Theochari M, Ioannidou D, Nounopoulos H, Bouloukos A, Papadogiannis M, Katsikari M, Karpathios T, Bartsocas C S
Department of Pediatrics, Faculty of Nursing, University of Athens, P. & A. Kyriakou Children's Hospital, Greece.
J Pediatr Endocrinol Metab. 2000 Mar;13(3):303-6. doi: 10.1515/jpem.2000.13.3.303.
Increased echogenicity of the pancreas, due to hemosiderosis, is a frequent laboratory finding in children and adolescents with beta-thalassemia. The aim of this study was to investigate whether increased echogenicity of the pancreas is associated with dysfunction. The ultrasonic image of the pancreas was examined in 34 children aged 12+/-3.8 years old and was compared to the endocrine and exocrine functioning of the gland. Oral glucose tolerance test (OGTT) was performed with simultaneous measurement of insulin and serum trypsin. Twenty-six of the 34 patients (76.5%) presented increased echogenicity, while 8 (23.5%) had a normal ultrasonic pancreatic image. 77% of the patients with increased echogenicity had abnormal OGTT, 46%, with subnormal or increased insulin values, and 32.5% manifested low levels of trypsin. Among the patients with normal ultrasound, 25% had abnormal OGTT and 37.5% abnormal insulin values. Statistical analysis with Student's t-test revealed that patients with increased echogenicity had significantly higher glucose values on OGTT at 60: 7.6 +/- 1.8 mmol/l (137.3 +/- 33.7 mg/dl) as compared to the patients with normal ultrasound: 6.1 +/- 1.2 mmol/l (110.75 +/- 21.72 mg/dl) (p<0.05). Insulin values were significantly affected at 30, 60, and 90 min: 570+/-301, 332+/-156, 294+/-158 pmol/l (79.54 +/- 42, 46.4 +/- 21.8, 41.04 +/- 22 mU/l) respectively in patients with increased echogenicity in comparison to those with normal ultrasonographic image of the gland: 301 +/- 170, 192 +/- 52, 135 +/- 63 pmol/l (42 +/- 23.7, 26.85 +/- 7.36, 18.9 +/- 8.8 mU/l) (p<0.05). No statistical significance was observed between the two groups regarding trypsin levels, even though abnormal values were observed in more children with increased echogenicity than in patients with a normal ultrasound. The above findings confirm that increased echogenicity of the pancreas is associated with disturbance of its function. This simple imaging method could be used as a rough early index of detection of an increased risk for developing diabetes mellitus in patients with beta-thalassemia.
由于含铁血黄素沉着症导致的胰腺回声增强，是β地中海贫血儿童和青少年常见的实验室检查结果。本研究的目的是调查胰腺回声增强是否与功能障碍有关。对34名年龄为12±3.8岁的儿童的胰腺超声图像进行了检查，并与该腺体的内分泌和外分泌功能进行了比较。进行口服葡萄糖耐量试验（OGTT），同时测量胰岛素和血清胰蛋白酶。34例患者中有26例（76.5%）胰腺回声增强，8例（23.5%）胰腺超声图像正常。胰腺回声增强的患者中77%的OGTT异常，46%胰岛素值低于正常或升高，32.5%胰蛋白酶水平较低。在超声正常的患者中，25%的OGTT异常，37.5%胰岛素值异常。采用学生t检验进行统计分析，结果显示，与超声正常的患者相比，胰腺回声增强的患者在OGTT 60分钟时的血糖值显著更高：分别为7.6±1.8 mmol/L（137.3±33.7 mg/dl）和6.1±1.2 mmol/L（110.75±21.72 mg/dl）（p<0.05）。胰岛素值在30、60和90分钟时受到显著影响：胰腺回声增强的患者分别为570±301、332±156、294±158 pmol/L（79.54±42、46.4±21.8、41.04±22 mU/L），而腺体超声图像正常的患者分别为301±170、192±52、135±63 pmol/L（42±23.7、26.85±7.36、18.9±8.8 mU/L）（p<0.05）。尽管胰腺回声增强的儿童中观察到异常值的人数多于超声正常的患者，但两组之间在胰蛋白酶水平上未观察到统计学差异。上述发现证实，胰腺回声增强与其功能紊乱有关。这种简单的成像方法可作为检测β地中海贫血患者发生糖尿病风险增加的粗略早期指标。
