儿童门冬酰胺酶相关性胰腺炎的临床影像特点分析  

Clinical and imaging characteristics analysis of childhood asparaginase-associated pancreatitis

作　　者：陈睿媛 叶文宏[1] 高芷欣 魏珂 曹卫国[1] CHENRui-yuan;YE Wen-hong;GAO Zhi-xin(Department of Radiology,Shenzhen Children's Hospital,Guangdong 518038,China)

机构地区：[1]深圳市儿童医院放射科,广东深圳518038 [2]中国医科大学,辽宁沈阳110122 [3]广东省中医院影像科,广东广州510120

出　　处：《放射学实践》2024年第8期1093-1098,共6页Radiologic Practice

基　　金：深圳市科技计划项目(JCY20220530155607018);深圳市医疗卫生三名工程项目(SZSM 202011005)。

摘　　要：目的:探讨急性淋巴细胞性白血病(ALL)患儿继发门冬酰胺酶(Asp)相关性胰腺炎(AAP)的临床特征、影像学表现及预后。方法:回顾性分析2014年10月-2022年1月在本院初诊为急性淋巴细胞性白血病(ALL)并接受Asp联合化疗后出现急性胰腺炎的14例患儿的临床和影像资料,主要包括ALL患儿的联合化疗方案、危险度分层、主要临床表现、发生胰腺炎时所处治疗阶段、药物累积用量、实验室指标(血常规、胰酶指标、肝肾功能、血脂血糖、凝血功能等化验结果)、影像学表现(胰腺是否坏死及坏死程度、出血、积液范围等影像特征)、转归及预后等。结果:14例中,男12例、女2例,中位年龄6.5岁(1~14岁);Asp用药1~8次(中位数为5次)后发病;中度AAP 9例,重度5例。14例行腹部超声检查,均可见声像异常,主要表现为胰腺增大,包膜回声欠光滑,实质回声增强且欠均匀,坏死部分表现为液性暗区,伴有胰周和腹、盆腔积液12例。13例行腹部CT检查,1例行MRI检查,主要影像特点为胰腺肿大、胰腺边缘毛糙和胰周液体积聚,其中11例胰腺实质内出现坏死灶;伴有腹腔积液11例,盆腔积液7例。禁食及药物治疗4周后随访结果为1例间质水肿性AAP发展为胰腺假性囊肿,8例出血坏死性AAP发展为包裹性坏死。2例AAP患儿分别于治疗后21及107天后再次使用Asp进行化疗,分别随访18、20个月,均未再发胰腺炎。结论:AAP是Asp药物治疗相关的严重并发症,随访显示AAP可完全吸收或形成胰腺假性囊肿或包裹性坏死,有必要及早通过临床影像特征确诊AAP,以便提早干预,从而改善预后。Objective:To summarize the clinical features,imaging findings,and prognosis of se-condary asparaginase-associated pancreatitis(AAP)in children with asparaginase(Asp)-related acute lymphoblastic leukemia(ALL).Methods:A retrospective analysis was conducted on the clinical and imaging data of 14 children with ALL initially diagnosed at the Shenzhen Children's Hospital between October 2014 and January 2022,who subsequently developed acute pancreatitis as a result of Asp-based combination chemotherapy.The data included the combination chemotherapy regimen,risk stra-tification,main clinical manifestations,treatment stage at which pancreatitis occurred,and cumulative drug dosage in ALL patients,laboratory indicators(blood routine,pancreatic enzyme indicators,liver and kidney function,blood lipids,blood glucose,coagulation function,etc.),imaging examinations and manifestations(the degree of pancreatic necrosis,bleeding,fluid accumulation range,etc.),outcomes and prognosis of the patient.Result:Among the 14 patients,there were 12 males and 2 females,with a median age of 6.5 years(1~14 years).The onset of AAP occurred after a median of 5(1~8)doses of medication.9 cases with moderate AAP and 5 cases with severe AAP.14 cases showed abnormal fin-dings on abdominal ultrasound imaging,mainly manifested as pancreatic enlargement,less smooth capsule echo,enhanced and uneven parenchymal echo,and necrotic areas appearing as liquid dark areas,and 12 cases of patients were accompanied by peripancreatic,abdominal and pelvic effusion.13 cases underwent abdominal CT scan,one case underwent MRI scan.The main imaging features were panc-reatic enlargement,irregular pancreatic margin,and peripancreatic fluid collection.Among them,11 cases had pancreatic necrosis,accompanied by ascites in 11 cases,and pelvic effusion in 7 cases.After 4 weeks or longer period of fasting and pharmacological intervention,the follow-up result showed that interstitial oedematous pancreatitis developed into pancreatic pseudocyst in one case,and necrotising pancrea

关 键 词：门冬酰胺酶 胰腺炎 急性淋巴细胞性白血病 儿童 体层摄影术 X线计算机 

分 类 号：R681[医药卫生—骨科学] R817.4[医药卫生—外科学] R814.42[医药卫生—临床医学]