Clinical and prognostic features of children with acute pancreatitis:A retrospective analysis of 105 cases

Zhong Rui; Xu Huan; Peng Yan; Yan YongFeng; Jiang Xin; Wang Min; Fu WenGuang; Tang XiaoWei

doi:10.3969/j.issn.1001-5256.2019.10.022

Volume 35 Issue 10

Oct. 2019

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2019 > 35(10): 2240-2245

PDF( 2157 KB)

Clinical and prognostic features of children with acute pancreatitis:A retrospective analysis of 105 cases

DOI: 10.3969/j.issn.1001-5256.2019.10.022

Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University

Research funding:

Received Date: 2019-06-19
Published Date: 2019-10-20

Abstract

Abstract

Objective To investigate the etiology and clinical features of acute pancreatitis(AP) in children. Methods A total of 105 children with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to December 2018 were enrolled,and according to the severity of AP,they were divided into mild acute pancreatitis(MAP) group with 77 children,moderate-severe acute pancreatitis(MSAP) group with 25 children,and severe acute pancreatitis(SAP) group with 3 children,and a comparative analysis was performed for the MAP group and the MSAP group. According to age,the children were divided into young age group with 36 children aged 2-9 years and old age group with 69 children aged 10-17 years,and according to the presence or absence of recurrence,they were divided into recurrence group with 17 children and non-recurrence group with 88 children; a comparative analysis was also performed. A total of 105 adults with incipient AP were randomly selected from databases and were enrolled as control group,and the groups were compared in terms of general data,etiology,laboratory markers,disease severity,complications,and treatment outcome. The t-test was used for comparison of normally distributed continuous data between groups,and the corrected t-test was used in case of heterogeneity of variance; the Mann-Whitney U test was used for comparison of non-normally distributed data and ranked data between groups; the chi-square test was used for comparison of categorical data between groups; the trend chi-square test was used for unidirectional ordered categorical variables,and a Goodman-Kruskal Gamma analysis was used for bidirectional ordered categorical variables; the Kaplan-Meier method and the log-rank test were used for the comparison of cumulative risk. Results As for etiology,among the 105 children with AP,31(29. 5%) had idiopathic AP,27(25. 7%) had biliary AP,20(19. 0%) had trauma,11(10. 5%) had hyperlipidemic AP,10(9. 5%) had viral infection,and 6(5. 7%) had drug-induced AP,and there was a significant difference in the constituent ratio of etiology between the pediatric patients and the adult patients(χ2= 99. 282,P < 0. 001). Compared with the adult patients,the pediatric patients had significantly lower severity(Z =-2. 325,P < 0. 02) and proportion of individuals with pancreatic necrosis(3. 8% vs 12. 4%,χ2=5. 184,P < 0. 023). Compared with the MSAP group at 24 hours after admission,the MAP group had significantly lower C-reactive protein,blood lipase,white blood cell count,and blood glucose(Z =-6. 406,-3. 096,and-2. 762,t = 3. 298,all P < 0. 05) and a significantly higher blood calcium level(t = 3. 43,P = 0. 001). During follow-up,17 children(16. 2%) developed AP again,and the recurrence rate increased with an increase in disease severity(χ2= 6. 503,P = 0. 011). Recurrent AP was often observed in girls(82. 4%)(χ2= 12. 241,P < 0. 001),and the children with first-onset AP and pancreatic necrosis had a higher recurrence rate(χ2= 6. 572,P =0. 01). Hyperlipidemia was the most common cause of acute recurrent pancreatitis(ARP) in children(χ2= 5. 533,P = 0. 019),and hyperlipidemic AP had the highest risk of recurrence over time,while viral and drug-induced AP had the lowest risk of recurrence(P =0. 028). Conclusion Idiopathic and biliary AP are the main causes of AP in children,and compared with adults,children tend to have milder disease conditions and a better prognosis. Female sex and first-onset AP with pancreatic necrosis and hyperlipidemia are high-risk factors for ARP.
- pancreatitis,
- incidence,
- child,
- prognosis

FullText(HTML)

References(33)

References

[1] ABU-EL-HAIJA M,KUMAR S,QUIROS JA,et al. Management of acute pancreatitis in the pediatric population:A clinical report from the North American Society for Pediatric Gastroenterology,Hepatology and Nutrition Pancreas Committee[J]. J Pediatr Gastroenterol Nutr,2018,66(1):159-176.

