三种低敏配方治疗牛奶蛋白过敏效果评价

Evaluation of therapeutic effects of three hypoallergenic formulae in infants with cow＇s milk protein allergy

目的通过对牛奶蛋白过敏患儿采用3种低敏配方（游离氨基酸配方、深度水解配方、大豆配方）进行治疗随访，评估各组患儿体格生长及过敏症状改善情况。方法初诊为牛奶蛋白过敏且无法进行母乳喂养的婴幼儿74例作为干预组，以健康体检儿童21例作为对照组。十预组遵循家长自愿选择原则分别给予游离氨基酸配方、深度水解配方、大豆配方替代治疗。于治疗开始后第1、2、3、6个月对患儿进行体格监测，同时对过敏症状缓解情况进行评估。采用SPSS13．0统计分析干’预组与对照组、干预组间儿童体格生长情况及症状缓解程度和速度。结果经半年随访，大豆配方替代组儿童年龄的体重及身长的体重z值分别为（-0．43±0．88）、（-0．31±0．78），显著低于游离氨基酸配方替代组[（0．11±0．77）、（0．20±0．69）]、深度水解配方替代组[（0．10±0．62）、（0．18±0．70）]及对照组[（0．22±0．54）、（0．22±0．64）]（P〈0．05）；而后3者间体格生长差异无统计学意义（P〉0．05）。年龄的身长与年龄的头围四组间差异均无统计学意义（P〉0．05）。3种低敏配方均可有效缓解过敏临床症状。游离氨基酸配方与深度水解配方治疗皮肤症状效果优于大豆配方（P=0．003）；且治疗1个月即可见显著疗效，而大豆配方缓解症状速度较慢（2个月）。结论游离氨基酸配方及深度水解配方均可维持牛奶蛋白过敏患儿正常的体格生长，而大豆配方治疗组生长速度明显不足。3种配方均可有效缓解牛奶蛋白过敏患儿临床症状，且游离氨基酸配方或深度水解配方治疗婴儿湿疹的效果、缓解速度要优于大豆配方。

Objective To compare the growth and symptom remission of infants with cow＇s milk protein allergy, who were fed with an amino acid formula, an extensively hydrolyzed formula or soy formula. Method Infants who were diagnosed as cow＇s milk protein allergy and can not be breastfed were enrolled in the intervention group, and were assigned to three special formulae （arnino acid formula, extensively hydrolyzed formula or soy formula ） according to the will of parents from March 2009 to March 2010 （ n = 74）. A non-randomized control group was made up of age-matched healthy children （n = 21 ）. Anthropometric measurements and symptoms were evaluated after 30, 60, 90, and 180 days. The differences of physical growth and the therapeutic effects among each group were calculated by SPSS 13.0 package. Result After 180 days follow-up, the weight for age Z score and length for weight Z score were -0. 43 ± 0. 88 and -0. 31± 0. 78 in patients fed with soy formula substitute, which were significantly lower than those of patients fed with amino acid formula （ 0. 11 ± 0. 77, 0. 20 ± 0. 69 ） , extensively hydrolyzed formula （0. 10 ±0. 62, 0. 18 ±0. 70） and control group（0. 22 ±0. 54, 0. 22 ±0. 64） （P 〈0. 05）. However, there were no significant differences in physical growth among patients fed with amino acid formula, extensively hydrolyzed formula and control group（P 〉0. 05）. Moreover, no significant difference was found in length for age and head circumference for age among four groups（ P 〉 0. 05 ）. All hypoallergenic formulae were much helpful in remission of the symptoms of eczema（ P 〈 0. 05 ）. However, amino acid formula and extensively hydrolyzed formula were more effective and rapid in relieving symptoms than soy formula （ 1 mo vs 2 too） （P = 0. 003 ）. Conclusion Both amino acid formula and extensively hydrolyzed formula can maintain the normal growth of infants with cow＇s milk protein allergy. While, the growth of patients fed with soy formula was significantly slower than that of the other three groups. All hypoallergenic formulae can be effective in relieving allergy symptoms, and amino acid formula or extensively hydrolyzed formula seems to be superior to soy formula.