儿童血液系统疾病并发药物性胰腺炎的临床特征  

Clinical Characteristics of Drug-Induced Pancreatitis in Children with Hematological Diseases

作　　者：周密 林彩琴 黎海欣 陈静静 翟宗 王易[1] 胡绍燕[1] 朱增燕[1] Zhou Mi;Lin Caiqin;Li Haixin;Chen Jingjing;Zhai Zong;Wang Yi;Hu Shaoyan;Zhu Zengyan(Children’s Hospital of Soochow University,Jiangsu Suzhou 215000,China;The First People’s Hospital of Hechi,Guangxi Hechi 546300,China;Wuzhou Red Cross Hospital,Guangxi Wuzhou 543002,China;Gaoxin Hospital,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]苏州大学附属儿童医院,江苏苏州215000 [2]河池市第一人民医院,广西河池546300 [3]梧州市红十字会医院,广西梧州543002 [4]安徽医科大学第一附属医院高新院区,合肥230000

出　　处：《儿科药学杂志》2023年第6期5-9,共5页Journal of Pediatric Pharmacy

基　　金：苏州市科技局项目,编号SYSD2018240;国家血液系统疾病临床研究中心项目,编号2020WSB05。

摘　　要：目的:分析血液系统疾病患儿发生药物性胰腺炎的特点,探讨药物性胰腺炎的触发工具。方法:以血清淀粉酶、脂肪酶或尿淀粉酶中任一指标超过3倍正常上限(ULN)为筛选条件,从医院信息系统(HIS)调取2018年1月至2021年6月苏州大学附属儿童医院血液科收治的病例。根据急性胰腺炎诊断标准、国家药品不良反应监测中心制定的评价标准和诺氏药物不良反应评估量表评价病例。经4名药师和1名副主任医师共同判定药物性胰腺炎病例,分析其临床特征。结果:共筛查出实验室指标阳性信息1522条,相关患者335例次。最终判定药物性胰腺炎50例,其中44例怀疑药物为培门冬酶,其他怀疑药物包括替加环素、阿糖胞苷等;2例各发生2次药物性胰腺炎,怀疑药物均为培门冬酶;主要症状为腹痛、呕吐、发热,4例(8.0%)发病时无典型症状;血脂肪酶401.5(194.4,884.6)U/L,血淀粉酶245.8(166.8,507.8)U/L,尿淀粉酶778.0(383.4,2048.0)U/L;12例(24.0%)伴有感染;考虑药物性胰腺炎后均停用怀疑药物,18例(36.0%)给予吸氧,7例(14.0%)给予血液净化,治疗后均好转,好转时间8.0(4.0,12.5)d。结论:血液系统疾病患儿的药物性胰腺炎,怀疑药物主要为培门冬酶,同时还需考虑其他药物的可能性;淀粉酶、脂肪酶、影像学可作为主动监测的触发工具加以应用并进一步验证。Objective:To analyze the characteristics of drug-induced pancreatitis in children with hematological diseases and to explore the trigger tool of drug-induced pancreatitis.Methods:Based on the screening condition that any abnormal value of serum amylase,lipase or urinary amylase exceeds the upper limit of the normal(ULN)value by 3 times or more,a retrospective analysis was conducted among cases from the hospital information system(HIS)who treated in the department of hematology&oncology in Children’s Hospital of Soochow University from Jan.2018 to Jun.2021.The cases were evaluated according to the diagnostic criteria of acute pancreatitis,the evaluation criteria formulated by the National Adverse Drug Reaction Monitoring Center and the Nordisk adverse drug reaction evaluation scale.All cases of drug-induced pancreatitis were determined and analyzed by four pharmacists and one vice-chief physician,and the clinical characteristics were analyzed.Results:A total of 1,522 positive laboratory indicators and 335 episodes were screened.Finally,50 cases were determined as drug-induced pancreatitis.The related drugs in 44 cases were pegaspargase,and other related drugs included tegacyclin,cytarabine,etc.Two patients had twice drug-induced pancreatitis,and the related drugs were both pegaspargase.Among all patients,4 cases(8.0%)had no clinical signs at the time of onset,and abdominal pain,vomiting and fever were the main positive signs.The average value of blood lipid lipase was 401.5(194.4,884.6)U/L,the average value of blood amylase was 245.8(166.8,507.8)U/L,and the average value of urinary amylase was 778.0(383.4,2,048.0)U/L.Among the patients,12 cases(24.0%)were infected,18 cases(36.0%)were given oxygen therapy,and 7 cases(14.0%)were given blood purification support.All the 50 patients stopped using the related drugs after considering the drug-related pancreatitis,and all improved after treatment,with an average improvement time of 8.0(4.0,12.5)d.Conclusion:For drug-induced pancreatitis in patients with hematological d

关 键 词：药物性胰腺炎 尿淀粉酶 副主任医师 血液系统疾病 评估量表 正常上限 替加环素 血液科 

分 类 号：R725.5[医药卫生—儿科]