[2] HUSAIN SZ,SRINATH AI. What’s unique about acute pancreatitis in children:Risk factors,diagnosis and management[J]. Nat Rev Gastroenterol Hepatol,2017,14(6):366-372.

[3] ZHAO ZQ,XI Z,YAN PF. Clinical value of combined detection of amylase,lipase and procalcitonin in the diagnosis of children with acute pancreatitis[J]. Chin J Clin Pharmacol Ther,2017,22(11):1265-1268.(in Chinese)赵志强,席錾,闫鹏飞.血清脂肪酶、血清淀粉酶与血清降钙素原在儿童急性胰腺炎诊断中的意义[J].中国临床药理学与治疗学,2017,22(11):1265-1268.

[4] BANKS PA,BOLLEN TL,DERVENIS C,et al. Classification of acute pancreatitis--2012:Revision of the Atlanta classification and definitions by international consensus[J]. Gut,2013.62(1):102-111.

[5] PARNICZKY A,ABU-EL-HAIJA M,HUSAIN S,et al. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis[J]. Pancreatology,2018,18(2):146-160.

[6] MORINVILLE VD,HUSAIN SZ,BAI H,et al. Definitions of pediatric pancreatitis and survey of present clinical practices[J].J Pediatr Gastroenterol Nutr,2012,55(3):261-265.

[7] BAI HX,LOWE ME,HUSAIN SZ. What have we learned about acute pancreatitis in children?[J]. J Pediatr Gastroenterol Nutr,2011,52(3):262-270.

[8] RESTREPO R,HAGEROTT HE,KULKARNI S,et al. Acute pancreatitis in pediatric patients:Demographics, etiology,and diagnostic imaging[J]. AJR Am J Roentgenol,2016,206(3):632-644.

[9] FAYYAZ Z,SULEMAN H,HASHMI MA,et al. Clinical presentation,aetiology and complications of pancreatitis in children[J]. J Ayub Med Coll Abbottabad,2015,27:628-632.

[10] GRZYBOWSKA-CHLEBOWCZYK U,JASIELSKA M,FLAKWANCERZ A,et al. Acute pancreatitis in children[J]. Prz Gastroenterol,2018,13(1):69-75.

[11] PANT C,DESHPANDE A,SFERRA TJ,et al. Emergency department visits for acute pancreatitis in children:Results from the Nationwide Emergency Department Sample 2006-2011[J]. J Investig Med,2015,63(4):646-648.

[12] ABU-EL-HAIJA M,EL-DIKA S,HINTON A,et al. Acute pancreatitis admission trends:A national estimate through the kids'inpatient database[J]. J Pediatr,2018,194:147-151. e1.

[13] MAJBAR AA,CUSICK E,JOHNSON P,et al. Incidence and clinical associations of childhood acute pancreatitis[J]. Pediatrics,2016,138(3). pii:e20161198.

[14] PODDAR U,YACHHA SK,BORKAR V,et al. A Report of 320cases of childhood pancreatitis:Increasing incidence,etiologic categorization,dynamics,severity assessment,and outcome[J]. Pancreas,2017,46(1):110-115.

[15] PARK A,LATIF S U,SHAH AU,et al. Changing referral trends of acute pancreatitis in children:A 12-year singlecenter analysis[J]. J Pediatr Gastroenterol Nutr,2009,49(3):316-322.

[16] SWEENY KF,LIN TK,NATHAN JD,et al. Rapid progression of acute pancreatitis to acute recurrent pancreatitis in children[J]. J Pediatr Gastroenterol Nutr,2019,68(1):104-109.

[17] YU XY. Clinical characteristics,diagnosis and treatment of 65cases of acute pancreatitis in children[J]. Anhui Med,2015,36(5):576-579.(in Chinese)余溪洋.小儿急性胰腺炎65例临床特点及诊治分析[J].安徽医学,2015,36(5):576-579.

[18] HU B,WANG XY. Etiology,diagnosis and treatment of acute pancreatitis in 93 children[J]. Chin J Surg Integr Tradit West Med,2016,22(6):583-585.(in Chinese)胡博,王晓晔. 93例儿童急性胰腺炎病因和诊治分析[J].中国中西医结合外科杂志,2016,22(6):583-585.

[19] KSIADZYNA D. Drug-induced acute pancreatitis related to medications commonly used in gastroenterology[J]. Eur J Intern Med,2011,22(1):20-25.

