Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Gastroenterol. 2024 Oct 1;119(10):2094-2102. doi: 10.14309/ajg.0000000000002772. Epub 2024 Mar 22.
Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP.
Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors.
Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001).
In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.
在患有急性复发性胰腺炎 (ARP) 或慢性胰腺炎 (CP) 的儿童中，急性胰腺炎 (AP) 发作会带来疼痛，往往需要住院治疗，并导致疾病并发症和进展。尽管有这种认识，但目前尚无预防 AP 发作的干预措施。在这项回顾性队列研究中，我们评估了胰腺酶治疗 (PERT) 的使用对具有胰充足性 ARP 或 CP 的儿童的临床结局的影响。
纳入 INSPPIRE-2 队列中具有胰充足性 ARP 或 CP 的儿童。比较了接受与不接受 PERT 的患者的临床结局，以及 PERT 前后 AP 的发生频率。使用逻辑回归研究开始 PERT 后发生 AP 发作与反应预测因子之间的关系。
在 356 名具有胰充足性的参与者中，270 名（76%）患有 ARP，60 名（17%）接受了 PERT。在接受 PERT 的患者中，42%在平均 2.1 年的随访期间没有发生后续的 AP 发作。具有 SPINK1 突变的儿童（ P = 0.005）和患有 ARP 的儿童（与 CP 相比， P = 0.008）在开始 PERT 后发生 AP 发作的可能性较小。开始 PERT 后，AP 的年发生率从 3.14 降至 0.71（ P < 0.001）。
在回顾性分析中，PERT 的使用与具有胰充足性 ARP 或 CP 的儿童中 AP 发生率的降低相关。这些结果支持需要进行临床试验，以评估 PERT 改善 ARP 或 CP 儿童临床结局的疗效。
