Department of Paediatric Surgery, St. John's Medical College Hospital, India.
Division of Nutrition, St. John's Research Institute, Bangalore, India.
Pancreatology. 2023 Sep;23(6):601-606. doi: 10.1016/j.pan.2023.07.006. Epub 2023 Jul 17.
/Objective: The extent of exocrine pancreatic insufficiency (EPI) in the paediatric population with acute pancreatitis (AP) is unknown. The primary objective was to use a 6 h stable-isotope breath test to determine the prevalence of EPI in children with AP. The secondary objective was to determine the diagnostic ability of a 4 h abbreviated breath test in the detection of EPI.
C-mixed triglyceride (MTG) breath test was used to measure fat digestibility in 12 children with AP and 12 normal children. EPI was diagnosed based on a cumulative dose percentage recovery (cPDR) cut-off value < 26.8% present in literature. To reduce the test burden, the diagnostic accuracy of an abbreviated 4 h test was evaluated, using a cPDR cut-off that was the 2.5 percentile of its distribution in control children.
The cPDR of cases was significantly lower than that of controls (27.71 ± 7.88% vs 36.37 ± 4.70%, p = 0.005). The cPDR during acute illness was not significantly different to that at 1 month follow up (24.69 ± 6.83% vs 26.98 ± 11.10%, p = 0.52). The 4 h and 6 h breath test results correlated strongly (r = 0.93, p < 0.001) with each other. The new 4 h test had 87.5% sensitivity and 93.8% specificity for detecting EPI.
Two-thirds (66.7%) of this sample of children with AP had EPI during admission, which persisted at 1 month follow up. The 4 h abbreviated C-MTG breath test has good diagnostic ability to detect EPI in children and may improve its clinical utility in this age group.
/目的：急性胰腺炎（AP）患儿胰腺外分泌功能不全（EPI）的程度尚不清楚。主要目的是使用 6 小时稳定同位素呼吸试验来确定 AP 患儿 EPI 的患病率。次要目的是确定 4 小时缩短呼吸试验在检测 EPI 中的诊断能力。
使用 C-混合甘油三酯（MTG）呼吸试验测量 12 例 AP 患儿和 12 例正常儿童的脂肪消化率。根据文献中存在的累积剂量百分比恢复（cPDR）<26.8%的截断值诊断 EPI。为了降低测试负担，评估了缩短 4 小时测试的诊断准确性，使用其在对照儿童分布中的第 2.5 个百分位数作为 cPDR 的截断值。
病例的 cPDR 明显低于对照组（27.71±7.88%比 36.37±4.70%，p=0.005）。急性疾病期间的 cPDR 与 1 个月随访时的 cPDR 无显著差异（24.69±6.83%比 26.98±11.10%，p=0.52）。4 小时和 6 小时呼吸试验结果彼此之间具有很强的相关性（r=0.93，p<0.001）。新的 4 小时测试检测 EPI 的敏感性为 87.5%，特异性为 93.8%。
该 AP 患儿样本中有三分之二（66.7%）在入院期间存在 EPI，在 1 个月随访时仍存在 EPI。4 小时缩短 C-MTG 呼吸试验具有良好的诊断能力，可检测儿童 EPI，可能提高其在该年龄组的临床应用价值。
