内分泌指标及超声检查在小儿胰腺损伤早期诊断中的应用

金明均; 孙溶涓; 董亮; 詹江华

doi:10.12449/JCH240335

内分泌指标及超声检查在小儿胰腺损伤早期诊断中的应用

DOI: 10.12449/JCH240335

金明均^{1, 2},
孙溶涓^{1, 3},
董亮^{1, 3},
詹江华^{1, 3, , ,}

1.
天津市儿童医院（天津大学儿童医院）外科，天津 300074
2.
天津市儿童出生缺陷防治重点实验室，天津 300134
3.
天津医科大学研究生院，天津 300070

基金项目:

天津市公共卫生科技重大专项 (21ZXGWSY00070);

天津市应用基础研究项目 (22JCZDJC00290);

新疆维吾尔自治区自然科学基金 (2022D01A27);

新疆维吾尔自治区自然科学基金 (2021D01A38)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：金明均、孙溶涓负责撰写论文；董亮、詹江华参与修改论文；詹江华负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
詹江华， zhanjianghuatj@163.com （ORCID： 0000-0002-5257-8619）

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出版历程
- 收稿日期: 2023-06-17
- 录用日期: 2023-09-08
- 出版日期: 2024-03-20

Application of endocrine indices and ultrasound examination in the early diagnosis of pediatric pancreatic injury

Mingjun JIN^{1, 2},
Rongjuan SUN^{1, 3},
Liang DONG^{1, 3},
Jianghua ZHAN^{1, 3
, ,
,}

1.
Department of Surgery，Tianjin Children’s Hospital/Children’s Hospital of Tianjin University，Tianjin 300074，China
2.
Tianjin Key Laboratory of Birth Defects for Prevention and Treatment，Tianjin 300134
3.
Graduate School，Tianjin Medical University，Tianjin 300070，China

Research funding:

Tianjin Science and Technology Bureau Special Project (21ZXGWSY00070);

Tianjin Applied Basic Research Project (22JCZDJC00290);

Xinjiang Uygur Autonomous Region Science Foundation Project (2022D01A27);

Xinjiang Uygur Autonomous Region Science Foundation Project (2021D01A38)

More Information

Corresponding author: ZHAN Jianghua， zhanjianghuatj@163.com （ORCID： 0000-0002-5257-8619）

摘要

摘要: 腹部外伤的发生率在小儿创伤中占比逐年增加，创伤性胰腺损伤应引起临床医生的足够重视。胰腺位于腹膜后，尤其是Ⅰ、Ⅱ级损伤的患儿，其早期诊断较为困难。本文通过文献复习，分析内分泌指标及腹部超声检查在小儿胰腺损伤早期诊断中的价值，以提高早诊率，避免相关并发症的发生。内分泌指标中血清胰岛素、C肽等指标的变化，对于诊断和评估小儿胰腺损伤有一定的优势，可作为小儿胰腺损伤病情的预警指标。超声弹性成像技术为胰腺损伤的诊断和鉴别提供了新的方法；而对比增强超声在识别患儿胰腺损伤中具有较高的特异度及敏感度，由于其无放射性损害，有望成为CT检查的替代方案。
- 腹部损伤 /
- 胰腺 /
- 儿童 /
- 早期诊断
Abstract: The incidence rate of abdominal trauma is increasing year by year in pediatric trauma， and traumatic pancreatic injury should be taken seriously by clinicians. The pancreas is located behind the peritoneum， and it is difficult to make an early diagnosis of pancreatic injury， especially in children with grade ‍Ⅰ‍/Ⅱ injury. Through a literature review， this article analyzes the application value of endocrine indices and abdominal ultrasound in the early diagnosis of pediatric pancreatic injury， so as to improve the rate of early diagnosis and avoid the onset of related complications. Changes of the endocrine indices such as serum insulin and C Peptide have certain advantages in diagnosing and evaluating the degree of pediatric pancreatic injury and can thus be used as early warning indices for pediatric pancreatic injury. Ultrasound elastography provides a new method for the diagnosis and differentiation of pancreatic injury； contrast-enhanced ultrasound， which has no radioactive damage， has relatively high specificity and sensitivity in identifying pediatric pancreatic injury， and therefore， it is expected to become an alternative to CT examination.
- Abdominal Injuries /
- Pancreas /
- Child /
- Early Diagnosis

