School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
J Pediatr Gastroenterol Nutr. 2013 Jun;56(6):602-8. doi: 10.1097/MPG.0b013e31828b36d8.
Pediatric pancreatitis remains poorly understood despite increasing incidence and risk of morbidity and mortality. Present predictive scores for severe pediatric acute pancreatitis (AP) are either extrapolated from adults or difficult to use in practice. We aimed to identify laboratory parameters for early prediction of severity of the course of pediatric AP.
A retrospective review of children with AP (January 2000-July 2011) was performed at 2 pediatric hospitals. Predictors of severe AP using laboratory parameters measured within 24 hours of presentation were derived in the cohort from one institution and validated in the other.
A total of 131 pancreatitis episodes, 73 (34% severe) and 58 (24% severe) in the derivation and validation cohorts respectively, were reviewed. In the derivation cohort, serum lipase was significantly higher in severe versus mild AP (median [interquartile range] 18.1 [9.2-39.1] vs 4.9 (3.2-13.3) × upper limit of normal [ULN]; P = 0.002). Logistic regression analysis in the derivation cohort showed serum lipase ≥7 × ULN to be predictive of severe AP. This finding was confirmed in the validation cohort. Based on the combined derivation and validation data, serum lipase ≥7 × ULN was associated with an odds ratio of 7.1 (95% confidence interval 2.5-20.5; P < 0.001) for developing severe AP. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were 85%, 56%, 46%, 89%, 1.939, and 0.27, respectively.
Serum lipase ≥7 × ULN within 24 hours of presentation may be a simple clinical predictor of severe AP in children. Lipase levels below this threshold are strongly associated with a milder course.
尽管小儿胰腺炎的发病率不断增加，且其发病率和死亡率风险较高，但人们对其仍知之甚少。目前，用于预测小儿重症急性胰腺炎（AP）的预测评分要么是从成人中推断出来的，要么在实际应用中很难使用。我们旨在确定实验室参数，以便早期预测小儿 AP 病程的严重程度。
对 2 家儿童医院 2000 年 1 月至 2011 年 7 月期间收治的儿童 AP 病例进行回顾性分析。在一家医院的队列中，根据发病后 24 小时内测量的实验室参数得出预测重症 AP 的指标，并在另一家医院的队列中进行验证。
共回顾了 131 例胰腺炎发作，其中 73 例（34%为重症）和 58 例（24%为重症）分别来自推导队列和验证队列。在推导队列中，血清脂肪酶在重症与轻症 AP 之间差异有统计学意义（中位数[四分位数间距] 18.1[9.2-39.1] vs 4.9[3.2-13.3]×正常上限[ULN]；P=0.002）。推导队列中的逻辑回归分析显示，血清脂肪酶≥7×ULN 可预测重症 AP。这一发现也在验证队列中得到了证实。基于推导和验证队列的数据，血清脂肪酶≥7×ULN 与发生重症 AP 的比值比为 7.1（95%置信区间 2.5-20.5；P<0.001）。敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为 85%、56%、46%、89%、1.939 和 0.27。
发病后 24 小时内血清脂肪酶≥7×ULN 可能是小儿重症 AP 的简单临床预测指标。低于此阈值的脂肪酶水平与较轻的病程密切相关。
