糖尿病酮症酸中毒合并急性胰腺炎青少年患儿的临床特点、治疗及转归

Clinical Characteristics,Treatment and Outcome of Children with Diabetic Ketoacidosis Complicated with Acute Pancreatitis

目的 研究糖尿病酮症酸中毒(DKA)合并胰酶异常升高青少年患儿的临床特点、治疗与转归,为急性胰腺炎(AP)的临床诊断与治疗提供依据。方法 回顾性分析山东省单县东大医院2017年1月—2020年12月间确诊DKA合并胰酶异常升高的200例患儿的病案资料,其中65例(32.50%)胰酶水平超过正常值的3倍,分为可疑AP组(n=45)与确诊AP组(n=20)。统计患儿症状、血脂、脂肪酶、血淀粉酶、胰腺影像学特点、治疗与转归情况。结果 本次所纳DKA合并胰酶异常升高患儿共计200例,确诊AP组所有患儿腹痛消失用时为(5.00±1.19)d,胰酶低于正常值3倍用时为(6.00±1.57)d,禁食时长为(20.23±6.82)d;随访1年未见AP复发。确诊AP组与可疑AP组患儿均以女性居多,但两组性别比较,差异无统计学意义(P>0.05);确诊AP组患儿罹患2型糖尿病居多,可疑AP组患儿罹患1型糖尿病居多,两组糖尿病分型比较,差异有统计学意义(P<0.05);确诊AP组患儿高脂血症比例高于可疑AP组患儿,但两组比较,差异无统计学意义(P>0.05);确诊AP组患儿腹痛比例、脂肪酶水平、淀粉酶水平、影像学示阳比例、禁食比例、经口喂养症状反复比例、经口喂养胰酶复升比例、胰酶降至低于正常值3倍用时、胰酶降至正常区间用时均高于可疑AP组患儿,差异有统计学意义(P<0.05)。结论 针对DKA合并胰酶异常升高患儿,不可轻易下诊断,而是要结合症状、实验室指标结果与影像学等手段,提升疾病真阳性检出率,以规范治疗的合理性。

Objective To study the clinical characteristics,treatment and prognosis of adolescent children with diabetic ketoacidosis(DKA) complicated with abnormally elevated pancreatic enzymes,so as to provide evidence for the clinical diagnosis and treatment of acute pancreatitis(AP).Methods The medical records of 200 children diagnosed with DKA and abnormally elevated pancreatic enzymes from January 2017 to December 2020 in Dongda Hospital of Shanxian County,Shandong Province were retrospectively analyzed,65 cases(32.50%) had pancreatic enzyme levels more than 3 times the normal value,and were divided into suspected AP group(n=45) and confirmed AP group(n=20).Symptoms,blood lipids,lipase,blood amylase,pancreatic imaging characteristics,treatment and prognosis of children were counted.Result A total of 200 children with DKA and abnormally elevated pancreatic enzymes were enrolled in the study.The average time for abdominal pain to disappear in all children in the AP group was(9.18±1.24) d,and the average time for pancreatic enzymes to be three times lower than the normal value was(6.02±0.54) d,the average fasting time was(20.23±6.82) d;no AP recurrence was found in the 1-year follow-up.Most of the children in the confirmed AP group and the suspected AP group were female,but there was no statistically significant difference in gender between the two groups(P>0.05).Most of the children in the confirmed AP group suffered from type 2 diabetes,and most of the children in the suspected AP group suffered from type 1 diabetes,and there was a statistically significant difference in the type of diabetes between the two groups(P0.05).The proportion of abdominal pain,lipase level,amylase level,positive ratio in imaging,fasting ratio,repeated ratio of oral feeding symptoms,ratio of oral feeding pancreatin rising again,time for pancreatin to be 3 times lower than the normal value and time for pancreatin to be reduced to the normal range in the confirmed AP group were higher than those in the suspected AP group,and the difference was statistically significant(P<0.05).Conclusion For children with DKA with abnormally elevated pancreatic enzymes,the diagnosis should not be made easily,but should be combined with symptoms,laboratory index results and imaging methods to improve the true positive detection rate of the disease and standardize the rationality of treatment.