Comparison Of Clinical Features And Prognosis Of 235 Cases Of Acute Pancreatitis Between Adolescents And Adults

OBJECTIVETo analyze the clinical characteristics and prognosis of acute pancreatitis in adolescents and adults,this study aims at providing the basis for clinical diagnosis,treatment and prognosis analysis.METHODSRetrospective analysis was performed on 118 cases of minor(< 18 years old)AP patients admitted to the First Hospital of Lanzhou University from January 2010 to June 2017,and 117 cases of adult(18 years old)AP patients admitted to the First Hospital of Lanzhou University from January 2017 to June 2017,a total of 235 cases.All patients met the inclusion and exclusion criteria.The clinical data of the patients were analyzed,such as gender,age,past history,symptoms,etiology,laboratory examination,nutrition,etc.The above data were processed and analyzed by statistical methods,and the differences between the juvenile group and the adult group were compared.Depending on the recurrence,the risk factors of recurrent acute pancreatitis in adolescents and adults were analyzed respectively.RESULTS1.The recurrence rate of AP in the adolescents group was higher than that in the adult group(P < 0.05).The mean length of hospital stay in the adolescents group was longer than that in the adult group(P < 0.05).There was no significant difference in gender composition between the minor group and the adult group(P > 0.05).2.The incidence of abdominal distension in the adult group was higher than that in the adult group(P < 0.05).The incidence of parotid swelling and upper respiratory tract infection symptoms such as cough and expectoration in the juvenile group was higher than that in the adult group(P < 0.05).There was no significant difference in the incidence of abdominal pain,nausea or vomiting,jaundice,fever and oligouria between the two groups(P > 0.05).3.The etiological factors were different between the juvenile group and the adult group(P <0.05).The most common diseases in the minor group were idiopathic,followed by biliary diseases,structural abnormalities,infectious diseases,systemic diseases,trauma and drugs.The most common diseases in the adult group were biliary,followed by idiopathic,hyperlipidemia,structural abnormalities,systemic diseases,trauma,and alcohol.4.Compared with the adult group,ALT,AST,TBIL,DBIL,GGT,BUN,SCr,TG and urine amylase levels in the adult group were all higher than those in the juvenile group(P < 0.05).ALP and serum calcium levels in the juvenile group were higher than those in the adult group(P <0.05).There was no significant difference in WBC,N%,LDH and serum amylase between the two groups(P > 0.05).Among the minor group,45.8% patients had blood amylase 3ULN,and24.6% patients had blood amylase < ULN.Blood amylase 3ULN in 47.9% of the adult group,and blood amylase < ULN in 29.1% of the patients.There was no significant difference in blood amylase between the two groups(P > 0.05).In the minor group,47.5% patients had urine amylase 3ULN,and another 17.8% patients had urine amylase < ULN.In the adult group,52.1%patients had urine amylase 3ULN,and another 23.1% patients had urine amylase < ULN.There was no significant difference in urine amylase between the two groups(P > 0.05).5.Compared with the adult group,the incidence of pancreatic pseudocyst in the juvenile group was higher(P < 0.05).The incidence of fatty liver in adult group was higher than that in juvenile group(P < 0.05).The incidence of pleural effusion in adults was higher than that in minors(P < 0.05).There was no significant difference in the incidence of pancreatic necrosis,pancreatic abscess,pancreatic duct dilatation,pancreatic duct stones,choledochal cyst,and peritoneal effusion between the two groups(P > 0.05).6.The rate of CT,ERCP and MRCP in the adult group was higher than that in the minor group(P < 0.05).There was a statistically significant difference between the minor group and the adult group in the items receiving imaging examinations(P < 0.05),and the adult group was more likely to receive multiple imaging examinations.7.The rate of gastrointestinal decompression in the juvenile group was higher than that in the adult group,while the rate of nasojejunal nutrition tube was lower than that in the adult group(P < 0.05).There was no significant difference in gastrointestinal decompression time,prohibit drinking water time,nasojejunal nutrition time,and recovery time of oral diet between the minor group and the adult group(P > 0.05).8.In systemic complications,the incidence of diabetes or impaired glucose tolerance in the adult group is higher than the minor group(P < 0.05),and there was no statistically significant difference of the incidence in MODS,abdominal cavity infection,gastrointestinal bleeding,theincidence of sepsis,abdominal bleeding between the two groups(P > 0.05);Among the local complications,the incidence of acute peripancreatic fluid accumulation in the adult group was higher than that in the juvenile group(P < 0.05).The incidence of pancreatic pseudocyst in juvenile was higher than that in adult group(P < 0.05).There was no significant difference in the incidence of acute necrosis material aggregation between the two groups(P > 0.05).9.In the study of risk factors for AP recurrence in the minor group,Logistic regression analysis indicated that structural abnormalities(OR = 8.321)and pancreatic necrosis(OR =4.535)were independent risk factors for AP recurrence in the minor group.For children with biliary pancreatitis,there was no statistically significant difference in the recurrence rate between the three treatments of cholecystectomy within 2 weeks,ERCP,conservative treatment or cholecystectomy after 2 weeks(P > 0.05).10.In the study of risk factors for recurrence in the adult group,Logistic regression analysis indicated that pancreatic necrosis(OR = 14.988),diabetes history(OR = 6.120),hyperlipidemia(OR = 47.417),and fatty liver(OR = 7.485)were independent risk factors for recurrence of AP in adults.For patients with biliary pancreatitis,there was statistically significant in the recurrence rate of the three treatment methods of cholecystectomy within 2 weeks,ERCP,conservative treatment or cholecystectomy after 2 weeks(P < 0.05),and the recurrence rate was successively the conservative treatment or cholecystectomy after 2 weeks,ERCP group,and cholecystectomy within 2 weeks.CONCLUSIONS1.Common causes of AP are different between minors and adults.Idiopathic AP is the main cause among minors,while gallbladder AP is the main cause among adults.If parotid gland enlargement and upper respiratory tract infection are complicated with AP,AP caused by parotid virus,mycoplasma and other pathogens should be considered,and it is common in minors..2.Because biliary acute pancreatitis is commom,adult patients are more likely to have impaired liver function.In some minor and adult AP patients,there may be insignificant changes in blood and urine amylase.3.In the enteral nutrition methods,the rate of gastrointestinal decompression for minors is higher than that for adults,while the rate of nasojejunal catheterization for adults is higher than that for minors.4.Adult AP patients are more likely to be complicated with diabetes mellitus,abnormal glucose tolerance,acute peripancreatic fluid accumulation,pleural effusion than minor AP patients;However,minor AP patients are more likely to have pancreatic cysts.5.The recurrence rate of AP in minor patients is higher than that in adults;After controllingfor confounders,multivariate analysis suggested that pancreatic structural abnormalities and pancreatic necrosis were independent risk factors for AP recurrence in minor patients.Pancreatic necrosis,history of diabetes,hyperlipidemia,and fatty liver were independent risk factors for AP recurrence in adult patients.In addition,early cholecystectomy can reduce the recurrence rate of adult AP.