[20] ZHU Y,PAN X,ZENG H,et al. A study on the etiology,severity,and mortality of 3260 patients with acute pancreatitis according to the revised atlanta classification in Jiangxi,China over an 8-year period[J]. Pancreas,2017,46(4):504-509.

[21] GUO YJ. Meta analysis of etiology and clinical characteristics of recurrent acute pancreatitis in China in recent ten years[J].Chin J Pancreatol,2017,17(4):231-237.(in Chinese)郭英杰.中国近十年复发性急性胰腺炎病因及临床特征的Meta分析[J].中华胰腺病杂志,2017,17(4):231-237.

[22] GAO F,YAN Z,ZHANG J. The relationship between the level of triglyceride and the severity of acute hypertriglyceridemia pancreatitis[J]. J Clin Hepatol,2018,34(11):2360-2363.(in Chinese)高峰,闫真,张杰.甘油三酯水平与急性高甘油三酯血症性胰腺炎严重程度的关系[J].临床肝胆病杂志,2018,34(11):2360-2363.

[23] RAIZNER A,PHATAK UP,BAKER K,et al. Acute necrotizing pancreatitis in children[J]. J Pediatr,2013,162(4):788-792.

[24] PARK AJ,LATIF SU,AHMAD MU,et al. A comparison of presentation and management trends in acute pancreatitis between infants/toddlers and older children[J]. J Pediatr Gastroenterol Nutr,2010,51(2):167-170.

[25] COLE S,WAKEHAM M,WERLIN S,et al. Classification and nutrition management of acute pancreatitis in the pediatric intensive care unit[J]. J Pediatr Gastroenterol Nutr,2018,67(6):755-759.

[26] ABU-EL-HAIJA M,UC A,WERLIN SL,et al. Nutritional considerations in pediatric pancreatitis:A position paper from the NASPHAN pancreas committee and ESPHAN cystic fibrosis/pancreas working group[J]. J Pediatr Gastroenterol Nutr,2018,67(1):131-143.

[27] ABU-EL-HAIJA M,LIN TK,NATHAN JD. Management of acute pancreatitis in children[J]. Curr Opin Pediatr,2017,29(5):592-597.

[28] ALABDULKAREEM A,ALMAHMOUD T,AL-TAHAN H,et al.Etiology and clinical characteristics of pediatric acute pancreatitis in Saudi Arabia:A 20-year experience from a single tertiary center[J]. Int J Pediatr Adolesc Med,2018,5(1):13-17.

[29] UC AHUSAIN SZ. Pancreatitis in children[J]. Gastroenterology,2019,156(7):1969-1978.

[30] HU JF,LU LG. Epidemiological characteristics,pathogenesis,diagnosis and treatment of alcoholic pancreatitis[J]. J Clin Hepatol,2019,35(2):448-450.(in Chinese)胡江峰,陆伦根.酒精性胰腺炎的流行病学特征、发病机制及诊疗进展[J].临床肝胆病杂志,2019,35(2):448-450.

[31] PANT C,SFERRA TJ,LEE BR,et al. Acute recurrent pancreatitis in children:A study from the pediatric health information system[J]. J Pediatr Gastroenterol Nutr,2016,62(3):450-452.

[32] SHUKLA-UDAWATTA M,MADANI SKAMAT D. An update on pediatric pancreatitis[J]. Pediatr Ann,2017,46(5):e207-e211.

[33] ABU-EL-HAIJA M,VALENCIA CA,HORNUNG L,et al.Genetic variants in acute,acute recurrent and chronic pancreatitis affect the progression of disease in children[J]. Pancreatology,2019,19(4):535-540.

