青少年急性胰腺炎病变范围及严重程度的预测

Prediction on pathological changes and their severity of teenagers with acute pancreatitis

目的探讨急性胰腺炎在青少年中的病变范围及严重程度。方法211例年龄小于18岁的急性胰腺炎患者入选本研究。评价Ranson评分、改良Glasgow昏迷评分及青少年急性胰腺炎病情严重度评分系统预测青少年急性胰腺炎主要并发症的准确性。结果211例青少年急性胰腺炎患者的病因主要有：自发性（31．3％）、药物诱导（19．9％）、胆石（11．8％）、创伤（7．6％）、结构（5．2％）及溶血性尿毒症综合征（3．3％）。56例（26．5％）患者继发严重并发症。回归性分析表明，青少年急性胰腺炎病情严重度评分系统中白细胞数〉18500／¨I（OR=3。1；P=0．010）、钙离子浓度〈8．3mg／dl（OR=3．0；P=0．019）、尿素氮上升〉5mg／dl（OR=4．1；P=O．004）都可以独立作为预测重症急性胰腺炎的指标。Ranson评分、改良Glasgow昏迷评分及青少年急性胰腺炎病情严重度评分系统的敏感性和阴性预测值分别是51．8％、51。8％、48．2％和83．2％、83．5％、80．5％，都不足以指导临床决定。结论通常使用的临床评分系统在预测青少年急性胰腺炎严重度中存在不足。细致和多次评估早期临床标志的患者是非常有必要的，因为这些患者同样存在继发严重并发症的可能。

ObJective To describe the spectrum of disease in teenagers with acute pancreatitisand assess predictors of severity. Methods Teenagers （≤ 18 years） admitted to a single institution with acute pancreatitis from 2000 to 2009 were included. The accuracy of the Ranson, modified Glasgow, and pediatric acute pancreatitis severity （PAPS） scoring systems for predicting major complications was assessed. Results The etiology of pancreatitis in these 211 teenagers was idiopathic （31.3%）, medication-induced （19.9%）, gallstones （11.8%）, trauma （7.6%）, transplantation （7.6%）, structural （5.2%）, and hemolytic ure- mic syndrome （3.3%）. 56 patients （26.5%） developed severe complications. Using the cutoff thresholds in the PAPS scoring system, only admission white blood cell counted more than 18,500/p~ I （odds ratio [OR], 3.1; P=0.010）, trough calcium less than 8.3 mg/dL （OR, 3.0; P = 0.019）, and blood urea nitrogen rised greater than 5 mg/dL （OR, 4.1; ,0=-0.004） were independent predictors of severe outcome in a logistic regression model. The sensitivity （51.8%, 51.8%, 48.2%） and negative predictive value （83.2%, 83.5%, 80.5%） of the Ranson, modified Glasgow, and PAPS scores were, respectively, insufficient to guide clinical decision making. Conclusions Commonly used scoring systems have limited ability to predict disease severity in teenagers and adolescents with acute pancreatitis. Careful and repeated evaluations are essential in managing these patients who may develop major complications without early signs.