Carroccio A, Fontana M, Spagnuolo M I, Zuin G, Montalto G, Canani R B, Verghi F, Bavusotto A, Bastoni K, Boccia M C, Guarino A
Internal Medicine, University of Palermo, Italy.
Scand J Gastroenterol. 1998 Sep;33(9):998-1001. doi: 10.1080/003655298750027056.
Numerous studies have shown pancreatic disease in adult human immunodeficiency virus (HIV)-infected patients, but there are very few reports on pediatric patients. Our aim was to determine the prevalence of increased serum pancreatic enzyme levels and their relationship to clinical manifestations of acute pancreatitis in HIV-infected children.
Forty-seven consecutive, symptomatic HIV-infected children (24 male; median age, 7.3 years; range, 1-17 years) and 45 sex- and age-matched controls without gastroenterologic disease were enrolled. In all subjects serum total amylase, pancreatic amylase, and lipase were assayed with commercial kits. The following were recorded: disease progression (CDC class), nutritional status (weight Z-score), CD4 lymphocyte count, drug treatment during the previous 12 months, presence of opportunistic infections, clinical evidence of acute pancreatitis (increased serum pancreatic enzymes associated with vomiting, abdominal distention, and intolerance when eating).
Ten of 47 HIV patients had increased serum total amylase values; however fewer patients had increased specific pancreatic enzymes: 6 of 47 for pancreatic amylase (range, 1.8- to 19.8-fold normal limit) and 7 of 47 for lipase (range, 1.4- to 4-fold normal limit). Values were normal in all controls. Two HIV patients with increased total amylase had clinically evident parotid inflammation. None of the patients with increased serum pancreatic amylase and/or lipase had clinical symptoms of acute pancreatitis. Regression analysis showed no correlation between increased serum pancreatic enzyme levels and disease progression (CDC class), immunologic status (CD4 count), nutritional status, drug administration, or opportunistic infections.
Fifteen per cent of HIV-infected children had biochemical evidence of pancreatic involvement; however, this condition was unrelated to clinical signs of pancreatitis. Neither drug administration nor opportunistic infections seem to determine the increased serum pancreatic enzyme levels.
大量研究已表明成人人类免疫缺陷病毒（HIV）感染患者存在胰腺疾病，但关于儿科患者的报道极少。我们的目的是确定HIV感染儿童血清胰腺酶水平升高的患病率及其与急性胰腺炎临床表现的关系。
纳入47例连续的有症状HIV感染儿童（24例男性；中位年龄7.3岁；范围1 - 17岁）以及45例年龄和性别匹配、无胃肠疾病的对照儿童。所有受试者均使用商用试剂盒检测血清总淀粉酶、胰腺淀粉酶和脂肪酶。记录以下内容：疾病进展（疾病控制中心分类）、营养状况（体重Z评分）、CD4淋巴细胞计数、过去12个月内的药物治疗情况、机会性感染的存在情况、急性胰腺炎的临床证据（血清胰腺酶升高伴呕吐、腹胀和进食不耐受）。
47例HIV患者中有10例血清总淀粉酶值升高；然而，特定胰腺酶升高的患者较少：47例中有6例胰腺淀粉酶升高（范围为正常上限的1.8至19.8倍），47例中有7例脂肪酶升高（范围为正常上限的1.4至4倍）。所有对照儿童的值均正常。2例总淀粉酶升高的HIV患者有临床上明显的腮腺炎症。血清胰腺淀粉酶和/或脂肪酶升高的患者均无急性胰腺炎的临床症状。回归分析显示血清胰腺酶水平升高与疾病进展（疾病控制中心分类）、免疫状态（CD4计数）、营养状况、药物使用或机会性感染之间无相关性。
15%的HIV感染儿童有胰腺受累的生化证据；然而，这种情况与胰腺炎的临床体征无关。药物使用和机会性感染似乎均不能决定血清胰腺酶水平的升高。
