From the University of Iowa, Stead Family Children's Hospital, Iowa City, IA.
The University of Texas, MD Anderson Cancer Center, Houston, TX.
J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):643-649. doi: 10.1097/MPG.0000000000003590. Epub 2022 Aug 17.
The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP).
Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP.
Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP.
Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.
本研究旨在探讨儿科急性复发性胰腺炎（ARP）和慢性胰腺炎（CP）的危险因素和疾病负担。
数据来自国际儿科胰腺炎研究组：寻找治疗（INSPPIRE-2），这是一项针对 ARP 或 CP 儿科患者的最大多中心前瞻性队列研究。
在 689 名儿童中，365 名患有 ARP（53%），324 名患有 CP（47%）。CP 更常见于女性、首次急性胰腺炎（AP）发作时年龄较小、亚洲人种、CP 家族史、BMI%较低、遗传和阻塞性因素、PRSS1 突变和胰腺分裂。CFTR 突变、毒性代谢因素、药物使用、高甘油三酯血症、克罗恩病在 ARP 患儿中更为常见。CP 患儿更常出现持续性或频繁腹痛、急诊室（ER）就诊、住院、医疗、内镜或手术治疗，而 ARP 患儿更常出现间歇性腹痛。33.1%的 CP 患儿存在外分泌胰腺功能不全（EPI），8.7%存在糖尿病。与男孩相比，女孩更有可能报告疼痛影响社交和学业、医疗治疗、胆囊切除术，但阿片类药物使用没有增加。男孩和女孩在种族、民族、首次 AP 发作年龄、CP 诊断年龄、疾病持续时间、危险因素、EPI 或糖尿病患病率方面没有差异。多变量分析显示，CP 家族史、持续性疼痛、阻塞性危险因素是 CP 的预测因素。
有 CP 家族史、持续性疼痛或阻塞性危险因素的儿童应怀疑 CP。
