儿童急性胰腺炎与全身炎症反应综合征的关系探讨

Relationship between acute pancreatitis and systemic inflammation response syndrome in children

目的了解儿童急性胰腺炎合并全身炎症反应综合征(SIRS)的临床特点,探讨SIRS发生与胰腺炎病情轻重的关系。方法对2005年5月至2007年6月该院儿科收治的71例胰腺炎患儿进行研究,全部病例分为SIRS组30例、非SIRS组41例;SIRS组中符合小儿SIRS诊断标准2项者为S1组(19例),符合3项者为S2组(6例),符合4项者为S3组(5例)。通过统计学方法总结急性胰腺炎合并SIRS时的临床特点,寻找能预测病情轻重的指标。结果①重症胰腺炎(SAP)时SIRS发生率为100%,SIRS组患儿临床症状多以剧烈腹痛和发热为主,与对照组相比差异有显著性(P<0.01);②CRP升高、血钙降低两组间比较差异有显著性(P<0.01),S3组CRP平均值(120.40±10.04)mg/L>S2组(75.78±9.50)mg/L>S1组(28.51±8.51)mg/L>非SIRS组(7.98±2.82)mg/L,CRP分界点在110mg/L时诊断SAP的敏感度和阴性预测值都是最高,分别是50%和96.8%;③SIRS组CT改变较重。结论SIRS组患儿临床症状多以剧烈腹痛和发热为主,CRP、血钙水平、CT可作为急性胰腺炎病情严重程度的辅助参考指标,CRP值随着SIRS诊断指标符合项目的增多而升高,当SIRS诊断指标符合项目多于3条时应警惕SAP的发生,CRP≥110mg/L时SAP存在的可能性增加。

Objective To study the clinical features of children with acute pancreatitis complicated by systemic inflammatory response syndrome （SIRS）. Methods Clinical data of 71 children with acute pancreatitis from May 2005 to June 2007 were retrospectively studied. According to complications with or without SIRS, the patients were classified into two groups： SIRS （n =30） and non-SIRS （n =41 ）. The SIRS group was subdivided into three groups based on the item number consistent with SIRS diagnostic criteria： S1 （2 items） , S2 （3 items） and S3 （4 items）. Results More patients had severe abdominal pain （n= 12 vs 3） and fever （n= 25 vs 15） in the SIRS group than in the non-SIRS group （P 〈 0.01 ）. The serum C-reactive protein （CRP） levels （49.61 ±8.09 mg/L） in the SIRS group were significantly higher than those in the non-SIRS group （7.98±2.82 mg/L） （P 〈0.01 ）. The serum calcium level （ 1.93 mol/L） in the SIRS group was statistically lower than that in the non-SIRS group （2.81 mol/L） （P 〈0.01 ）. Among the SIRS group, the S3 group showed the highest CRP level （120.40 ±10.04 mg/L） , followed by the S2 group （75.78 ±9.50 mg/L） and S1 group （28.51 ± 8.51 mg/L） （P 〈 0.01 ）. The highest sensitivity （50%） and negative predictive value （96.8%） for the diagnosis of severe acute pancreatitis was obtained for a CRP cut-off at 110 mg/L. The imaging changes were more severe in the SIRS group than in the non-SIRS group. Conclusions Severe abdominal pain and fever were common clinical symptoms in children with acute pancreatitis complicated by SIRS. Serum CRP and calcium levels as well as imaging changes are important markers for the severity evaluation of acute pancreatitis. The patients with serum CRP level above 110 mg/L or with more than three items consistent with SIRS diagnostic criteria are at high risk for the development of severe acute pancreatitis.