儿童胰酶异常的临床特征及预后分析

Clinical characteristics and prognostic analysis of pancreatic enzyme abnormalities in children

目的探讨血清淀粉酶、脂肪酶异常儿童的病因、预后和临床特征。方法本研究为回顾性研究。以湖南省儿童医院2017年8月至2020年8月检测了血清淀粉酶和脂肪酶的7813例年龄大于28 d的患儿为研究对象,排除急慢性胰腺炎患儿。收集患儿年龄、性别、入住科室、影像学检查、出院转归、主要诊断、诊断ICD10编码及住院期间血清淀粉酶和脂肪酶最高值。根据血清淀粉酶、脂肪酶水平将患儿分为:A组,血清淀粉酶和脂肪酶正常;B组,1倍<血清淀粉酶或脂肪酶升高<3倍;C组,血清淀粉酶或脂肪酶升高≥3倍;胰酶异常组:B+C组。根据预后情况分为:存活组,死亡组。分析儿童血清淀粉酶、脂肪酶异常的发生情况与年龄、性别、病种及预后的关系。结果男性和女性胰酶异常的占比分别为11.5%、12.9%,在28 d~1岁组、>1~3岁组、>3~6岁组、>6~12岁组、>12岁组患儿中,胰酶水平异常患儿的例数分别为37例(4.6%)、185例(15.4%)、199例(10.5%)、431例(13.9%)、94例(11.7%)。A组患儿病死率为1.6%(112/6867例),B组病死率为5.2%(32/617例),C组病死率为7.6%(25/329例),其中B组和C组的死亡风险均高于A组,B组、C组与A组相比OR(95%CI)分别为3.30(2.21~4.93)、4.96(3.17~7.77)。C组患儿的病种构成中,前5位分别为腮腺炎(26.4%)、胆管扩张症(11.6%)、胆总管囊肿(8.5%)、胃肠炎(4.5%)、脓毒症(3.3%)。结论儿童胰酶异常与不良预后有关,>1~3岁患儿胰酶异常相对高发,腮腺炎、消化系统疾病及先天性消化系统结构畸形的患儿易发生胰酶异常,此外脓毒症也易出现胰酶异常,临床应警惕此类患儿继发胰腺损伤的可能。

Objective To investigate the etiology,prognosis and clinical characteristics of abnormal serum amylase and lipase in children.Methods This study was a retrospective study.A total of 7813 children older than 28 days who had their serum amylase and lipase detected in Hunan Children′s Hospital from August 2017 to August 2020 were included as the study subjects.Children with acute and chronic pancreatitis were excluded.The age,gender,impatient department,imaging exams,discharge outcomes,main diagnosis,diagnostic ICD10 code,and the highest values of serum amylase and lipase during hospitalization were collected through the medical record system.According to the levels of serum amylase and lipase,the children were divided into 3 groups.Patients in group A had normal serum amylase and serum lipase levels.The serum amylase or lipase levels of patients in group B was 1 to 3 times higher than that of group A.The serum amylase or lipase levels in group C was 3 times higher than that of group A.Group B and group C had abnormal pancreatic enzyme levels.According to the prognosis,patients were divided into the survival group and the death group.The relationship of the occurrence of abnormal serum amylase and lipase levels with the age,sex,disease type and prognosis of children was analyzed.Results The ratio of abnormal trypsin in male and female was 11.5%and 12.9%,respectively.The number of children with abnormal pancreatic enzyme levels in the 28 day-1 year old group,>1-3 years old group,>3-6 years old group,>6-12 years old group and>12 year old group were 37 cases(4.6%),185 cases(15.4%),199 cases(10.5%),431 cases(13.9%),and 94 cases(11.7%),respectively.The mortality rate was 1.6%(112/6867 cases)in group A,5.2%(32/617 cases)in group B,and 7.6%(25/329 cases)in group C.The mortality risk of group B and C was both higher than that of group A.Compared with group A,the OR(95%CI)of group B and group C was 3.30(2.21-4.93)and 4.96(3.17-7.77),respectively.In group C,the top five diseases were parotitis(26.4%),cholangiectasis(11.6%),choledochal cysts(8.5%),gastroenteritis(4.5%)and sepsis(3.3%).Conclusions Pancreatic enzyme abnormalities in children are associated with adverse prognosis.Pancreatic enzyme abnormalities are more prone to occur in children aged>1-3 with mumps,digestive diseases and congenital digestive system structural deformities.In addition,children with sepsis are also easy to present pancreatic enzyme abnormalities.Clinical attention should be paid to the possibility of secondary pancreatic damage in children with sepsis.