Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Dig Dis Sci. 2023 Apr;68(4):1500-1510. doi: 10.1007/s10620-022-07676-5. Epub 2022 Aug 28.
Pain is a major problem in 90% of patients with chronic pancreatitis (CP). Studies evaluating response to antioxidants (AO) are conflicting and no pediatric studies are available.
To evaluate markers of oxidative stress (OS), and efficacy and predictors of response to AO in improving pain in children with CP.
Antioxidants were given to CP children for 6 months. Subjects were assessed at baseline and post-therapy for pain and markers of OS [serum thiobarbituric acid reactive substances (TBARS), superoxide dismutase (S-SOD)] and antioxidant levels [vitamin C, selenium, total antioxidant capacity-ferric reducing ability of plasma (FRAP)]. Matched healthy controls were assessed for OS and antioxidant levels. Good response was defined as ≥ 50% reduction in number of painful days/month.
48 CP children (25 boys, age 13 years) and 14 controls were enrolled. 38/48 cases completed 6 months of therapy. CP cases had higher OS [TBARS (7.8 vs 5.2 nmol/mL; p < 0.001)] and lower antioxidant levels [FRAP (231 vs. 381.3 µmol/L; p = 0.003), vitamin C (0.646 vs. 0.780 mg/dL; p < 0.001)] than controls. Significant reduction in TBARS and S-SOD and increase in FRAP, vitamin C, and selenium occurred after 6 months. 10.5% cases had minor side effects. 26(68%) cases had a good response, with 9(24%) becoming pain-free. Subjects with severe ductal changes had lower median BMI (- 0.73 vs 0.10; p = 0.04) and responded less often than those with mild changes (17/29 vs 9/9; p = 0.036).
CP children have higher OS than healthy controls. Antioxidant therapy is safe. Pain response is seen in 68% cases, less often in patients with severe ductal changes.
90%的慢性胰腺炎（CP）患者存在疼痛问题。评估抗氧化剂（AO）疗效的研究结果相互矛盾，且尚无儿科研究。
评估氧化应激（OS）标志物，以及 AO 改善 CP 患儿疼痛的疗效和反应预测因子。
CP 患儿接受 AO 治疗 6 个月。在基线和治疗后评估疼痛和 OS 标志物[血清硫代巴比妥酸反应物质（TBARS）、超氧化物歧化酶（S-SOD）]以及抗氧化剂水平[维生素 C、硒、总抗氧化能力-血浆铁还原能力（FRAP）]。匹配健康对照组评估 OS 和抗氧化剂水平。定义良好反应为疼痛天数/月减少≥50%。
纳入 48 例 CP 患儿（25 例男性，年龄 13 岁）和 14 例对照组。38/48 例病例完成了 6 个月的治疗。CP 组 OS 更高[TBA（7.8 与 5.2 nmol/mL；p<0.001）]，抗氧化剂水平更低[FRAP（231 与 381.3 µmol/L；p=0.003）、维生素 C（0.646 与 0.780 mg/dL；p<0.001）]。治疗 6 个月后，TBARS 和 S-SOD 显著降低，FRAP、维生素 C 和硒水平显著升高。10.5%的病例有轻微副作用。26 例（68%）病例有良好反应，9 例（24%）患儿疼痛完全缓解。与轻度胰管改变的患儿相比，重度胰管改变的患儿中位 BMI 更低（-0.73 与 0.10；p=0.04），且反应较少（29 例中的 17 例与 9 例中的 9 例；p=0.036）。
CP 患儿 OS 高于健康对照组。抗氧化剂治疗安全。68%的病例出现疼痛缓解，重度胰管改变的患儿缓解频率较低。
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