Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE.
Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE.
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DOI：
10.1001/jamapediatrics.2015.4955
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发表时间：
2016-06-01
期刊：
影响因子：
26.1
通讯作者：
Uc A
中科院分区：
文献类型：
--
作者：
Kumar S;Ooi CY;Werlin S;Abu-El-Haija M;Barth B;Bellin MD;Durie PR;Fishman DS;Freedman SD;Gariepy C;Giefer MJ;Gonska T;Heyman MB;Himes R;Husain SZ;Lin TK;Lowe ME;Morinville V;Palermo JJ;Pohl JF;Schwarzenberg SJ;Troendle D;Wilschanski M;Zimmerman MB;Uc A
小儿急性复发性胰腺炎（阿普）和慢性胰腺炎（CP）的了解甚少。描述和识别与儿童期阿普和CP相关的危险因素。一项在入组INSPPIRE（儿童胰腺炎国际研究组：寻找治愈方法）研究时对阿普或CP儿童进行的多国横断面研究。INSPPIRE联合会的参与机构。从2012年9月至2015年2月，入组了155例阿普儿童和146例CP儿童（≤ 19岁）。将他们的人口统计学和临床信息输入15个中心的REDCap数据库。一个也没有。对该队列进行横断面研究，以评估人口统计学、风险因素、腹痛和疾病负担。连续变量采用双样本t检验或Wilcoxon秩和检验，分类变量采用Pearson卡方检验或Fisher精确检验。使用Wilcoxon秩和检验比较疾病负担变量（疼痛变量、医院/ER访视、缺课日）。大多数CP儿童报告既往急性胰腺炎复发。两组之间的性别分布相似。阿普在西班牙裔中更常见，CP在非西班牙裔中更常见。48%的阿普患者与73%的CP患者在胰腺炎相关基因中至少有一个基因突变（p=0.0002）。与阿普相比，PRSS 1或SPINK 1突变的儿童更容易患CP（分别为p<0.0001和p<0.05）。阿普和CP患儿的梗阻性（约30%的患者）和毒性/代谢危险因素（约20%的患者）无差异。胰腺炎相关的腹痛是81%的阿普或CP儿童在过去一年中的主要投诉。与阿普相比，CP的疾病负担更高（更多的ER访视，住院，缺课，医疗，内窥镜和手术干预）。基因突变在阿普和CP中都很常见。种族和PRSS 1或SPINK 1基因突变可能影响CP的发生。儿童CP的高疾病负担强调了识别儿童阿普进展为CP的易感因素的重要性。
Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are poorly understood. To characterize and identify risk factors associated with ARP and CP in childhood. A multinational cross-sectional study of children with ARP or CP at the time of enrollment to INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a CuRE) study. Participant institutions of the INSPPIRE Consortium. From September 2012 to February 2015, 155 children with ARP and 146 with CP (≤ 19 years of age) were enrolled. Their demographic and clinical information were entered into the REDCap database at fifteen centers. None. A cross-sectional study of the cohort was performed to assess demographics, risk factors, abdominal pain and disease burden. Differences were analyzed using two-sample t-test or Wilcoxon-rank sum test for the continuous variables, and Pearson Chi-square or Fisher’s exact test for categorical variables. Disease burden variables (pain variables, hospital/ER visits, missed school days) were compared using Wilcoxon rank-sum test. The majority of children with CP reported prior recurrent episodes of acute pancreatitis. Gender distribution was similar between the groups. ARP was more common in Hispanics, CP in non-Hispanics. Forty-eight percent of patients with ARP versus 73% of patients with CP had at least one gene mutation in pancreatitis-related genes (p=0.0002). Children with PRSS1 or SPINK1 mutations were more likely to present with CP compared with ARP (p<0.0001 and p<0.05 respectively). Obstructive (~30% of patients) and toxic/metabolic risk factors (~20% of patients) did not differ between children with ARP or CP. Pancreatitis-related abdominal pain was a major complaint in 81% of children with ARP or CP within the last year. The disease burden was higher in CP compared with ARP (more ER visits, hospitalizations, missed school days, medical, endoscopic and surgical interventions). Genetic mutations are common in both ARP and CP. Ethnicity and mutations in PRSS1 or SPINK1 genes may influence the development of CP. The high disease burden in pediatric CP underlines the importance of identifying predisposing factors for progression of ARP to CP in children.