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参考文献(38)

[1]	RICHARDS JR, KNOPF NA, WANG L, et al. Blunt abdominal trauma in children: evaluation with emergency US[J]. Radiology, 2002, 222( 3): 749- 754. DOI: 10.1148/radiol.2223010838.
[2]	HO VP, PATEL NJ, BOKHARI F, et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma[J]. J Trauma Acute Care Surg, 2017, 82( 1): 185- 199. DOI: 10.1097/TA.0000000000001300.
[3]	AHMED N, VERNICK JJ. Pancreatic injury[J]. South Med J, 2009, 102( 12): 1253- 1256. DOI: 10.1097/SMJ.0b013e3181c0dfca.
[4]	ANTONSEN I, BERLE V, SØREIDE K. Blunt pancreatic injury in children[J]. Tidsskr Nor Laegeforen, 2017, 137( 17). DOI: 10.4045/tidsskr.16.0888.
[5]	ROSENFELD EH, VOGEL A, RUSSELL RT, et al. Comparison of diagnostic imaging modalities for the evaluation of pancreatic duct injury in children: a multi-institutional analysis from the Pancreatic Trauma Study Group[J]. Pediatr Surg Int, 2018, 34( 9): 961- 966. DOI: 10.1007/s00383-018-4309-2.
[6]	DI SERAFINO M, VITALE V, SEVERINO R, et al. Pediatric ultrasonography of the pancreas: normal and abnormal findings[J]. J Ultrasound, 2019, 22( 3): 261- 272. DOI: 10.1007/s40477-018-0348-8.
[7]	SUTHERLAND I, LEDDER O, CRAMERI J, et al. Pancreatic trauma in children[J]. Pediatr Surg Int, 2010, 26( 12): 1201- 1206. DOI: 10.1007/s00383-010-2705-3.
[8]	HERMAN R, GUIRE KE, BURD RS, et al. Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma[J]. J Pediatr Surg, 2011, 46( 5): 923- 926. DOI: 10.1016/j.jpedsurg.2011.02.033.
[9]	TAN Y, HAN LQ, YANG Q, et al. Impairment of endocrine function in acute pancreatitis[J/CD]. Chin J Clinicians(Electronic Edition), 2018, 12( 9): 535- 538. DOI: 10.3877/cma.j.issn.1674-0785.2018.09.011. 谭杨, 韩连强, 杨奇, 等. 急性胰腺炎时胰腺内分泌功能损伤的研究进展[J/CD]. 中华临床医师杂志(电子版), 2018, 12( 9): 535- 538. DOI: 10.3877/cma.j.issn.1674-0785.2018.09.011.
[10]	RICHARDSON A, PARK WG. Acute pancreatitis and diabetes mellitus: a review[J]. Korean J Intern Med, 2021, 36( 1): 15- 24. DOI: 10.3904/kjim.2020.505.
[11]	DONG Q, LI L, XIAO XM, et al. Pediatric hepatobiliary surgery[M]. 2^nd ed. Beijing: People’s Medical Publishing House, 2017. 董蒨, 李龙, 肖现民, 等. 小儿肝胆外科学[M]. 第二版. 北京: 人民卫生出版社, 2017.
[12]	SRINIVASAN V. Glucose metabolism and stress hyperglycemia in critically Ill children[J]. Indian J Pediatr, 2023, 90( 3): 272- 279. DOI: 10.1007/s12098-022-04439-y.
[13]	LOSSER MR, DAMOISEL C, PAYEN D. Bench-to-bedside review: Glucose and stress conditions in the intensive care unit[J]. Crit Care, 2010, 14( 4): 231. DOI: 10.1186/cc9100.
[14]	DAS SL, SINGH PP, PHILLIPS AR, et al. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis[J]. Gut, 2014, 63( 5): 818- 831. DOI: 10.1136/gutjnl-2013-305062.
