摘要
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.
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.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第11期854-858,共5页
Chinese Journal of Pediatrics
关键词
胰腺炎
儿童
白血病
Pancreatitis
Child
Leukemia