Relative Articles

[1]	Development Committee of Clinical Practice Guidelines for Robotic Hepatopancreatobiliary Surgery. Clinical practice guidelines for robotic hepatopancreatobiliary surgery[J]. Journal of Clinical Hepatology, 2019, 35(7): 1459-1471. doi: 10.3969/j.issn.1001-5256.2019.07.009
[2]	Development Committee of Clinical Practice Guidelines for Laparoscopic Hepatopancreatobiliary Surgery. Clinical practice guidelines for laparoscopic hepatopancreatobiliary surgery[J]. Journal of Clinical Hepatology, 2019, 35(7): 1450-1458. doi: 10.3969/j.issn.1001-5256.2019.07.008
[3]	Xu YanLing, Zhao Xu, Guo XiaoLin, Ji HuiFan, Zhang Ying, Song XinYue, Wang JingYu, Sun XiaoFeng, Liu Kai, He RongHua, Gao PuJun. Clonorchiasis complicated by multiple cholelithiasis and cholestatic cirrhosis misdiagnosed as Budd-Chiari syndrome: A case report[J]. Journal of Clinical Hepatology, 2018, 34(7): 1514-1516. doi: 10.3969/j.issn.1001-5256.2018.07.029
[4]	Zhao GuoPing, Hu JianPing, Wang JiRong. Clinical experience in choledochoscopy for the treatment of intrahepatic bile duct stones complicated by biliary stricture:a clinical analysis of 230 cases[J]. Journal of Clinical Hepatology, 2017, 33(11): 2166-2169. doi: 10.3969/j.issn.1001-5256.2017.11.023
[5]	Jiang Chao, Wang HaiJiu, Ren Li, Yang DanCaiRang, Hou LiChao, Zhou Ying, Wen Hao, Fan HaiNing. Application status of three- dimensional CT reconstruction in hepatobiliary surgery[J]. Journal of Clinical Hepatology, 2017, 33(2): 389-393. doi: 10.3969/j.issn.1001-5256.2017.02.041
[6]	Lu Xia, Jia HaiMing, Mi TaiYu, Zhang WenQuan, Gao Peng. Effect of fast track surgery on anxiety index and stress indices in patients undergoing laparoscopic cholecystectomy[J]. Journal of Clinical Hepatology, 2017, 33(2): 308-312. doi: 10.3969/j.issn.1001-5256.2017.02.022
[7]	Wu Xiao, Xia Hao, Wu Jian, Zhang Ming. Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy[J]. Journal of Clinical Hepatology, 2016, 32(9): 1756-1759. doi: 10.3969/j.issn.1001-5256.2016.09.025
[8]	Wu ErBin, Zhang JinWei. Clinical application of selective intraoperative cholangiography in biliary system surgery[J]. Journal of Clinical Hepatology, 2016, 32(7): 1357-1359. doi: 10.3969/j.issn.1001-5256.2016.07.031
[9]	Chen ZhiYu, Bie Ping. Clinical application of combined vascular resection and reconstruction in surgical treatment of hilar cholangiocarcinoma[J]. Journal of Clinical Hepatology, 2016, 32(7): 1277-1279. doi: 10.3969/j.issn.1001-5256.2016.07.011
[10]	Han Wei, Yue Qing, Yan JingZhe, Jia BaoXing, Wang YingChao, Liu YaHui. Concept of fast-track surgery and its application in perioperative period of hepatectomy for liver cancer[J]. Journal of Clinical Hepatology, 2016, 32(10): 2007-2011. doi: 10.3969/j.issn.1001-5256.2016.10.044
[11]	Qi WenLei, Zhang RuoYan, Chai WenGang, Liu MingJiang, Du XiaoHong, Ye JunFeng. Diagnosis of clonorchiasis during and after biliary tract surgery: a clinical analysis of 15 cases[J]. Journal of Clinical Hepatology, 2016, 32(11): 2134-2137. doi: 10.3969/j.issn.1001-5256.2016.11.026
[12]	Cheng XiangChao, Yuan QiDong, Zhao JianHong, Liu Bin. Percutaneous transhepatic approach for intrahepatic and extrahepatic bile duct stones: a clinical analysis of 19 cases[J]. Journal of Clinical Hepatology, 2015, 31(10): 1685-1687. doi: 10.3969/j.issn.1001-5256.2015.10.031
[13]	Zhang HaoYu, Liu Bin. Research advances in surgical treatment of intrahepatic bile duct stones[J]. Journal of Clinical Hepatology, 2015, 31(10): 1726-1729. doi: 10.3969/j.issn.1001-5256.2015.10.046
[14]	Li QiNan, Zhang YuHuai, Geng Jie. Safety and efficacy of fast-track surgery in perioperative nursing for biliary calculi surgery: a meta-analysis[J]. Journal of Clinical Hepatology, 2015, 31(10): 1660-1664. doi: 10.3969/j.issn.1001-5256.2015.10.025
[15]	Xing TongChao, Ren Bin, Wang YuPeng, Yang DongXing. Clinical effect of choledochofiberscope-assisted secondary surgery in treatment of intrahepatic and extrahepatic biliary stones[J]. Journal of Clinical Hepatology, 2015, 31(8): 1325-1327. doi: 10.3969/j.issn.1001-5256.2015.08.036
[16]	Li Jiang, Liu Bin. More attention to initial surgical treatment of hepatolithiasis[J]. Journal of Clinical Hepatology, 2015, 31(10): 1612-1614. doi: 10.3969/j.issn.1001-5256.2015.10.012
[17]	Tang CaiXi, Zhao ZhiJian, Feng Bin, Yang KaiQing. Surgical treatment of cholangiolithiasis with cavernous transformation of the portal vein: a review and analysis of 18 cases[J]. Journal of Clinical Hepatology, 2014, 30(1): 39-41. doi: 10.3969/j.issn.1001-5256.2014.01.013
[18]	Lu: WenPing. Clinical classification of hepatolithiasis and choice of surgical strategy[J]. Journal of Clinical Hepatology, 2013, 29(6): 404-406+410.
[19]	Wu LiMing, Cheng CaiTao, Wang JiangHua, Chen XianXiang. Clinical effect of laparoscopic reoperation combined with choledochoscope in treatment of intra-and extrahepatic bile duct stones:analysis of 35 cases[J]. Journal of Clinical Hepatology, 2013, 29(7): 516-519. doi: 1001-5256 (2013) 07-0516-04
[20]	Ou Xi, Xiong Pei, Ye JianYu, Liu JiKui. Application of medical obturation glue in the treatment of hepatolithiasis with laparoscopic hepatectomy[J]. Journal of Clinical Hepatology, 2011, 27(9): 927-930.

