血清淀粉酶及脂肪酶升高在重症儿童中的发生率及其与胰腺损伤的关系  

The Incidence of Serum Amylase and Lipase Elevation in Severe Children and Its Relationship with Pancreas Trauma

作　　者：林才[1] 张明真[1] 贺道机[1] 何海燕[1] 李前[1] 吕波[1] Lin Cai;Zhang Mingzhen;He Daoji(Zhaoqing First People's Hospital,Zhaoqing,Guangdong 526000,China)

机构地区：[1]肇庆市第一人民医院新生儿科,广东肇庆526000

出　　处：《四川医学》2019年第4期398-401,共4页Sichuan Medical Journal

基　　金：肇庆市科技局项目(小儿危重病继发胰腺损害的临床研究;编号:2016040305)

摘　　要：目的探讨血清淀粉酶(AMY)及脂肪酶(LPS)升高在重症儿童中的发生及其与胰腺损伤的关系。方法选取2016年5月至2017年12月在我院儿科重症监护病房(PICU)治疗的重症患儿168例,检测患儿血清AMY和LPS水平,根据AMY和LPS水平将患儿分为三组,A组111例(AMY和LPS正常),B组40例(AMY或LPS升高>1倍正常值,而<3倍正常值),C组17例(AMY或LPS升高≥3倍正常值),比较各组小儿危重病例评分(PCIS)、胰岛素内分泌指标、死亡率等。结果 AMY或LPS升高的总发生率为33. 93%; A组患儿年龄0. 94(0. 20,3. 20)岁,低于B组和C组,差异有统计学意义(P<0. 05); C组PCIS评分为(70. 46±5. 06)分,低于A组和B组,差异有统计学意义(P<0. 05); B组PCIS评分为(79. 16±4. 54)分,低于A组,差异有统计学意义(P<0. 05); C组胰岛素和C肽分别为(24. 06±5. 24) m U/L和(3. 32±0. 62) ng/m L,高于A组和B组,而HOMA-IR指数为(4. 21±20. 15),明显低于A组和B组(P<0. 05); B组胰岛素和C肽分别为(16. 11±4. 80) m U/L和(2. 60±0. 51) ng/m L,明显高于A组(P<0. 05),而HOMA-IR指数为(90. 42±32. 15),明显低于A组,差异有统计学意义(P<0. 05); C组和B组胰腺厚度增大率分别为60. 00%和76. 47%,明显高于A组,差异有统计学意义(P<0. 05); C组和B组患儿死亡率分别为29. 41%和22. 50%,明显高于A组,差异有统计学意义(P<0. 05)。结论有部分重症儿童可发生血清AMY或LPS升高,其与胰腺损伤以及患儿预后有一定关系,可作为重症儿童病情的预警指标。Objective To investigate the occurrence of serum amylase(AMY)and lipase(LPS)elevation and its relationship with pancreatic trauma in severe children.Methods We included 168 severe children treated in the pediatric intensive care unit(PICU)of our hospital from May 2016 to December 2017,and the serum AMY and LPS levels were measured.According to the levels of AMY and LPS,the children were divided into three groups:group A( n=111)with normal AMY and LPS,group B in which the level of AMY/LPS increased within 1-3 times of normal value(n=40),and group C with the elevation of AMY/LPS more than one times of normal value(n=17).The pediatric critical illness score(PCIS),insulin endocrine index,and mortality were compared in each group.Results The total incidence of elevated AMY or LPS was 33.93%.The age of group A was 0.94(0.20,3.20)years old,which was significantly lower than that of group B and group C(P<0.05).The PCIS score of group C was 70.46 ±5.06,which was significantly lower than that of group A and B(P<0.05).The PCIS score of group B was 79.16 ±4.54,lower than that of group A(P<0.05).In group C,insulin and C peptide were(24.06 ±5.24)mU/L and(3.32 ±0.62)ng/mL,which were higher than those in group A and group B.HOMA-IR index in group C was(4.21±20.15),which was significantly lower than that in group A and group B(P<0.05).The levels of insulin and C peptide in group B were(16.11±4.80)mU/L and(2.60 ±0.51)ng/mL,which were significantly higher than those in group A(P<0.05).While the HOMA-IR index was(90.42±32.15),which was significantly lower than that in group A(P<0.05).The increase rate of pancreatic thickness in group C and B were 60.00% and 76.47% respectively,which was significantly higher than that in group A.The mortality in group C and B were 29.41% and 22.50% respectively,which were significantly higher than that in A group(P<0.05).Conclusion AMY and LPS can be increased in some severe children,which may be related to pancreatic trauma and prognosis.They can be used as an early warning index for severe

关 键 词：血清 淀粉酶 脂肪酶 重症儿童 胰腺损伤 预后 

分 类 号：R725.7[医药卫生—儿科]