227例儿童急性胰腺炎的临床特征和预后分析

Clinical characteristics and prognosis of 227 children with acute pancreatitis

目的分析儿童急性胰腺炎(AP)的临床特点和预后,为临床预防和治疗儿童AP提供参考。方法基于遵义医科大学附属医院电子病历系统,回顾分析2011年1月至2020年12月本院收治的AP患儿的临床资料。根据病情严重程度将患儿分为轻症急性胰腺炎(MAP)组和重症急性胰腺炎(SAP)组。收集并比较两组患儿的一般资料、实验室检查指标和预后指标;分析AP患儿的流行病学特征;采用多因素Logistic回归法分析儿童发生SAP的危险因素。结果共纳入227例AP患儿,其中MAP组161例,SAP组66例。AP患儿中位年龄12.00(8.00,16.00)岁,男性126例(占55.51%),首发临床症状以腹痛、恶心呕吐和腹胀为主(分别占97.36%,61.67%和14.10%),21例(9.25%)入住重症监护病房(ICU),4例(1.76%)患儿因合并脓毒症、多器官功能衰竭、创伤性休克等发生院内死亡。流行病学特征显示,AP患儿首次发病年龄主要集中在7~17岁(占85.02%);病因以胆源性疾病(29.96%)、病毒感染(29.07%)和特发性因素(19.82%)为主;2011至2020年,AP患儿就诊人数呈波动趋势,其中2018至2020年AP患儿就诊人数连续3年上升。与MAP组比较,SAP组患儿年龄明显更大,女性比例、农村来源比例、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、体质量指数(BMI)、白细胞计数(WBC)、C-反应蛋白(CRP)水平、住院费用、病因为创伤性因素和药物性因素比例明显更高,血钙水平、病因为病毒感染因素比例明显更低,住院时间明显更长(均P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分〔优势比(OR)=1.495,95%可信区间(95%CI)为1.293~1.728〕和年龄(OR=1.352,95%CI为1.182~1.546)可能与儿童发生SAP密切相关(均P<0.001)。结论儿童AP多发生于学龄前儿童和青春期儿童,总体病死率较低;胆源性疾病、病毒感染和特发性因素是常见病因;APACHEⅡ评分和年龄可能是儿童发生SAP的危险因素。

Objective To analyze the clinical characteristics and prognosis of acute pancreatitis(AP)in children,and provide reference for clinical prevention and treatment of AP in children.Methods Based on the electronic medical record system of the Affiliated Hospital of Zunyi Medical University,the clinical data of children with AP in the hospital from January 2011 to December 2020 were retrospectively analyzed.According to the severity of the disease,the children were divided into mild acute pancreatitis(MAP)group and severe acute pancreatitis(SAP)group.The general data,laboratory tests and outcomes indicators of the two groups were collected and compared.The epidemiological characteristics of children with AP were analyzed.Multivariate Logistic regression was used to analyze the risk factors of SAP in children.Results A total of 227 children with AP were enrolled,including 161 in MAP group and 66 in SAP group.The median age of children with AP was 12.00(8.00,16.00)years old,and 126 cases(55.51%)were male.The main initial clinical symptoms were abdominal pain,nausea,vomiting and abdominal distension(97.36%,61.67%and 14.10%,respectively),21 cases(9.25%)were admitted to intensive care unit(ICU),and 4 cases(1.76%)died in hospital due to sepsis,multiple organ dysfunction or traumatic shock.The epidemiological characteristics showed that the first onset age of AP was mainly 7-17 years old(85.02%);the main etiologies were biliary tract disease(29.96%),viral infection(29.07%)and idiopathic factors(19.82%).From 2011 to 2020,the number of children with AP showed a fluctuating trend,and from 2018 to 2020,the number of children with AP increased for three consecutive years.Compared with MAP group,the age of SAP group was significantly older,the proportion of female,the proportion of rural source,acute physiology and chronic health evaluationⅡ(APACHEⅡ),body mass index(BMI),and the levels of white blood cell count(WBC),C-reactive protein(CRP),hospitalization expenses,the proportion of AP caused by traumatic factors and drug factors in SAP group were significantly higher(all P<0.05).The level of blood calcium and the proportion of AP caused by virus infection were significantly lower,and the length of hospital stay in SAP group was significantly longer(all P<0.05).The multivariate Logistic regression analysis showed that APACHEⅡscore[odds ratio(OR)=1.495,95%confidence interval(95%CI)was 1.293-1.728]and age(OR=1.352,95%CI was 1.182-1.546)were closely related to SAP in children(all P<0.001).Conclusion Children with AP mostly occurs in preschool and adolescence,and the overall mortality is relatively low;biliary tract disease,viral infection and idiopathic factors are common causes;APACHEⅡscore and age may be risk factors for SAP in children.