Supplements(0)

Cited By

Cited by

Periodical cited type(13)

1.	路燕，陈明月，郑秀良，雷宇. 185例药物性肝损伤患者的临床特征分析. 安徽医学. 2022(03): 308-313 .
2.	赵临潇，左博云，李静亚，于东升. 妊娠期肝内胆汁淤积症孕妇胎盘ABCB4基因表达与妊娠结局的关系. 海南医学. 2022(11): 1424-1427 .
3.	张慧芳，王高莹，邹萍，王晶，董蕊锐，张婷，孟西娜. 妊娠期肝内胆汁淤积症血清甘胆酸水平与妊娠结局的关系. 中国临床研究. 2022(06): 793-796 .
4.	林洪萍，黄晋萍，黄淑兰，卢君，黎春，杨佳柳. 中药外洗在妊娠期肝内胆汁淤积症诱发皮肤瘙痒患者中的应用. 中国医学创新. 2022(19): 96-99 .
5.	李媛，郑泽玉，田阗，邬洪明，田嫣然，李茂. 妊娠期肝内胆汁淤积症的危险因素分析. 临床和实验医学杂志. 2021(02): 200-203 .
6.	段兴平，王燕，黄常友，郑会贤，罗一，覃正文，任郁. 妊娠期肝病的临床特征及研究进展. 临床肝胆病杂志. 2020(06): 1407-1411 . 本站查看
7.	陈韵洁，张晨，谭娟. 脂肪酸转运体蛋白FATP4、CD36、FABP1在妊娠期肝内胆汁淤积胎盘中表达研究. 中外医疗. 2020(15): 30-31+46 .
8.	唐照青，俞海珍. 联合监护评估对妊娠期无症状高胆汁酸血症孕妇围生儿预后的价值. 中国现代药物应用. 2020(18): 19-22 .
9.	汪学耀，张涛，荆成宝. 血清总胆汁酸与甘胆酸水平诊断妊娠期肝内胆汁淤积症能力的Meta分析. 现代检验医学杂志. 2020(05): 73-76 .
10.	吕玉清. 我院中药处方中妊娠患者疾病及用药情况分析研究. 海峡药学. 2020(10): 176-178 .
11.	刘燕，王丽娟，李盈盈. 综合护理在妊娠期肝内胆汁淤积症患者中的临床效果分析. 妇产与遗传(电子版). 2020(03): 40-44 .
12.	张燕，王伟红. 妊娠期肝内胆汁淤积症孕妇血清总胆汁酸、谷草转氨酶及Th17/Treg平衡水平及临床意义. 中国计划生育学杂志. 2020(12): 2093-2097 .
13.	马艳辉，邵久玲，王双梅. 低分子肝素治疗妊娠期肝内胆汁淤积症的疗效及对肝胆指标、母婴结局的影响. 哈尔滨医药. 2020(05): 438-440 .

Other cited types(3)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (1600) PDF downloads(233)

Clinical and prognostic features of children with acute pancreatitis:A retrospective analysis of 105 cases

DOI: 10.3969/j.issn.1001-5256.2019.10.022