婴幼儿牛奶蛋白过敏的临床特点分析

Clinical Characteristics of Cow's Milk Protein Allergy in Infants

目的分析牛奶蛋白过敏患儿的临床表现及特点。方法对江西省儿童医院79例通过双盲食物激发与回避实验确诊为牛奶蛋白过敏患儿的临床资料进行回顾性分析。结果 79例患儿表现为迁延性腹泻病26例(32.91%);慢性腹泻病10例(12.66%);呕血15例(19.00%);便血7例(8.86%);呕吐9例(11.39%);腹胀6例(7.59%);夜间哭闹3例(3.80%);湿疹2例(2.53%);咳喘1例(1.27%)。35例存在营养不良,30例存在轻中度贫血,15例患儿IgE阳性。22例行电子胃镜检查,其中13例十二指肠球部可见滤泡样隆起,病理检查示轻-中度慢性炎;另9例病理检查:1例示嗜酸性食道炎,2例嗜酸性胃炎,6例未见明显异常。所有患儿均于改变饮食后2周左右临床症状缓解出院。结论婴幼儿牛奶蛋白过敏临床主要表现为腹泻及消化道出血,且上述临床表现常混合存在;双盲食物激发与回避实验是诊断牛奶蛋白过敏的金标准,通过电子胃镜及胃、十二指肠黏膜病理检查有助于诊断;饮食回避是主要治疗方法。

Objective To analyze the clinical manifestations and characteristics of cow＇s milk protein allergy in infants. Methods A retrospective analysis was performed in 79 infants who were diagnosed as having cow＇s milk protein allergy by double-blind food challenge and avoidance test in our hospital. Results Among the 79 infants, persistent diarrhea disease occurred in 26 （32.91%）, chronic diarrhea in 10 （12.66%）, hematemesis in 15 （19.00%）, hemafecia in 7 （8.86%）, vomiting in 9 （11.39%）, abdominal distention in 6 （7,59%）, night crying in 3 （3.80%）, eczema in 2 （2.53%）, and cough and dyspnea in 1 （1.27%）. In addition, malnutrition was found in 35 infants, mild to mode- rate anemia in 30 and positive IgE in 15. Among the 22 infants who underwent electronic gastroscopy, 13 showed follicular bulge within duodenal bulb. Pathological examination revealed mild to moderate chronic inflammation in 9 infant, eosinophilic esophagitis in 1, eosinophilic gastritis in 2, and no obvious abnormalities in 6. All infants were discharged from hospital due to symptom remission at 2 weeks after changing diet. Conclusion Clinical manifestations of cow＇s milk protein allergy mainly include diarrhea, gastrointestinal bleeding, and and avoidance test are considered as the gold mucosal pathological examination are used as mixed symptoms in infants. Double-blind food challenge standard and electronic endoscopy and gastroduodenal aiding methods for the diagnosis of cow＇s milk protein allergy. Food-allergen avoidance is the main method for the treatment of cow＇s milk protein allergy.