Etiology and clinical characteristic analysis of pediatric acute pancreatitis

doi:10.3877/cma.j.issn.1673-5250.2021.03.008

Objective

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

Methods

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)].

Results

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).

Conclusions

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.

Key words: Pancreatitis, acute, Recurrence, Virulence factors, Disease attributes, Logistic models, Child

表1 2组AP患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	体重(kg，±s)	住院时长[d，M(P₂₅～P₇₅)]
组别	例数	男	女	年龄(岁，±s)	体重(kg，±s)	住院时长[d，M(P₂₅～P₇₅)]
初发性AP组	181	84(46.4)	97(53.6)	10.8±4.9	38.3±20.1	9.0(7.0～16.0)
复发性AP组	36	23(63.9)	13(36.1)	11.5±3.4	41.9±17.1	9.0(6.5～12.0)
检验值		χ²＝3.671		t＝-1.013	t＝-0.896	Z＝-0.885
P值		0.068		0.315	0.372	0.376

表1 2组AP患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	体重(kg，±s)	住院时长[d，M(P₂₅～P₇₅)]
组别	例数	男	女	年龄(岁，±s)	体重(kg，±s)	住院时长[d，M(P₂₅～P₇₅)]
初发性AP组	181	84(46.4)	97(53.6)	10.8±4.9	38.3±20.1	9.0(7.0～16.0)
复发性AP组	36	23(63.9)	13(36.1)	11.5±3.4	41.9±17.1	9.0(6.5～12.0)
检验值		χ²＝3.671		t＝-1.013	t＝-0.896	Z＝-0.885
P值		0.068		0.315	0.372	0.376

表2 2组AP患儿病因分布情况[例数(%)]

组别	例数	胆源性因素	先天性胰腺解剖结构异常	药物因素	高三酰甘油血症	创伤	甲状旁腺功能亢进	胰腺肿瘤	原因不明
初发性AP组	181	37(20.4)	19(10.5)	12(6.7)	9(5.0)	7(3.9)	2(1.1)	2(1.1)	93(51.4)
复发性AP组	36	5(13.9)	3(8.3)	2(5.6)	2(5.6)	2(5.6)	0(0)	0(0)	22(61.1)
合计	217	42(19.4)	22(10.1)	14(6.5)	11(5.1)	9(4.1)	2(0.9)	2(0.9)	115(53.0)

表2 2组AP患儿病因分布情况[例数(%)]

组别	例数	胆源性因素	先天性胰腺解剖结构异常	药物因素	高三酰甘油血症	创伤	甲状旁腺功能亢进	胰腺肿瘤	原因不明
初发性AP组	181	37(20.4)	19(10.5)	12(6.7)	9(5.0)	7(3.9)	2(1.1)	2(1.1)	93(51.4)
复发性AP组	36	5(13.9)	3(8.3)	2(5.6)	2(5.6)	2(5.6)	0(0)	0(0)	22(61.1)
合计	217	42(19.4)	22(10.1)	14(6.5)	11(5.1)	9(4.1)	2(0.9)	2(0.9)	115(53.0)

表3 初发性AP组中，不同年龄段AP患儿病因分布情况比较[例数(%)]

年龄段(岁)	例数	胆源性	先天性	药物	高三酰甘油血症	创伤	甲状旁腺功能亢进	胰腺肿瘤	原因不明
0～10	78	12(15.4)	17(21.8)	2(2.6)	2(2.6)	5(6.4)	0(0)	0(0)	40(51.3)
11～17	103	25(24.3)	2(1.9)	10(9.7)	7(6.8)	2(1.9)	2(1.9)	2(1.9)	53(51.5)
χ²值		2.156	18.621	3.660	0.906	1.333	—	—	0.001
P值		0.142	<0.001	0.056	0.341	0.248	0.507	0.507	0.981

表3 初发性AP组中，不同年龄段AP患儿病因分布情况比较[例数(%)]

年龄段(岁)	例数	胆源性	先天性	药物	高三酰甘油血症	创伤	甲状旁腺功能亢进	胰腺肿瘤	原因不明
0～10	78	12(15.4)	17(21.8)	2(2.6)	2(2.6)	5(6.4)	0(0)	0(0)	40(51.3)
11～17	103	25(24.3)	2(1.9)	10(9.7)	7(6.8)	2(1.9)	2(1.9)	2(1.9)	53(51.5)
χ²值		2.156	18.621	3.660	0.906	1.333	—	—	0.001
P值		0.142	<0.001	0.056	0.341	0.248	0.507	0.507	0.981

表4 初发性AP组中，MSAP及SAP患儿并发症比较[例数(%)]

分型	例数	胰周积液	胰腺坏死	胰腺假性囊肿	呼吸功能障碍	循环功能障碍	肾脏功能障碍
MSAP	26	2(7.7)	4(15.4)	8(30.8)	6(23.1)	5(19.2)	0(0)
SAP	14	0(0)	2(14.3)	2(14.3)	9(64.3)	6(42.9)	4(28.6)

