Both Exocrine Pancreatic Insufficiency and Signs of Pancreatic Inflammation Are Prevalent in Children with Complicated Severe Acute Malnutrition: An Observational Study
Both Exocrine Pancreatic Insufficiency and Signs of Pancreatic Inflammation Are Prevalent in Children with Complicated Severe Acute Malnutrition: An Observational Study
复制标题
DOI：
10.1016/j.jpeds.2016.04.013
复制
发表时间：
2016-07-01
影响因子：
5.1
通讯作者：
Voskuijl, Wieger P.
中科院分区：
文献类型：
--
作者：
Bartels, Rosalie H.;Meyer, Sophie L.;Voskuijl, Wieger P.
目的 评估严重急性营养不良儿童的胰腺功能是否受损、水肿性营养不良与非水肿性营养不良之间的差异以及通过营养康复得到改善。 研究设计 我们对马拉维布兰太尔伊丽莎白女王中心医院收治的 89 名严重急性营养不良儿童进行了随访。入院时和初次稳定后 3 天采集粪便和血液样本，通过粪便弹性蛋白酶-1 (FE-1) 和血清胰蛋白酶原和淀粉酶水平测定外分泌胰腺功能。 结果 共有 33 名儿童 (37.1%) 患有非水肿性严重急性营养不良，而 56 名儿童 (62.9%) 患有水肿性严重急性营养不良。入院时，92% 的患者表现出胰腺功能不全的证据（通过粪便 FE-1 < 200 μg/g 测量）。水肿性严重急性营养不良患者的 FE-1 水平更可能较低（98% vs 82.8%，P=0.026）。在整个评估期间，这些人的 FE-1 水平仍然较低。 28%的儿童血清胰蛋白酶原升高（> 57 ng/mL），21%的儿童血清淀粉酶升高（> 110 U/L），提示胰腺炎症。 结论 严重急性营养不良儿童普遍存在胰腺外分泌功能不全，尤其是水肿性严重急性营养不良儿童。此外，提示胰腺炎的生化体征在严重急性营养不良的儿童中很常见。这些结果对严重急性营养不良儿童的标准康复治疗具有影响，这些儿童可能受益于胰酶替代疗法。
Objectives To assess whether pancreatic function is impaired in children with severe acute malnutrition, is different between edematous vs nonedematous malnutrition, and improves by nutritional rehabilitation.Study design We followed 89 children with severe acute malnutrition admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi. Stool and blood samples were taken on admission and 3 days after initial stabilization to determine exocrine pancreatic function via fecal elastase-1 (FE-1) and serum trypsinogen and amylase levels.Results A total of 33 children (37.1%) had nonedematous severe acute malnutrition, whereas 56 (62.9%) had edematous severe acute malnutrition. On admission, 92% of patients showed evidence of pancreatic insufficiency as measured by FE-1 < 200 mu g/g of stool. Patients with edematous severe acute malnutrition were more likely to have low FE-1 (98% vs 82.8%, P=.026). FE-1 levels remained low in these individuals throughout the assessment period. Serum trypsinogen was elevated (> 57 ng/mL) in 28% and amylase in 21% (> 110 U/L) of children, suggesting pancreatic inflammation.Conclusion Exocrine pancreatic insufficiency is prevalent in children with severe acute malnutrition and especially in children with edematous severe acute malnutrition. In addition, biochemical signs suggestive of pancreatitis are common in children with severe acute malnutrition. These results have implications for standard rehabilitation treatment of children with severe acute malnutrition who may benefit from pancreatic enzyme replacement therapy.