探讨儿童急性胰腺炎(AP)病因、分型及危险因素。

选择2009年1月至2018年10月在四川大学华西医院及华西第二医院住院治疗的217例AP患儿为研究对象。按照既往病史，将其分为初发性AP组(n＝181)及复发性AP组(n＝36)。收集AP患儿一般临床资料，实验室检查与影像学检查结果及并发症发生率等。采用单因素方差分析或成组t检验，对患儿年龄、体重、白细胞计数、血细胞比容(HCT)、血清白蛋白水平等进行比较。采用Mann-Whitney U检验或Kruskal-Wallis H检验，对患儿住院时长与脂肪酶、淀粉酶、三酰甘油和血清肌酐水平进行比较。采用χ²检验或Fisher确切概率法，对患儿性别、病因构成比等进行比较。本研究符合2013年新修订的《世界医学协会赫尔辛基宣言》要求，并且通过四川大学华西医院生物医学伦理委员会审核批准[审批文号：2019年审(437)号]。

①2组患儿的性别构成比、年龄、体重及住院时长比较，差异均无统计学意义(P>0.05)。②这217例AP患儿中，有明确病因者为102例(47.0%)，其中，胆源性AP为42例(19.4%)、先天性胰腺解剖结构异常为22例(10.1%)、药物所致AP为14例(6.5%)。初发性AP组和复发性AP组患儿病因构成比比较，差异无统计学意义(P＝0.952)。初发性AP组181例患儿中，不同年龄段患儿常见病因构成比比较，差异有统计学意义(P<0.001)。③初发性AP患儿中，中症AP(MSAP)及重症AP(SAP)患儿所占比例分别为14.4%(26/181)及7.7%(14/181)，AP患儿病死率及SAP患儿病死率分别为1.1%(2/181)和14.3%(2/14)。胰腺假性囊肿(25.0%，10/40)是MSAP及SAP患儿最常见的局部并发症。④初发性AP组181例患儿中，不同AP分型患儿的入院时白细胞计数、血清白蛋白和血清Ca²⁺水平比较，差异均有统计学意义(P<0.05)。入院时，白细胞计数越高，患儿出现SAP的风险越高(OR＝1.114，95%CI：1.054～1.176, P<0.001)；血清白蛋白水平越低，患儿出现SAP的风险越高(OR＝0.911，95%CI：0.862～0.963, P＝0.001)。

AP具有较高的复发率，胆源性、先天性胰腺解剖结构异常、药物均是导致儿童发生AP的常见病因。初发性AP患儿常因年龄不同而病因各异，并且入院时白细胞计数、血清白蛋白水平与儿童初发性AP的分型相关。对于AP患儿的诊治，应重视病因诊断及对AP分型评估。

To investigate etiology, classification and risk factors of pediatric acute pancreatitis (AP).

A total of 217 AP children who were admitted to the West China Hospital and West China Second Hospital, Sichuan University from January 2009 to October 2018 were included into this study. They were divided into first-onset AP group (n=181) and recurrent AP group (n=36) according to the initial medical history.The clinical, laboratory and radiographic data, and complications were collected. Comparisons of age, weight, white blood cell count, serum albumin (ALB), hematocrit (HCT)were conducted by one-way ANOVA or independent-samples t test. Comparisons of hospital stay, lipase, amylase, triglyceride and serum creatinine were conducted by Mann-Whitney U or Kruskal-Wallis H test. Constituent ratio of gender and etiology were analyzed by chi-square test or Fisher′s exact test. This study was in line with the requirements of the World Medical Association Helsinki Declaration revised in 2013, and was authorized by the West China Hospital of Sichuan University Biomedical Research Ethics Committee [Approval No.2019(437)].

①There were no significant differences between first-onset AP group and recurrent AP group in gender, age, weight and hospital stay (P>0.05). ②Among 217 AP patients, there were 102 patients (47.0%) with specific etiologies.The proportion of biliary cause, congenital anatomic abnormalities and drug was 19.4% (42/217), 10.1%(22/217) and 6.5% (14/217), respectively. There was no significant difference in etiological composition ratio between first-onset AP group and recurrent AP group (P=0.952). But among 181 children in first-onset AP group, the constituent ratios of common causes in AP patients at different age periods were compared, and the difference was statistically significant (P<0.001). ③In first-onset group, the proportion of moderately severe AP (MSAP) and severe AP (SAP) was 14.4% (26/181) and 7.7% (14/181), respectively. The mortality of AP and SAP were 1.1% (2/181) and 14.3% (2/14) in first-onset group, respectively. The most common local complication in MSAP and SAP was pancreatic pseudocyst with the proportion of 25.0% (10/40). ④In first-onset group, there were significant differences among mild AP, MSAP and SAP in white blood cell count, serum albumin and Ca²⁺ levels (P<0.05). Elevated white blood cell count increased the severity risk of first-onset AP (OR=1.114, 95%CI: 1.054-1.176, P<0.001), while reduced serum albumin level increased it as well (OR=0.911, 95%CI: 0.862-0.963, P=0.001).

Pediatric AP has quite high recurrent rate. Biliary causes, congenital anatomic abnormalities and drug were the common etiologies of pediatric AP.There was a significant etiological difference between different age periods in first-onset AP. White blood cell count and serum albumin levels on admission were correlated to the severity of first-onset AP. Etiological diagnosis and severity assessment should be valued in treatment of pediatric AP.