Miller T L, Winter H S, Luginbuhl L M, Orav E J, McIntosh K
Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, MA 02115.
J Pediatr. 1992 Feb;120(2 Pt 1):223-7. doi: 10.1016/s0022-3476(05)80431-7.
Because pancreatitis has been reported frequently in adults with human immunodeficiency virus infection, we sought to determine the incidence of pancreatitis in children with acquired immunodeficiency syndrome by reviewing all records of children with AIDS, their serum amylase and lipase levels, and the factors associated with pancreatitis through a case-control analysis. During a 6-year period pancreatitis developed in 9 (17%) of 53 pediatric patients with AIDS. Six children had vertical transmission of infection and three patients had acquired HIV infection through contaminated blood products. Pancreatitis developed at a median age of 5.2 years (range 1.2 to 20 years). All patients had vomiting and abdominal pain. When the patients were first seen, lipase values were elevated more than amylase values (p = 0.028). Amylase and lipase levels declined at comparable rates. In the case-control analysis, pentamidine isethionate was significantly associated with pancreatitis (p = 0.02); the risk was greater in patients who received pentamidine isethionate and had absolute CD4 T-lymphocyte counts less than 100 cells/mm3 (p = 0.001). Infections associated with the onset of pancreatitis included cytomegalovirus (4), Cryptosporidium (1), Pneumocystis carinii pneumonia (3), and Mycobacterium avium intracellulare (1). Coinfection with cytomegalovirus was associated with a protracted course in four children. Ultrasonographic examination demonstrated biliary ductal dilatation 6 months after the onset of pancreatitis in one child. Seven children have died at a mean of 8 months after the initial onset of pancreatitis; the one living child has survived 5 months from the onset of pancreatitis. We conclude that pancreatitis is common in pediatric patients with AIDS and may be related to pentamidine isethionate exposure, especially when absolute CD4 T-lymphocyte counts are less than 100 cells/mm3. Serum amylase levels do not always accurately predict the onset of pancreatitis; serum lipase levels should be measured in children with symptoms. The onset of pancreatitis in an HIV-infected child is a poor prognostic indicator.
由于胰腺炎在成人艾滋病病毒感染患者中屡有报道，我们通过回顾所有艾滋病患儿的记录、其血清淀粉酶和脂肪酶水平，以及通过病例对照分析确定与胰腺炎相关的因素，来试图确定获得性免疫缺陷综合征患儿胰腺炎的发病率。在6年期间，53例艾滋病患儿中有9例（17%）发生了胰腺炎。6例患儿为母婴垂直传播感染，3例患者通过受污染的血液制品感染了艾滋病毒。胰腺炎发病的中位年龄为5.2岁（范围1.2至20岁）。所有患者均有呕吐和腹痛症状。患者初诊时，脂肪酶值升高幅度大于淀粉酶值（p = 0.028）。淀粉酶和脂肪酶水平以相似速率下降。在病例对照分析中，乙磺半胱氨酸戊烷脒与胰腺炎显著相关（p = 0.02）；接受乙磺半胱氨酸戊烷脒且绝对CD4 T淋巴细胞计数低于100个细胞/mm³的患者风险更高（p = 0.001）。与胰腺炎发病相关的感染包括巨细胞病毒（4例）、隐孢子虫（1例）、卡氏肺孢子虫肺炎（3例）和鸟分枝杆菌胞内复合群（1例）。4例患儿巨细胞病毒合并感染与病程迁延有关。1例患儿胰腺炎发病6个月后超声检查显示胆管扩张。7例患儿在胰腺炎初次发病后平均8个月死亡；存活的1例患儿自胰腺炎发病已存活5个月。我们得出结论，胰腺炎在艾滋病患儿中很常见，可能与接触乙磺半胱氨酸戊烷脒有关，尤其是当绝对CD4 T淋巴细胞计数低于100个细胞/mm³时。血清淀粉酶水平并不总是能准确预测胰腺炎的发病；有症状的患儿应检测血清脂肪酶水平。艾滋病毒感染患儿发生胰腺炎是预后不良的指标。
