培门冬酶相关急性胰腺炎的MSCT影像分析

CT features of polyethylene glycol conjugated asparaginase-related acute pancreatitis

目的 探讨培门冬酶(PEG-Asp)相关急性胰腺炎(PAP)的CT表现并总结其影像特征。方法 回顾性分析10例培门冬酶相关急性胰腺炎患者的临床及影像资料,其中8例为儿童(中位年龄6.5岁),2例为成人(24岁和49岁)。10例均因血液系统恶性肿瘤行化疗(急性淋巴细胞白血病7例、急性髓系白血病1例、NK/T-细胞淋巴瘤2例),治疗期间均应用培门冬酶行诱导化疗或化疗。7例行MSCT平扫及增强检查,3例仅行MSCT平扫检查。结合临床资料及治疗史,分析影像特点。结果 10例患者于用药2~65 d出现腹痛,实验室检查血清淀粉酶或脂肪酶均达正常值上限3倍以上。5例发生于化疗诱导期;强化期、巩固期、维持期各1例;2例NK/T细胞淋巴瘤分别发生于化疗第1周期初期及第4周期结束后。MSCT上10例均表现为不同程度的胰腺整体肿胀,3例胰腺局灶性密度减低,未见强化;7例胰周液体积聚;8例胰腺周围脂肪间隙模糊。胰腺实质斑点状钙化7例,肝脏斑片状钙化6例;2例患儿见胆囊结石。按照改良CT严重指数分级,本组病例中2例重度急性胰腺炎,6例中度重症,2例轻度。结论 PAP常见于因血液病接受含培门冬酶治疗方案的患者,儿童诱导期发病多见;可表现为各种类型的急性胰腺炎,易出现肝胰钙化和胆结石。

Objective To investigate the CT features of polyethylene glycol conjugated asparaginase(PEG-Asp)-related acute pancreatitis(PAP). Methods The clinical information and CT of 10 patients(8 children, median age: 6.5 years;2 adults, age: 24 and 49 years) with PAP were retrospectively analyzed. The patients received PEG-Asp during chemotherapy for acute lymphoblastic leukemia(7), NK/T-cell lymphoma(2), or acute myeloid leukemia(1). All patients underwent unenhanced(10) and enhanced(7) multi-slice CT scanning. The imaging features were analyzed in correlation with clinical information and treatment history. Results All patients suffered abdominal pain 2-65 days after treatment. The serum amylase or lipase was elevated 3 times above normal in the chemotherapy induction period(5), intensification period(1), consolidation period(1), or maintenance period(1) for leukemia, at the beginning of the first cycle(1) and after the end of the fourth cycle of chemotherapy for NK/T-cell lymphoma. CT showed varying degrees of swelling of the entire pancreas(10), focal density reduction without enhancement(3), peripancreatic fluid collection(7), and blurred fat space around the pancreas(8). There were punctate calcifications in the pancreatic parenchyma(7), patchy hepatic calcifications(6), and calcified gallstones in 2 children. Using the modified CT severity grading system, the acute pancreatitis was severe(2), moderately severe(6), or mild(2). Conclusion PAP is common in patients receiving PEG-Asp-containing regimen for treatment of hematologic diseases. The severity of acute pancreatitis is variable with tendency to develop hepatic and pancreatic calcifications and gallstones.