14例牛奶蛋白过敏婴儿胃镜和胃黏膜病理特点分析

Clinical research on gastroscope and pathological characteristics of gastric mucosa for infants allergic to milk protein.

目的探讨IgE介导型和非IgE介导型牛奶蛋白过敏患儿胃镜和胃、十二指肠黏膜病理改变的区别,初步探讨胃镜在婴儿牛奶过敏中的诊断价值。方法对比14例牛奶蛋白过敏婴儿食物回避治疗前后4周胃镜改变情况,对比非IgE介导组和IgE介导组胃镜和病理改变情况。结果两组胃镜检查均显示:胃黏膜多发糜烂;十二指肠黏膜颗粒样增粗,部分伴糜烂。食物回避治疗4周后胃、十二指肠黏膜基本恢复正常。两组胃黏膜病理均表现为慢性炎症性改变,部分伴嗜酸细胞浸润。结论牛奶蛋白过敏婴儿胃镜改变具有一定特征性,对诊断有一定帮助,但对区分非IgE介导型和IgE介导型无帮助;胃黏膜病理检查无特征性改变,可能无助于诊断及分型。

Objective To summarize the pathological differences in duodenal mucosa of infants with IgE-mediated milk protein allergy and those with non-IgE-mediated milk protein allergy, and to investigate the application of gastroscope in the diagnosis of milk protein allergy in infants. Methods The gastroscopic changes of 14 infants with milk protein allergy were investigated 4 weeks before and after food avoidance. The pathological changes were studied in the infants with IgE-mediated milk protein allergy and those with non-IgE-mediated milk protein allergy. Results Gastroscopy of the infants showed multifocal erosion in gastric mucosal and mucosal thickening like particle of the duodenum, some of which were accompanied by erosive lesions. Four weeks after food avoidance, duodenal mucosa basically returned to normal. Pathological manifestations of gastric mucosa all displayed chronic inflammatory changes, some were accompanied by eosinophil infiltration. Conclusion The changes of gastroscope has certain characteristics for infants allergic to milk protein, which might be helpful for the diagnosis of milk protein allergy, but make no contribution to the distinction between IgE-mediated and non-IgE-mediated allergy. The pathological changes of gastric mucosa are not characteristic, and might be of no significance for the diagnosis and classification.