儿童慢性胰腺炎临床特征分析  

The clinical characteristics of chronic pancreatitis in children

作　　者：房永利 吴捷 于飞鸿[1] 周锦[1] 王国丽[1] 官德秀[1] 秦秀敏[1] Fang Yongli;Wu Jie;Yu Feihong;Zhou Jin;Wang Guoli;Guan Dexiu;Qin Xiumin(Department of Gastroenterology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院消化内科,100045

出　　处：《中国小儿急救医学》2024年第10期756-760,共5页Chinese Pediatric Emergency Medicine

基　　金：北京市医院管理中心“登峰”计划(DF20221003)。

摘　　要：目的分析慢性胰腺炎(CP)患儿的常见病因及不同干预方式对预后的影响。方法回顾性分析2010年1月至2023年12月就诊于北京儿童医院诊断为CP患儿的临床资料, 包括病因、临床表现、影像学资料、治疗方式。随访患儿的预后, 包括身高、体重、并发症发生情况, 通过计算Z评分比较不同干预方式的CP患儿远期营养状态。结果共纳入98例CP患儿, 其中男51例, 女47例, 年龄1.95~15.96岁(中位年龄8.49岁)。病因方面以基因突变(39/98, 39.8%)(主要有基因PRSS1、SPINK1和CFTR)、先天性解剖结构异常(26/98, 26.5%)及特发性(33/98, 33.7%)为主。患儿以腹痛(78/98, 79.6%)、恶心/呕吐(48/98, 49.0%)、胸闷/胸痛(10/98, 10.2%)为主要表现, 伴有营养不良(44/98, 44.9%), 部分病程中可伴有淀粉酶升高。影像学检查包括:腹部超声, 表现为胰腺回声不均匀、胰管扩张、胰管结石;腹部核磁共振, 表现为胰腺形态饱满、萎缩、边缘不规则, 胰管迂曲扩张。与其他原因CP相比, 遗传性CP发生胰腺形态学改变比例更高(100.0% 比88.1%, P<0.05)。截至2024年3月完成随访时, 98例患儿均先行内科保守治疗, 13例行手术治疗, 51例予内镜下逆行胰胆管造影干预, 34例患儿未予手术或内镜干预;共有6例患儿出现糖尿病, 6例粪便胰弹性蛋白酶-1减低, 未出现脂肪泻。远期随访内镜下逆行胰胆管造影干预后, 患儿营养状态更好(Z评分:-1.22比0.74, P<0.001)。结论儿童CP以基因突变及解剖结构异常为主要病因, 早期内镜干预可明显改善患儿远期预后。Objective To analyze the etiology of chronic pancreatitis(CP)and evaluate the impact of different intervention methods on the prognosis.Methods This is a retrospective analysis conducted on clinical data of pediatric patients with CP admitted to Beijing Children's Hospital between January 2010 and December 2023,including etiology,clinical manifestations,imaging data and treatments.Follow-up assessments included height,weight,complications occurrence,and long-term nutritional status evaluated by using Z scores.Results A total of 98 patients with CP were included in the study,containing 51 males and 47 females,with an age range of 1.95 to 15.96 years(median 8.49 years).The etiological contained the gene mutation(39.8%,39/98)(involving PRSS1,SPINK1,CFTR),the anatomical abnormality(26/98,26.5%),idiopathic pancreatitis(33.7%,33/98).Predominant clinical manifestations included abdominal pain(79/98,79.6%),nausea/vomit(48/98,49.0%),chest tightness/chest pain(10/98,10.2%),with malnutrition(44/98,44.9%)and the serum amylase increased in some patients.Imaging findings revealed heterogeneous pancreatic echoes,dilated pancreatic ducts and pancreatic stones via abdominal ultrasound,and a full or atrophic pancreas with irregular margins,tortuous or dilated pancreatic ducts through abdominal magnetic resonance imaging.Compared with CP caused by other reasons,hereditdry CP had a higher rate of pancreatic morphological changes(100.0%vs.88.1%,P<0.05).By March 2024,follow-up showed all 98 patients underwent initial medical treatment,followed by surgical intervention in 13 cases,endoscopic retrograde cholangiopancreatography intervention in 51 cases,and no surgical or endoscopic intervention in 34 cases.Six children developed diabetes,six had reduced fecal pancreatic elastase-1 but without fat diarrhea.Long-term follow-up indicated improved nutritional status among children who underwent endoscopic retrograde cholangiopancreatography intervention(Z score,-1.22 vs.0.74,P<0.001).Conclusion Gene mutations and anatomical abnormalities is

关 键 词：慢性胰腺炎 儿童 遗传性胰腺炎 内镜下逆行胰胆管造影 临床特征 

分 类 号：R725.7[医药卫生—儿科]