children with AP were included, with a male/female ratio of 1:1 and a mean age of (9±4) years. Adolescents (34%, 31/92) and pre-school children (33%, 30/92) were more commonly affected, while infants and toddlers (7%, 6/92) were less commonly affected. The etiology of the disease from most to least was as follows: drug-induced (40%, 37/92), biliary (18%, 17/92), dietary (14%, 13/92), idiopathic (13%, 12/92), trauma-related (9%, 8/92), and infectious (5%, 5/92). Mild, moderate, and severe AP accounted for 68% (63/92), 21% (19/92), and 11% (10/92), respectively. Among all 92 children, 62 (67%) received abdominal ultrasound, with a positive rate of 66% (41/62); 67 (73%) underwent abdominal CT, with a positive rate of 90% (60/67); 20 (22%) underwent magnetic resonance cholangiopancreatography (MRCP), with a positive rate of 95% (19/20). There were significant differences in the levels of D-dimer, procalcitonin, and amylase among children with different degrees of severity of the condition (P<0.05), and there were significant differences in the levels of leukocyte count, hematocrit, blood urea nitrogen, albumin, and blood calcium among children with different etiologies (P<0.05). Of all 92 children, 89 (97%) had a good prognosis.Conclusions The primary cause of pediatric AP is medication-induced, with a predominantce of mild cases. Abdominal CT has a high rate of utilization and positivity in the diagnosis of pediatric AP, while MRCP has the highest specificity among imaging techniques. Laboratory tests aid in determining the severity and etiology of AP. The prognosis of AP is favorable in children.