新生儿牛奶蛋白过敏症40例的诊治分析

Retrospective analysis of diagnosis and treatment of cow's milk protein allergy in 40 neonates

目的总结新生儿牛奶蛋白过敏症（CMPA）的临床表现及最佳诊治方案。方法回顾性分析西安医学院第二附属医院新生儿科自2012年2月至2013年3月收治的40例CMPA患儿的临床表现及治疗方案。结果40例CMPA中（排除了消化道畸形及其他原因所致病变），表现为消化道症状者18例，皮肤湿疹者8例，呼吸系统症状者3例，哭闹、拒乳者11例。确诊时平均日龄为（9．6±3．7）d。牛奶蛋白回避试验和双盲食物激发试验均为阳性。确诊过敏患儿在基础治疗上，持续使用游离氨基酸配方粉（AAF）或深度水解配方奶粉（eHF）喂养7—14天后，病情均得到显著缓解。出院后每2周电话随访或门诊复查进一步指导喂养及治疗。经随访后发现22．5％患儿症状反复出现，原因主要为家长依从性不佳。结论新生儿牛奶蛋白过敏症发生在日龄10天左右，临床表现多样化，且缺乏特异性，容易误诊或漏诊。在保证患儿安全，并有紧急抢救过敏性休克等措施下行牛奶蛋白激发试验是确诊的金标准。治疗上轻至中度过敏可以从使用深度水解配方开始，而重度过敏症使用游离氨基酸配方才是最佳方案，并可以达到诊断、治疗二合一的效果。家长的依从性同样对治疗起着重大作用。

Objective To summarize the clinical manifestations and best diagnosis and treatment of neonates with cow＇s milk protein allergies （CMPA）. Methods Retrospective analysis was conducted on the clinical manifestations and treatment scheme of CMPA in 40 cases admitted in neonatology department of the Second Affiliated Hospital of Xi＇ an Medical College in the period of February 2012 to March 2013. Results Among 40 cases of CMPA （ excluding digestive tract deformities and lesions due to other reasons）, 18 cases were found with digestive tract symptoms, 8 cases with skin eczema, 3 cases with respiratory symptoms, and 11 case with crying and milk refusal. The average age of the neonates was 9.6 ± 3.7 day. Milk protein avoidance experiment and double-blind food provocation test were positive. With foundation treatment, children diagnosed with allergies were fed with free amino acid formula（AAF） or extensive hydrolysate formula （eHF） for 7-14 days, and all of them were significantly mitigated. Telephone follow-up every 2 weeks after discharge from hospital or outpatient review provided further guidance on feeding and treatment. Follow-up found that 22.5% neonates had symptoms again, and the major reason was poor compliance of parents. Conclusion Neonatal CMPA occurs around the age of 10 days. The clinical manifestations are diversified and lack specificity, which may lead to misdiagnosis or missed diagnosis. Under the condition of guaranteeing children security and emergency measures, milk protein provocation test is gold standard for confirmed diagnosis. For mild to moderate allergies eHF can be used. But for severe allergy, AAF is the best solution, and both diagnosis and treatment can be obtained. Compliance of parents also plays an important role in the treatment.