纯母乳喂养婴儿腹泻影响因素分析

Analysis of risk factors for diarrhea in breast fed infants

目的通过分析纯母乳喂养婴儿腹泻影响因素,为重新定义"生理性腹泻"、预防腹泻、治疗腹泻、提高婴儿生活质量,降低远期过敏性及其他疾病的发生,提供理论依据。方法本组334例,均为2004年8月至2006年6月,在北京大学第三医院儿科门诊就诊的纯母乳喂养儿,其中男207名、女127名,平均年龄(3.0±0.4)个月。所有研究对象均通过问卷调查获悉父母的年龄、身高、文化程度、吸烟(支/d)、饮酒(g/月)情况、父亲的体重、母亲妊娠前体重、妊娠反应持续时间及程度、孕期有无感染及妊高征、母亲既往有无流产史、低体重儿生育史及慢性疾病史、新生儿的胎次、产次、分娩时孕周,家族过敏性疾病病史、消化道疾病家族史。母亲的饮食情况(哺乳期)。并观察患儿年龄、身高、体重、头围、胸围、有无皮疹、湿疹、纳食情况、呕吐、腹胀、哭闹、母乳的前列腺素 E_2、脂肪含量、乳糖含量、母、子血清的过敏原、点刺试验等。应用 SPSS10.0软件进行 Logistic 回归分析。结果母乳喂养儿出现腹泻的相关影响因素有:母亲吸烟(OR=2.3)、母亲过敏史(OR=2.7)、家族过敏性疾病病史(OR=2.8)、母亲摄食海鲜(OR=1.8)、鸡蛋(OR=2.3)、花生(OR=2.0),湿疹(OR=2.9)、哭闹(OR=2.7)、母乳前列腺素 E_2水平(OR=2.4)、脂肪含量(OR=3.0)、母子血清过敏原阳性(OR=4.0)、子点刺试验阳性(OR=2.7,P 均<0.05)等。结论通过研究发现,母亲或家族过敏史,母亲饮食结构、母乳前列腺素水平和脂肪水平增加等显示与母乳喂养儿腹泻有关。母乳喂养儿腹泻不单纯是一个生理过程,有环境因素和遗传学背景。其发病机制及预后值得进一步探讨。

Objective To analyze possible risk factors for diarrhea in breast fed infants and provide evidences for prevention and treatment of diarrhea, reducing allergic and other diseases in infants and for renewing the definition of ＂physiological diarrhea＂. Methods Totally 334 infants （207 boys and 127 girls, mean age 3.0 ± 0. 4 months） who were solely breast fed and seen between August 2004 and June 2006 at the outpatient clinic of the Department of Pediatrics, the 3rd Hospital of Peking University were enrolled in this study. The following information concerning parental and the infants＇ possible risk factors was obtained through a questionnaire that included parents＇ age, education, smoking, alcohol consumption, weight, height, maternal pregnancy weight, weight gain and health status during pregnancy and family history of hypersensitivity, family history of digestive tract disease, diet of mother in lactation, the infants＇ age, height, weight, head circumference, chest circumference, rash, eczema, diet, vomiting, abdominal distention, and blubber. The levels of PGE2, fat and lactose in breast milk, serum allergea and skin prick test were performed in all the 334 infants. Logistic regression analysis was performed by using the software SPSS 10. 0. Results Maternal smoking （ OR = 2. 3 ）, hypersensitivity （ OR = 2. 7 ）, family history of hypersensitivity（ OR = 2. 8）, diet of mother included seafood（ OR = 1.8 ）, egg（ OR = 2. 3 ） and peanut（ OR = 2. 0）, infants＇ eczema （ OR = 2. 9 ）, blubber （ OR = 2.7 ）, high level of PGE2 （ OR = 2. 4 ） and fat in breast milk （ OR = 3.0）, serum allergen positive （ OR = 4. 0 ）, positive skin prick test （ OR = 2. 7 ） were the risk factors for diarrhea in breast fed infants （P 〈 0. 05 ）. Conclusions Diarrhea in breast fed infants is not a simple physiologic process. It may be associated with many factors and the underlying mechanism remains to be clarified via further studies.