食物不耐受在消化系统疾病发病中的作用

Pathogenesis of Food Intolerance in Pediatric Digestive System Diseases

目的探讨食物不耐受（FI）在小儿胃肠道疾病发病中的作用,为诊断、预防和治疗由FI引起的小儿慢性消化系统疾病提供更有效的手段。方法采用ELISA法检测182例消化系统疾病（研究组）和32例择期手术患儿及健康儿童（对照组）血清FI特异性IgG（sIgG）抗体,并根据病史、临床症状及血清sIgG检测结果剔除相应食物,观察随访患儿临床症状改善情况。结果研究组中158例有1-9种血清sIgG水平升高,总阳性率为86.81%;对照组7例血清sIgG呈阳性反应,且均为单一抗体阳性,sIgG阳性程度均为轻度,阳性率为21.88%,二组sIgG阳性率比较差异有统计学意义（P〈0.01）。sIgG水平升高的消化系统疾病158例患儿中,1种sIgG升高者48例（占30.38%）,2种及2种以上sIgG升高者110例（占69.62%）。优势敏感食物为牛奶、鸡蛋,sIgG升高例数分别为117例（74.05%）和105例（66.46%）,其余依次为巧克力31例、大豆25例、虾21例、小麦20例、米7例、花生5例、猪肉1例。对sIgG阳性程度达＋2级及以上患儿采取忌食过敏食物治疗1-3个月,并予回访。其中迁延性慢性腹泻患儿回访49例,症状明显改善45例（91.84%）,症状改善4例（8.16%）,总有效率100%;再发性腹痛回访21例,症状明显改善10例（47.62%）,症状有改善6例（28.57%）,无效5例（23.81%）,总有效率76.19%;胃食管反流病回访12例,症状均明显改善,有效率100%;周期性呕吐综合征回访6例,症状有明显改善2例（33.33%）,症状改善2例（33.33%）,无效2例（33.33%）,总有效率66.67%。结论由IgG介导的FI在某些小儿消化系统疾病特别是慢性胃肠道疾病的发病中起重要作用。检测血清食物sIgG,进而了解患儿FI情况,可为一些不明原因的小儿慢性消化系统疾病的诊断、预防及调整饮食治疗提供更客观的依据。

Objective To provide more effective means for diagnosis,prevention and treatment of pediatric chronic digestive diseases caused by food intolerance（FI）,by exploring the pathogenesis of FI in pediatric gastrointestinal diseases.Methods Enzyme-linked immunosorbent assay was adopted to test the FI specific IgG（sIgG） antibody in serum of 182 children who suffered from digestive system diseases and 32 control children.Meanwhile related foods were excluded according to the medical histories,clinical symptoms and serum sIgG test results,and the improvement of clinical symptoms of such children were observed.Results Among the 182 children,158 children were found to have 1-9 kinds of serum sIgG with elevated levels,with a total positive rate of 86.81%.Among the 32 children in the control group,serum sIgG gave positive reaction in 7 cases,which had only 1 positive antibody and sIgG positive degree was light,with a positive rate of 21.88%.The difference of positive rate between the 2 groups was statistically significant（P0.01）.Among the 158 children suffered from digestive diseases who had increased levels of sIgG,48 children（30.38%） had 1 kind of sIgG with elevated level,while 110 children（69.62%） had 2 kinds or more than 2 kinds of sIgG with elevated level.Milk and egg were the most allergenic foods,to which 117 children（74.05%） and 105 children（66.46%） were found to have elevated level of sIgG,respectively,while other foods were less allergenic.And the number of children who had elevated level of sIgG was 31 children responding to chocolate,25 children to soybean,21 children to shrimp,20 children to wheat,7 children to rice,5 children to peanut and 1 child to pork.For children whose sIgG positive degree reached ＋2 and above,prohibiting eating allergenic foods was adopted and such treatment lasted 1-3 months,and then these children were revisited.Among the 49 children suffered from chronic diarrhea who received the above treatment,45 children′s（91.84%） symptoms had been evidently relieved,and 4 cases relieved,so a total effective rate was 100%.Among the revisited 21 children with recurrent abdominal pain,10 children′s（47.62%） symptoms had been evidently relieved,6 children（28.57%） relieved,and 5 children（23.81%） not relieved,with a total effective rate of 76.19%.The revisited 12 children suffering from gastroesophageal reflux disease all proved that their symptoms had been evidently relieved,indicating a 100% effective rate.Among the revisited 6 children with cyclic vomiting syndrome,2 children′s symptoms had been evidently relieved,2 children（33.33%） relieved,and 2 children（33.33%） not relieved,showing a total effective rate of 66.67%.Conclusions The FI mediated by IgG plays an important role in the pathogenesis of some pediatric digestive system diseases,in particular,chronic gastrointestinal diseases.By testing serum food sIgG to know about FI,it will provide more objective basis for the diagnosis,prevention and treatment by food adjustment for some pediatric chronic digestive system diseases which are caused by unknown reasons.