中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
11期
854-858
,共5页
胰腺炎%儿童%白血病
胰腺炎%兒童%白血病
이선염%인동%백혈병
Pancreatitis%Child%Leukemia
目的 分析门冬酰胺酶相关胰腺炎(AAP)的临床特征和诊治经过.方法 收集福建医科大学附属协和医院2011年3月至2014年3月使用培门冬酶后并发AAP 13例患儿的临床资料,分析其临床特点、辅助检查、治疗及转归情况.结果 本组病例包括12例急性淋巴细胞型白血病和1例T淋巴母细胞淋巴瘤,男8例,女5例,平均年龄6岁,12例发生在诱导化疗期间,1例在维持强化期.AAP发生于最近一次培门冬酶使用后的平均时间为9d;平均使用次数为2次.腹痛为主要临床表现(11例).AAP诊断48 h内血淀粉酶最高值为118～1 585 U/L(正常值25～ 125 U/L)、血脂肪酶221～1 673 U/L(正常值25～ 300 U/L).3例反复增高达正常值上限3倍并发胰腺假性囊肿.胰腺CT检查11例发现胰腺炎特征性影像学改变,其中胰腺周围渗出8例,形成假性囊肿4例.采用奥曲肽和乌司他丁抑制胰酶分泌,并联合糖皮质激素抑制炎症反应可显著缓解腹痛.腹腔穿刺置管引流3例.鼻空肠置管行肠内营养5例.13例中9例痊愈,4例并发胰腺假性囊肿的患儿2例囊肿消退,2例死亡.结论 AAP主要表现为腹痛,有时症状隐匿,易迅速进展,早期识别意义重大,并发胰腺假性囊肿者预后较差.
目的 分析門鼕酰胺酶相關胰腺炎(AAP)的臨床特徵和診治經過.方法 收集福建醫科大學附屬協和醫院2011年3月至2014年3月使用培門鼕酶後併髮AAP 13例患兒的臨床資料,分析其臨床特點、輔助檢查、治療及轉歸情況.結果 本組病例包括12例急性淋巴細胞型白血病和1例T淋巴母細胞淋巴瘤,男8例,女5例,平均年齡6歲,12例髮生在誘導化療期間,1例在維持彊化期.AAP髮生于最近一次培門鼕酶使用後的平均時間為9d;平均使用次數為2次.腹痛為主要臨床錶現(11例).AAP診斷48 h內血澱粉酶最高值為118～1 585 U/L(正常值25～ 125 U/L)、血脂肪酶221～1 673 U/L(正常值25～ 300 U/L).3例反複增高達正常值上限3倍併髮胰腺假性囊腫.胰腺CT檢查11例髮現胰腺炎特徵性影像學改變,其中胰腺週圍滲齣8例,形成假性囊腫4例.採用奧麯肽和烏司他丁抑製胰酶分泌,併聯閤糖皮質激素抑製炎癥反應可顯著緩解腹痛.腹腔穿刺置管引流3例.鼻空腸置管行腸內營養5例.13例中9例痊愈,4例併髮胰腺假性囊腫的患兒2例囊腫消退,2例死亡.結論 AAP主要錶現為腹痛,有時癥狀隱匿,易迅速進展,早期識彆意義重大,併髮胰腺假性囊腫者預後較差.
목적 분석문동선알매상관이선염(AAP)적림상특정화진치경과.방법 수집복건의과대학부속협화의원2011년3월지2014년3월사용배문동매후병발AAP 13례환인적림상자료,분석기림상특점、보조검사、치료급전귀정황.결과 본조병례포괄12례급성림파세포형백혈병화1례T림파모세포림파류,남8례,녀5례,평균년령6세,12례발생재유도화료기간,1례재유지강화기.AAP발생우최근일차배문동매사용후적평균시간위9d;평균사용차수위2차.복통위주요림상표현(11례).AAP진단48 h내혈정분매최고치위118～1 585 U/L(정상치25～ 125 U/L)、혈지방매221～1 673 U/L(정상치25～ 300 U/L).3례반복증고체정상치상한3배병발이선가성낭종.이선CT검사11례발현이선염특정성영상학개변,기중이선주위삼출8례,형성가성낭종4례.채용오곡태화오사타정억제이매분비,병연합당피질격소억제염증반응가현저완해복통.복강천자치관인류3례.비공장치관행장내영양5례.13례중9례전유,4례병발이선가성낭종적환인2례낭종소퇴,2례사망.결론 AAP주요표현위복통,유시증상은닉,역신속진전,조기식별의의중대,병발이선가성낭종자예후교차.
Objective To analyze the clinical characteristics and the course of diagnosis and therapy of PEG-asparaginase associated pancreatitis (AAP)in childhood,and to reveal the pathophysiology of AAP,enhance the ability of diagnosis and treament.Method Data of 13 cases with AAP in childhood seen from March 2011 to March 2014 were analyzed with regard to clinical manifestations,laboratory findings,imaging feature and treatment.Result AAP was found in 12 of acute lymphoblastic leukemia (ALL) and 1 of non-Hodgkin's lymphoma (NHL),8 were boys and 5 were girls,with a mean age 6 years.In 12 cases AAP occurred during the induction-remission treatment,in 1 case during the maintenance-intensification phase.AAP occurred after a median of two doses,and 9 d (median) from the latest administration of PEG-asparaginase.The major manifestations of AAP was abdominal pain (11/13).At the time of AAP diagnosis during the first 48 hours the median peak serum amylase and serum lipase levels were 559 U/L (range 118 -1 585,upper normal limit:125) and 934 U/L (range 221-1 673,upper normal limit:300).Three cases with serum amylase and serum lipase levels above 3 times upper normal limit were repeatedly complicated with pancreatic pseudocyst; 11 patients had abnormal CT imaging,8 cases revealed effusion around the pancreas,and 4 cases had pseudocyst.Therapy with ulinastatin,octreotide acetate,glucocorticoid could relieve abdominal pain significantly.Three cases underwent abdominal puncture drainage and 5 cases fulfilled nasojejunal nutrition therapy.Nine of them were cured,4 developed pseudocyst,in 2 AAP vanished gradually and 2 died with pseudocyst.Conclusion The major manifestations of AAP were abdominal pain,but sometimes apparent and sometimes latent.Condition of acute pancreatitis may exacerbate rapidly and easily.Early identification had significance.Pancreatic pseudocyst suggested a poor prognosis.