表4 初发性AP组中，MSAP及SAP患儿并发症比较[例数(%)]

分型	例数	胰周积液	胰腺坏死	胰腺假性囊肿	呼吸功能障碍	循环功能障碍	肾脏功能障碍
MSAP	26	2(7.7)	4(15.4)	8(30.8)	6(23.1)	5(19.2)	0(0)
SAP	14	0(0)	2(14.3)	2(14.3)	9(64.3)	6(42.9)	4(28.6)

表5 初发性AP组中，不同分型AP患儿入院时实验室检查结果比较

分型	例数	白细胞计数(×10⁹/L，±s)	HCT(%，±s)	脂肪酶[IU/L，M(P₂₅～P₇₅)]	淀粉酶[IU/L，M(P₂₅～P₇₅)]
MAP	141	11.7±5.6	38.4±4.7	650.0(212.0～1 540.0)	387.0(149.0～972.0)
MSAP	26	15.1±8.2	37.3±6.7	481.0(111.0～1 212.5)	349.0(147.0～926.5)
SAP	14	19.1±8.5	38.4±9.7	987.0(253.2～2 103.5)	286.0(100.2～853.5)
检验值		F＝6.622	F＝0.296	χ²＝2.469	χ²＝0.346
P值		0.005	0.746	0.291	0.841
分型	例数	血清白蛋白(g/L，±s)	三酰甘油[mmol/L，M(P₂₅～P₇₅)]	血清肌酐[μmol/L，M(P₂₅～P₇₅)]	血清Ca²⁺(mmol/L，±s)
MAP	141	41.3±6.2	0.9(0.6～1.3)	45.5(36.0～63.2)	2.3±0.3
MSAP	26	37.6±6.6	1.1(0.8～2.2)	47.5(33.0～67.2)	2.2±0.2
SAP	14	37.2±6.4	1.2(0.5～2.6)	44.0(39.8～148.0)	2.2±0.2
检验值		F＝5.722	χ²＝2.548	χ²＝0.836	F＝4.212
P值		0.004	0.280	0.658	0.016

表5 初发性AP组中，不同分型AP患儿入院时实验室检查结果比较

分型	例数	白细胞计数(×10⁹/L，±s)	HCT(%，±s)	脂肪酶[IU/L，M(P₂₅～P₇₅)]	淀粉酶[IU/L，M(P₂₅～P₇₅)]
MAP	141	11.7±5.6	38.4±4.7	650.0(212.0～1 540.0)	387.0(149.0～972.0)
MSAP	26	15.1±8.2	37.3±6.7	481.0(111.0～1 212.5)	349.0(147.0～926.5)
SAP	14	19.1±8.5	38.4±9.7	987.0(253.2～2 103.5)	286.0(100.2～853.5)
检验值		F＝6.622	F＝0.296	χ²＝2.469	χ²＝0.346
P值		0.005	0.746	0.291	0.841
分型	例数	血清白蛋白(g/L，±s)	三酰甘油[mmol/L，M(P₂₅～P₇₅)]	血清肌酐[μmol/L，M(P₂₅～P₇₅)]	血清Ca²⁺(mmol/L，±s)
MAP	141	41.3±6.2	0.9(0.6～1.3)	45.5(36.0～63.2)	2.3±0.3
MSAP	26	37.6±6.6	1.1(0.8～2.2)	47.5(33.0～67.2)	2.2±0.2
SAP	14	37.2±6.4	1.2(0.5～2.6)	44.0(39.8～148.0)	2.2±0.2
检验值		F＝5.722	χ²＝2.548	χ²＝0.836	F＝4.212
P值		0.004	0.280	0.658	0.016

表6 初发性AP组患儿分型的有序多分类logistic回归分析变量含义及赋值情况

自变量/因变量	变量名	赋值
AP分型	y	y＝0表示MAP，y＝1表示MSAP，y＝2表示SAP
入院时白细胞计数(×10⁹/L)	x₁	为定量变量
入院时血清白蛋白水平(g/L)	x₂	为定量变量

表6 初发性AP组患儿分型的有序多分类logistic回归分析变量含义及赋值情况

自变量/因变量	变量名	赋值
AP分型	y	y＝0表示MAP，y＝1表示MSAP，y＝2表示SAP
入院时白细胞计数(×10⁹/L)	x₁	为定量变量
入院时血清白蛋白水平(g/L)	x₂	为定量变量

表7 初发性AP组患儿分型的有序多分类logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
入院时白细胞计数	0.108	0.028	15.039	<0.001	1.114	1.054～1.176
入院时血清白蛋白水平	-0.093	0.028	10.994	0.001	0.911	0.862～0.963

表7 初发性AP组患儿分型的有序多分类logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
入院时白细胞计数	0.108	0.028	15.039	<0.001	1.114	1.054～1.176
入院时血清白蛋白水平	-0.093	0.028	10.994	0.001	0.911	0.862～0.963

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