[15]	BHARMAL SH, PENDHARKAR SA, SINGH RG, et al. Relationship between circulating levels of pancreatic proteolytic enzymes and pancreatic hormones[J]. Pancreatology, 2017, 17( 6): 876- 883. DOI: 10.1016/j.pan.2017.09.007.
[16]	CHO IR, HAN KD, LEE SH, et al. Association between glycemic status and the risk of acute pancreatitis: a nationwide population-based study[J]. Diabetol Metab Syndr, 2023, 15( 1): 104. DOI: 10.1186/s13098-023-01086-x.
[17]	PENDHARKAR SA, ASRANI VM, XIAO AY, et al. Relationship between pancreatic hormones and glucose metabolism: A cross-sectional study in patients after acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol, 2016, 311( 1): G50- G58. DOI: 10.1152/ajpgi.00074.2016.
[18]	ANDERSEN DB, HOLST JJ. Peptides in the regulation of glucagon secretion[J]. Peptides, 2022, 148: 170683. DOI: 10.1016/j.peptides.2021.170683.
[19]	BELLIN MD. Pancreatogenic diabetes in children with recurrent acute and chronic pancreatitis: risks, screening, and treatment(mini-review)[J]. Front Pediatr, 2022, 10: 884668. DOI: 10.3389/fped.2022.884668.
[20]	FRANKE D, ANUPINDI SA, BARNEWOLT CE, et al. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children[J]. Pediatr Radiol, 2021, 51( 12): 2229- 2252. DOI: 10.1007/s00247-021-05131-7.
[21]	ZHANG D, CHEN YJ, WANG ZM, et al. Management of blunt pancreatic trauma in children: a report of 42 cases[J]. J Clin Ped Surg, 2018, 17( 7): 523- 527. DOI: 10.3969/j.issn.1671-6353.2018.07.011. 张丹, 陈亚军, 王增萌, 等. 小儿不同级别闭合性胰腺损伤的疗效分析[J]. 临床小儿外科杂志, 2018, 17( 7): 523- 527. DOI: 10.3969/j.issn.1671-6353.2018.07.011.
[22]	PALTIEL HJ, BARTH RA, BRUNO C, et al. Contrast-enhanced ultrasound of blunt abdominal trauma in children[J]. Pediatr Radiol, 2021, 51( 12): 2253- 2269. DOI: 10.1007/s00247-020-04869-w.
[23]	LAUGESEN NG, NOLSOE CP, ROSENBERG J. Clinical applications of contrast-enhanced ultrasound in the pediatric work-up of focal liver lesions and blunt abdominal trauma: a systematic review[J]. Ultrasound Int Open, 2017, 3( 1): E2- E7. DOI: 10.1055/s-0042-124502.
[24]	GOLDBERG-MUROW M, STEINER Z, LAKOVSKY Y, et al. Blunt high-grade pancreatic injury in children: a 20-year experience in two pediatric surgical centers[J]. Isr Med Assoc J, 2021, 23( 3): 180- 185.
[25]	DARGE K, BACK SJ, BULAS DI, et al. Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States[J]. Pediatr Radiol, 2021, 51( 12): 2128- 2138. DOI: 10.1007/s00247-021-05102-y.
[26]	MENICHINI G, SESSA B, TRINCI M, et al. Accuracy of contrast-enhanced ultrasound(CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT[J]. Radiol Med, 2015, 120( 11): 989- 1001. DOI: 10.1007/s11547-015-0535-z.
