左旋门冬酰胺酶诱发儿童急性胰腺炎临床分析

摘要

目的：分析左旋门冬酰胺酶（L-ASP）诱发儿童急性胰腺炎的临床特点，以降低L-ASP后急性胰腺炎发病率，提高临床预后。方法：对本院应用L-ASP后7例急性胰腺炎的诱因、临床表现、实验室检查、及治疗结果进行总结分析。结果：351例次应用L-ASP化疗的患儿中，发生急性胰腺炎7例，发生率2%，其中重症胰腺炎6例，发病前有暴饮暴食者3例，临床表现中腹痛6例、腹胀5例、发热6例、休克5例，所有病例均有血淀粉酶及脂肪酶增高，胰腺彩超均异常。7例胰腺炎中存活3例，中位年龄11岁（7~14岁），死亡4例，中位年龄4岁（2.6~6岁），均死于休克。结论：暴饮暴食、年龄>7岁为胰腺炎发生的重要危险因素，儿童急性胰腺炎症状不典型，重症胰腺炎死亡率高，早期诊断是提高预后的关键。%Objective:To analyze clinical features of children with acute pancreatitis induced by L-asparaginase (L-ASP),so as to reduce incidence of pancreatitis caused by L-ASP and improve clinical outcomes.Method:The incentives,clinical manifestations,laboratory tests,and outcome of 7 acute pancreatitis caused by L-ASP in our hospital were analyzed.Result:Of 351 cases with L-ASP application,7 cases suffered acute pancreatitis,the incidence was 2%, 6 cases were severe pancreatitis,3 cases were before the onset of overeating,6 cases had abdominal pain,5 cases had stomachache,6 cases had fever,and 5 cases suffered shock.All patients had elevated serum amylase and lipase,and all pancreatic ultrasound showed abnormalities.3 cases survived with a median age of 11 years(7-14 years old),4 cases died with a median age of 4 years(2.6-6 years old),all died of shock.Conclusion:Overeating,age more than 7 years old are important risk factors for pancreatitis.Symptoms of pancreatitis in children are atypical,severe pancreatitis have high mortality rate,early diagnosis is key to improve prognosis.