Analysis of related factors for biliary pancreatitis in children
10.3760/cma.j.issn.2095-428X.2017.07.011
- VernacularTitle:儿童胆源性胰腺炎的相关因素分析
- Author:
Zhihua WANG
;
Yushui WANG
- Keywords:
Acute pancreatitis;
Cholelithiasis;
Cholestasis;
Child
- From:
Chinese Journal of Applied Clinical Pediatrics
2017;32(7):516-519
- CountryChina
- Language:Chinese
-
Abstract:
Objective In order to raise the clinicians' recognition of biliary pancreatitis in children,the clinical features between children with biliary pancreatitis and those with non-biliary pancreatitis were compared.Methods In this retrospective study,a total of 88 children with acute pancreatitis(AP)were enrolled,who stayed at the Department of Pediatrics,Tianjin Nankai Hospital from January 2010 to December 2015.The clinical characteristics,biochemical index(amylase,lipase,glucose,calcium,hepatic and renal function)and imageology examination [pancreatic ultrasound,pancreatic computed tomography,magnetic resonance cholangiopancreatography(MRCP)] were analyzed and evaluated.The etiology of biliary pancreatitis was analyzed.In addition,the clinical features,laboratory examinations and imageology between the children with biliary pancreatitis and those with non-biliary pancreatitis were also compared.Then,multiple Logistic regression analysis was conducted to identify the factors which were significantly associated with biliary pancreatitis independently.Results Of the 88 cases,there were 68 cases of non-biliary pancreatitis,aged(9.5±4.2)years,and 20 cases of biliary pancreatitis,aged(6.7±4.5)years,who represented the plurality(22.7％),including 9 cases of anatomic abnormalities and 11 cases of choledocholithiasis,cholecystolithiasis and cholestasis.Compared with children of non-biliary pancreatitis,children with biliary pancreatitis had more severe condition,there was statistically significance between 2 groups(x2=23.313,P=0.000).However,there was no statistically significance between 2 groups related to the gender,course of disease,hospitalization time,body mass index(BMI)percentile and clinical symptoms(all P>0.05).Children with biliary pancreatitis showed higher levels of serum amylase,serum lipase and urine amylase than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-3.535,-3.980,-2.952,P=0.000,0.000,0.003).In addition,children with biliary pancreatitis had higher levels of alanin aminotransferase(ALT),aspartate aminotransferase(AST)than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-5.625,-2.341,P=0.000,0.019).However,total bilirubin did not differ significantly between 2 groups(Z=-0.453,P=0.650).There was no statistically significance between 2 groups in relation to white blood cell count,C-reactive protein(CRP),lactate dehydrogenase(LDH),blood urea nitrogen(BUN),creatinine(Cr),calcium and glucose(all P>0.05).Of the 88 cases,all children with AP were fasting,fluid and electrolyte supplementation,acid suppression of omeprazole,and octreotide by conservative treatment,which was an inhibitor of exocrine pancreatic secretion.In addition,children with AP should be given intravenous antibiotics covering gram-negative bacteria in the early stage.Children with non-biliary pancreatitis had better prognosis than those with biliary pancreatitis,and there was a statistical significance between 2 groups(P=0.000).Children with non-biliary pancreatitis had lower recurrence risk than those with biliary pancreatitis,and there was a statistical significance between 2 groups(x2=4.778,P=0.044).The positive rate was higher by abdominal ultrasound(45.0％)and computed tomography(CT)(81.2％)in biliary pancreatitis group than those with non-biliary pan-creatitis group(17.9％,35.2％),and there were statistical significances between 2 groups(x2=4.782,10.554,P=0.029,0.002).However,there was no statistical significance in relation to MRCP between the biliary pancreatitis group(83.3％)and the non-biliary pancreatitis group(85.7％)(P=1.000).In multiple Logistic regression analysis,ALT was an independent predictor of biliary pancreatitis(OR=0.896,P=0.001).Conclusions ALT is the significant risk factor for predicting biliary pancreatitis over other etiology.A biliary cause should be suspected in children with AP who are presented with high levels of ALT.These findings will spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.
