儿童糖尿病酮症酸中毒合并急性胰腺炎临床特征研究

目的:探究儿童糖尿病酮症酸中毒(DKA)合并急性胰腺炎(AP)的临床特征,旨在减少临床漏诊误诊,为疾病治疗提供指导。方法:选取2017年1月至2023年12月江西省儿童医院内分泌遗传代谢科收治的80例DKA合并胰酶升高患儿的临床资料进行回顾性分析,据AP诊断指南将患者分为确诊AP组(n=30)及疑诊AP组(n=50),比较两组临床表现、影像学征象、实验室检查指标、治疗及转归情况的差异。结果:确诊AP组急性上腹痛、压痛反跳痛发生率、胰腺影像示阳性占比、甘油三酯、血淀粉酶、脂肪酶水平均高于疑诊AP组(P<0.05);两组均予以常规DKA措施治疗,在此基础上确诊AP组30例患儿均予以禁食及质子泵抑制剂治疗,10例行胃肠减压,治疗后3例患儿合并肾损伤,2例患儿合并重症肺炎,其余均治愈出院;疑诊AP组患儿全部治愈出院。结论:对于DKA合并AP患儿的诊断需结合临床症状、影像学及实验室检查结果综合判断,以期为早期合理治疗提供依据。

Objective To explore the clinical characteristics of pediatric diabetic ketoacidosis(DKA)complicated with acute pancreatitis(AP),in order to reduce clinical misdiagnosis and provide guidance for disease treatment.Methods Clinical data of 80 children with DKA combined with elevated pancreatic enzymes admitted to the Department of Endocrinology,Genetics and Metabolism of Jiangxi Children's Hospital from January 2017 to December 2023 were retrospectively analyzed.According to AP diagnostic guidelines,the patients were divided into confirmed AP group(n=30)and suspected AP group(n=50).The clinical manifestations,imaging signs,laboratory indicators,treatment and outcome were compared between the two groups.Results The incidence of acute epigastric pain,tenderness and rebound pain,the proportion of positive pancreatic imaging,triglyceride,blood amylase and lipase levels in confirmed AP group were higher than those in suspected AP group(P<0.05).Both groups were treated with routine DKA measures.On this basis,30 children in AP group were treated with fasting and proton pump inhibitor,10 were treated with gastrointestinal decompression.After treatment,3 children were complicated with kidney injury,2 with severe pneumonia,and the rest were cured and discharged from hospital.All the children in AP group were cured and discharged from hospital.Conclusion The diagnosis of DKA with AP should be combined with clinical symptoms,imaging and laboratory results,so as to provide basis for early rational treatment.