Risk Factors For Pancreatic Exocrine And Endocrine Insufficiency In Pediatric Chronic Pancreatitis

Chronic pancreatitis(CP)is a rare disease in children.Recent studies have found that the incidence rate of pediatric CP is 0.5 / 100 thousand per year.The pathophysiological characteristics of pediatric CP are chronic progressive inflammation and fibrosis,which leads to irreversible destruction of pancreatic parenchyma and eventually leads to dysfunction of pancreatic exocrine and endocrine.The pediatric CP will cause repeated abdominal pain and malnutrition,which will affect their growth and development,and even the intellectual development.The life-long suffering will bring heavy burden to the patients,both economically and mentally.Therefore,it is imperative to deeply understand pediatric CP,explore the clinical characteristics and propose treatment methods.We need to pay more attention to the problem.When CP patients have the symptoms of insufficiency of exocrine and endocrine,it indicates that the disease is not in early stage.Children may have the symptoms of diarrhea,weight loss and liposoluble vitamin deficiency(A,D,E,K),etc.Diabetes means that the endocrine function is seriously damaged.Because the Islet cells are destroyed during the pancreatic fibrosis,the blood sugar of this kind of child is very unstable.This study was conducted to identify the incidence rate of pancreatic exocrine and endocrine(steatorrhea and diabetes)in pediatric CP by constructing cohort and Cox regression analysis.We sought to identify risk factors and to achieve individualized prediction of pancreatic dysfunction.It may reduce the adverse events related to insufficiency of exocrine and endocrine in pediatric CP.In the first part,2153 CP patients were retrieved in retrospective and prospective method.Initially,a retrospective cohort of CP patients were retrieved via clinical record from January 2000 to December 2004.Then the CP patients were retrieved by prospective way from January 2005 to December 2013.From January 2000 to December 2013,a total of2,287 CP patients were retrieved.134 patients(10 with groove pancreatitis,108 with autoimmune pancreatitis,16 with pancreatic cancer diagnosed within 2 years)were excluded,then remaining 2153 with CP.Finally,the cohort study included 291 children and 1862 adults.The median follow-up period was 7.6 years(0.0-52.7 years).The clinical characteristics of pediatric CP was analyzed.It was found that the onset age of was 11.6years old and the diagnosis age of was 19.7 years old.The incidence ratio of male to female was close to 1:1(143 vs.148).5.5%(16 / 291)of the children had smoking history and 6.5%(19 / 291)had drinking history.The most common etiology were idiopathic chronic pancreatitis(85.2%),followed by abnormal anatomy of pancreatic duct(8.2%),hereditary chronic pancreatitis(4.1%),post-traumatic CP(1.0%),hyperlipidemic CP(4.1%)and 0.7% of alcoholic chronic pancreatitis;The most onset symptom was abdominal pain(96.2%),followed by diabetes(DM,13.1%),steatorrhea(15.8%),severe acute pancreatitis(SAP,2.4%).At the end of follow-up 1 case turn into pancreatic cancer.In the second part,for the analysis 291 pediatric CP cases,the cumulative incidence rate of DM in 3 years,5 years and 10 years after diagnosis of CP were 2.1%[95% confidence interval(CI),1.3%-2.9%],2.7%(95%CI,1.6%-3.8%)and 5.2%(95%CI,3.6%-6.8).54 patients with DM among third degree relatives and DM diagnosed before CP were excluded,and finally 237 pediatric CP were included for single factor and multiple regression analysis.Finally,four predictive factors of DM in pediatric CP were determined:the onset age of CP(hazard ratio(HR),0.962,95% CI,0.706-1.312),smoking history(HR,5.030,95% CI,0.229-110.610),body mass index(HR,1.195,95% CI,0.811-1.761),and the etiology was also a risk factor.Identification of risk factors is helpful for the risk stratification of children.Through effective monitoring,we can early detect DM and reduce DM related adverse event.In the third part,for the analysis 291 pediatric CP cases,the cumulative incidence rate of steatorrhea in 3 years,5 years and 10 years after diagnosis of CP was 2.1%(95%CI,0.5-3.7%),4.1%(95%CI,1.6-6.6%)and 7.2%(95%CI,3.5-10.9).35 patients with steatorrhea diagnosed before CP were excluded Excluding,and 256 children were included were included for single factor and multiple regression analysis: history of SAP had significantly higher risk of diarrhea(HR,13.946,95% CI,1.442-134.909).Early identification of risk factors can help early pancreas enzyme replacement therapy,and reduce the steatorrhea related adverse event.