Otusbo S, Huruzono T, Kobae H, Yoshimi S, Miyata K
Department of Pediatrics, Faculty of Medicine, Kagoshima University, Japan.
Brain Dev. 1995 May-Jun;17(3):219-21. doi: 10.1016/0387-7604(95)00025-7.
The patient was a 1-year-old infant with severe postencephalitis syndrome. Diarrhea and elevation of the pancreatic enzymes, except for serum amylase (elastase 1 > 1, 5000 ng/dl (100-400); lipase, 885 IU/I/37 degrees C (10-48); trypsin, > 900 ng/ml (110-460)), were observed starting 70 days after starting valproate (dose, 70 mg/kg; serum level, 83.8 micrograms/ml). These findings as well as those obtained by abdominal ultrasonography suggested a diagnosis of pancreatitis, which was thought to be caused by sodium valproate. Important signs of valproate-induced pancreatitis may be easily overlooked in patients with neurological impairment, such as in ours. Because the blood half-life of amylase is short, not only amylase but some other pancreatic enzymes should be promptly investigated when valproate-related pancreatitis is clinically suspected in physically or mentally handicapped children.
该患者为一名患有严重脑炎后综合征的1岁婴儿。在开始使用丙戊酸盐（剂量为70mg/kg；血清水平为83.8μg/ml）70天后，观察到腹泻以及除血清淀粉酶外的胰腺酶升高（弹性蛋白酶1>15000ng/dl（100 - 400）；脂肪酶，885IU/I/37℃（10 - 48）；胰蛋白酶，>900ng/ml（110 - 460））。这些发现以及腹部超声检查结果提示为胰腺炎，认为是由丙戊酸钠引起的。在患有神经功能障碍的患者中，如我们的患者，丙戊酸盐诱导的胰腺炎的重要体征可能很容易被忽视。由于淀粉酶的血液半衰期较短，当临床上怀疑身体或精神残疾儿童发生与丙戊酸盐相关的胰腺炎时，不仅应及时检测淀粉酶，还应检测其他一些胰腺酶。