[27]	SQUIRES JH, MCCARVILLE MB. Contrast-enhanced ultrasound in children: implementation and key diagnostic applications[J]. AJR Am J Roentgenol, 2021, 217( 5): 1217- 1231. DOI: 10.2214/AJR.21.25713.
[28]	ESPOSITO F, DI SERAFINO M, SGAMBATI P, et al. Ultrasound contrast media in paediatric patients: is it an off-label use? Regulatory requirements and radiologist’s liability[J]. Radiol Med, 2012, 117( 1): 148- 159. DOI: 10.1007/s11547-011-0718-1.
[29]	ZHANG Z, HONG Y, LIU N, et al. Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis[J]. Sci Rep, 2017, 7( 1): 4446. DOI: 10.1038/s41598-017-04779-2.
[30]	LIN TK, TROENDLE DM, WALLIHAN DB, et al. Specialized imaging and procedures in pediatric pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report[J]. J Pediatr Gastroenterol Nutr, 2017, 64( 3): 472- 484. DOI: 10.1097/MPG.0000000000001371.
[31]	MIELE V, PICCOLO CL, TRINCI M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients[J]. Radiol Med, 2016, 121( 5): 409- 430. DOI: 10.1007/s11547-016-0637-2.
[32]	LV F, TANG J, LUO Y, et al. Emergency contrast-enhanced ultrasonography for pancreatic injuries in blunt abdominal trauma[J]. Radiol Med, 2014, 119( 12): 920- 927. DOI: 10.1007/s11547-014-0410-3.
[33]	NAKAOKA K, HASHIMOTO S, MIYAHARA R, et al. Current status of the diagnosis of chronic pancreatitis by ultrasonographic elastography[J]. Korean J Intern Med, 2022, 37( 1): 27- 36. DOI: 10.3904/kjim.2021.252.
[34]	ZHU L, YANG JR, HE LL, et al. Advances on the application of transient elastography in the diagnosis of liver fibrosis[J/CD]. Chin J Liver Dis(Electronic Version), 2023, 15( 3): 16- 22. DOI: 10.3969/j.issn.1674-7380.2023.03.003. 朱璐, 杨君茹, 何玲玲, 等. 瞬时弹性成像在肝纤维化诊断中的应用研究进展[J/CD]. 中国肝脏病杂志(电子版), 2023, 15( 3): 16- 22. DOI: 10.3969/j.issn.1674-7380.2023.03.003.
[35]	DONG M, ZHANG BY, XING BY. Application progress of ultrasound elastography in breast diseases[J]. China Med Herald, 2022, 19( 22): 42- 45, 61. 董梦, 张秉宜, 邢博缘. 超声弹性成像技术在乳腺疾病中的应用进展[J]. 中国医药导报, 2022, 19( 22): 42- 45, 61.
[36]	YAMASHITA Y, YAMAZAKI H, SHIMOKAWA T, et al. Shear-wave versus strain elastography in endoscopic ultrasound for the diagnosis of chronic pancreatitis[J]. Pancreatology, 2023, 23( 1): 35- 41. DOI: 10.1016/j.pan.2022.11.009.
[37]	WU J, LIU YF, KONG WW, et al. Advances in the diagnosis and treatment of pediatric acute pancreatitis[J]. J Clin Hepatol, 2017, 33( 6): 1196- 1200. DOI: 10.3969/j.issn.1001-5256.2017.06.039. 吴杰, 刘羽飞, 孔文文, 等. 儿童急性胰腺炎诊断与治疗的研究进展[J]. 临床肝胆病杂志, 2017, 33( 6): 1196- 1200. DOI: 10.3969/j.issn.1001-5256.2017.06.039.
[38]	GIRARD E, ABBA J, ARVIEUX C, et al. Management of pancreatic trauma[J]. J Visc Surg, 2016, 153( 4): 259- 268. DOI: 10.1016/j.jviscsurg.2016.02.006.