儿童炎症性肠病相关的急性胰腺炎：危险因素、临床病程和预后。

The Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.

Tel Aviv University, The Faculty of Medical & Health Sciences, Tel-Aviv, Israel.

J Pediatr Gastroenterol Nutr. 2024 Aug;79(2):325-334. doi: 10.1002/jpn3.12279. Epub 2024 Jun 5.

OBJECTIVES

To characterize the clinical course of acute pancreatitis (AP) in pediatric inflammatory bowel disease (IBD) patients compared to children with AP without IBD and to identify risk factors associated with AP among IBD patients.

METHODS

This retrospective, single-center study compared clinical characteristics of children (<19 years) with AP with and without concomitant IBD who were hospitalized 2005-2019. We also conducted a risk factor analysis of AP development in pediatric IBD.

RESULTS

Sixty-eight (54% males) patients with 120 episodes of AP were admitted at a median age of 15.3 years. Thirteen patients (14 episodes) had a co-diagnosis of IBD, representing 4% of our IBD patient population. The AP-IBD patients presented with lower amylase levels compared to the non-IBD patients (160 [interquartile range, IQR: 83-231] vs. 418 [IQR: 176-874] U/L, p > 0.01), all had a mild pancreatitis, and none required invasive intervention. The presumed etiology for AP in all IBD patients was IBD-related: IBD flare-up in five, side effects of medications in two, and undetermined in seven. The only risk factor for AP development among IBD patients was IBD-associated arthritis (23% vs. 3% for IBD-non-AP, p = 0.04), while extracolonic Crohn's disease and induction therapy with nutrition were negative risk factors (15% vs. 51%, p = 0.05, and 8% vs. 44%, p = 0.04, respectively). Other parameters, including disease type and medications, were nonsignificant.

CONCLUSION

The clinical course of AP in pediatric IBD patients is mild. Only IBD-associated arthritis emerged as a risk factor for the development of AP, while, unexpectedly, IBD medication did not.

目的

比较伴有和不伴有炎症性肠病（IBD）的儿童急性胰腺炎（AP）患者的临床病程，并确定 IBD 患者发生 AP 的相关危险因素。

方法

这项回顾性单中心研究比较了 2005 年至 2019 年住院的伴有和不伴有 IBD 的儿童 AP 患者的临床特征。我们还对儿童 IBD 患者发生 AP 的危险因素进行了分析。

结果

共纳入 68 例（男童占 54%）120 例 AP 发作的患儿，中位年龄为 15.3 岁。13 例（14 次发作）患儿合并 IBD 诊断，占 IBD 患者人群的 4%。与非 IBD 患者相比，AP-IBD 患者的血清淀粉酶水平较低（160 [四分位距：83-231] vs. 418 [IQR：176-874] U/L，p>0.01），均为轻度胰腺炎，均未行有创干预。所有 IBD 患者 AP 的推测病因均与 IBD 相关：5 例为 IBD 活动，2 例为药物相关，7 例原因不明。IBD 患者发生 AP 的唯一危险因素是 IBD 相关关节炎（23% vs. IBD-非 AP 组的 3%，p=0.04），而结肠外克罗恩病和营养诱导治疗是负相关因素（15% vs. 51%，p=0.05；8% vs. 44%，p=0.04）。其他参数，包括疾病类型和药物，均无统计学意义。