成人门冬酶相关胰腺炎的临床诊治  

Clinical diagnosis and treatment of asparaginase associated pancreatitis in adults

作　　者：李梦洁[1] 何牧卿[2] 沈益民[1] 

机构地区：[1]浙江医院血液内科,杭州325027 [2]温州医科大学附属第二医院血液科

出　　处：《中华胰腺病杂志》2015年第6期385-388,共4页Chinese Journal of Pancreatology

摘　　要：目的探讨成人门冬酶相关胰腺炎（AAP）的临床特点及诊治过程，旨在提高AAP诊治水平。方法回顾性分析2009年1月至2015年6月间浙江医院血液内科及温州医科大学附属第二医院血液科收治的384例急性淋巴细胞白血病（ALL）患者的临床资料，所有患者均给予含培门冬酶或左旋门冬酰胺酶（L-asp）的多药联合化疗，分析AAP的发生情况、临床表现、诊断、治疗及转归。结果384例ALL患者中18例发生AAP，发生率为4．7％，其中轻症AAP（MAAP）13例，重症AAP（SAAP）5例。16例AAP发生在诱导化疗期，2例发生在维持强化期。腹痛为主要临床表现，血淀粉酶及脂肪酶活性均升高。治疗后，MAAP患者的腹痛症状缓解，血淀粉酶及脂肪酶活性明显下降，继续使用培门冬酶或L-asp化疗，未见胰腺炎复发。5例SAAP患者血淀粉酶及脂肪酶反复升高，其中1例因合并重症感染及囊肿破裂出血而病死。结论成人ALL患者在门冬酶化疗期间出现腹痛症状应考虑AAP可能，加强血淀粉酶及脂肪酶检测，辅以B超和CT检查有助于早期诊治AAP，并改善患者预后。Objective To investigate the clinical characteristics and the course of diagnosis and therapy of asparaginase associated pancreatitis （AAP） in adults, in order to improve the ability of diagnosis and treatment. Methods Data of 384 cases of acute lymphoblastic leukemia （ALL） who received treatment in Department of Hematology, Zhejiang Hospital, and Department of Hematology, Second Hospital Mfiliated to Wenzhou Medical University from January 2009 to June 2015 was retrospectively analyzed. All patients were given muhi-drug chemotherapy including PEG-asparaginase or L-asparaginase, the incidence of AAP, clinical manifestations, diagnosis, treatment and prognosis were analyzed. Results Among the 384 cases, 18 patients developed AAP, and the incidence of AAP was 4.7%, including 13 cases of mild AAP （MAAP）, 5 cases of severe AAP （SAAP）. Sixteen cases of AAP occurred during the induction-remission treatment phase, 2 cases during the maintenance-intensification phase. The major manifestations of AAP were abdominal pain, and increased serum amylase and lipase. After treatment, abdominal pain of MAAP patients alleviated, serum amylase and lipase obviously decreased, and re-use of PEG-Asparaginase or L-Asparaginase was not associated with the recurrence of AP. Levels of serum amylase and lipase in 5 cases of SAAP repeatedly increased, 1 case died of severe infection, cyst rupture and hemorrhage. Conclusions Adults patients with ALL present with abdominal pain during chemotherapy of aspargase should consider the possibility of AAP, the measurement of serum amylase and serum lipase should be strengthened, in addition, ultrasound and CT scanning may be helpful for early diagnosis and treatment of AAP, and improve the prognosis.

关 键 词：胰腺炎 门冬酶 白血病 淋巴样 药物毒性 

分 类 号：R576[医药卫生—消化系统]