婴儿食物过敏致上消化道出血35例分析

Clinical,endoscopic and pathologic characteristics of food allergy inducing upper gastrointestinal tract hemorrhage in 35 infants

目的研究婴儿食物过敏致上消化道出血的临床表现、内镜下特点及组织病理学改变,以提高婴儿食物过敏致上消化道出血的诊断水平。方法以江西省儿童医院2006年6月至2010年7月住院的35例食物过敏致上消化道出血患儿为研究对象,回顾分析婴儿食物过敏致上消化道出血的临床表现、内镜下特点及组织病理学改变。结果所有患儿均有呕血和轻度-中度贫血,其中嗜酸性粒细胞升高19例,轻度低蛋白血症6例,血清IgE升高20例,血清幽门螺杆菌抗体检测阳性2例;所有患儿血小板计数均正常,肝功能及凝血象检查均正常;3例患儿行血清学食物过敏原特异性IgG抗体测定,其中2例牛奶喂养患儿对牛奶高度敏感,1例母乳喂养患儿对蛋清和(或)蛋黄高度敏感。35例患儿均呈现镜下糜烂性胃炎,且为多发性病灶,其中21例患儿病变以胃底、胃体黏膜多发糜烂为主,14例为胃体、胃窦黏膜多发性糜烂,3例伴胃窦、幽门管水肿,1例食管炎。所有患儿组织病理提示胃黏膜有嗜酸性粒细胞浸润,且均经患儿和母亲食物回避治疗有效。结论婴儿食物过敏致上消化道出血的临床症状无特异性,以牛奶喂养多见,消化道出血是常见的表现之一,内镜下表现以胃黏膜糜烂为主,饮食回避是主要的诊断及治疗方法,且疗效肯定;胃黏膜病理学检查及结合嗜酸性粒细胞计数有助于诊断。

Objective To analyze the clinical manifestations, endoscopic features and histopathologic changes of food allergy inducing upper gastrointestinal tract hemorrhage in infants in order to improve the level of dignosis. Methods From Jun.2006 to Jul.2010 in Jiangxi Children＇ s Hospital, clinical manifestations, endoscopic features and pathologic changes in 35 infants who sufferred from allergic gastritis were collected and retrospectively analyzed. Results All patients had haematemesis and mild or moderate anemia, among whom 19 cases were with high eosinophile granuloeyte, 6 cases with mild hypoproteinemia and 20 cases with high immunoglobin E level in serum ; 2 cases had positive antibody to H. pylori in serum. At the same time , food allergen-specific immunoglohin G was detected, among which 2 milk-feeding infants were hypersensitive to milk, and 1 breast-feeding patient was hypersensitive to albumen/yolk, while the platelet counting, liver function and the blood clot test were normal. All the patients had erosive gastritis and multiple focus, among which 21 cases had multiple erosion mostly in fundus ventrieuli and sinuses ventriculi and 14 eases in body and sinuses ; 3 eases had sinuses ventriculi and eanalispylorieus edema, and 1 had esophagitis. All the 35 patients showed eosinophilia in gastric mucosa histopathologieally, and recovered effectively after an elimination diet. Conclusion Food allergy inducing upper gastrointestinal tract hemorrhage in infants has no specific clinical symptoms; patients are mainly milk-feeding, hemorrhage of digestive tract is one of common manifestations, and gastric mueosal erosion is frequently seen under endoscope; elimination diet is the primary diagnostic and therapeutic method and gets favorable effect; pathological observation of gastric mucosa and eosinophile granulocyte counting contribute to the diagnosis.