儿童血脂异常诱导的急性胰腺炎13例临床分析

Clinical analysis of acute pancreatitis induced by dyslipidemia in 13 children

目的探讨儿童血脂异常诱导的急性胰腺炎(AP)的临床特点。方法回顾分析2015年12月至2019年12月诊断的血脂异常诱导AP患儿的临床资料。结果确诊AP患儿62例,其中血脂异常诱导的AP 13例,占20.97%。男10例、女3例,年龄2~15岁,病程1天~1年,重型1例、轻型12例。13例血脂异常诱导的AP患儿均有腹痛;8例有恶心、呕吐;4例蛋白质能量营养不良;1例休克;1例伴脂肪瘤,肝脾肿大,红细胞、白细胞及血小板下降;2例肥胖;1例糖尿病。高三酰甘油血症4例、高胆固醇血症4例、混合性高脂血症3例、低高密度脂蛋白胆固醇2例。3例行全外显子基因检测,2例LPL基因变异,确诊为家族性高乳糜微粒血症。10例影像学异常,其中9例B超有胰腺炎改变,8例MRCP示胰腺增大。治疗包括饮食管理、抑酸及生长抑素等,2例静滴左卡尼汀及口服烟酰胺片治疗;1例重型AP抗休克治疗。13例均临床缓解,1例出院后2周进食大量鱼汤复发。结论血脂异常诱导的儿童AP并不罕见,规范的饮食指导是治疗的重要措施之一。

Objective To explore the clinical characteristics of acute pancreatitis(AP)induced by dyslipidemia in children.Method The clinical data of children diagnosed with AP induced by dyslipidemia from December 2015 to December 2019 were retrospectively analyzed.Results In 62 cases of confirmed AP,there were 13 cases(20.97%)of AP induced by dyslipidemia and they were 10 boys and 3 girls aged from 2 to 15 years.The course of disease ranged from 1 day to 1 year in 1 severe case and 12 mild cases.There were abdominal pain in 13 cases,nausea and vomiting in 8 cases,protein energy malnutrition in 4 cases and shock in one case.One patient was accompanied by lipoma,hepatosplenomegaly,decreases of red blood cells,white blood cells and platelets.Two cases had obesity and one case had diabetes.There were 4 cases of hypertriglyceridemia,4 cases of hypercholesterolemia,3 cases of mixed hyperlipidemia and 2 cases of low-density lipoprotein cholesterol.The whole exon gene tests were performed in 3 patients,among whom two patients with LPL gene variant were diagnosed with familial hyperchylomicemia.Imaging abnormalities were found in 10 cases.B-ultrasonography showed pancreatitis in 9 cases and MRCP showed pancreas enlargement in 8 cases.The treatment included diet management,acid suppression and somatostatin.Two patients received intravenous levocarnitine and oral nicotinamide tablets,and one with severe AP received anti-shock treatment.Clinical remission was achieved in all 13 patients,and one patient relapsed 2 weeks after discharge due to eating a large amount of fish soup.Conclusion Dyslipidemia induced AP in children is not rare and standardized diet guidance is one of the important measures for treatment.