96例婴儿过敏性直肠结肠炎临床特征分析

Clinical characteristics of infants with allergic proctocolitis: a retrospective study of 96 cases

目的通过分析婴儿过敏性直肠结肠炎的临床特征,为早期诊断和有效治疗提供科学依据。方法回顾性调查2011年9月至2013年3月期间96例婴儿过敏性直肠结肠炎病例,对其临床特征进行分析。结果患儿临床表现以腹泻最常见。电子结肠镜检查发现40%患儿表现为多发性小结节,26%患儿表现为灶性红斑、黏膜变脆,25%患儿表现为多发浅表糜烂,9%的患儿表现为溃疡表面渗出。病变部位:87%累及乙状结肠,24%累及直肠,13%累及降结肠,8%累及横结肠、升结肠及回盲部。组织病理学检查显示黏膜各层嗜酸性粒细胞浸润,89%患儿为轻中度,12%患儿为重度和极重度。治疗上母亲和患儿都回避致敏食物,其中43%继续母乳喂养,45%予深度水解蛋白奶粉喂养,13%予游离氨基酸营养粉喂养。所有患儿经治疗后症状完全缓解。结论婴儿过敏性直肠结肠炎临床表现无特异性,电子结肠镜及组织病理学检查可提高早期诊断率。治疗采用回避致敏食物,人工喂养患儿给予深度水解配方或氨基酸配方疗效显著。

Objective To study the clinical characteristics of hospitalized infants with allergic proctocolitis, and to provide a scientific basis for early diagnosis and effective treatment of allergic proctocolitis. Methods The clinical data of 96 infants with allergic proctocolitis between September 2011 and March 2013 were reviewed retrospectively. Descriptive analysis was performed to assess the clinical characteristics of allergic proctocolitis. Results The most common clinical manifestation was diarrhea in the 96 infants. The electronic colonoscopy results indicated that 40% of the infants had multiple small nodules, 26% showed focal erythema and brittle mucous membranes, 25% showed multiple superficial erosion, and 9% showed ulcers with surface exudates. The affected areas included the sigmoid colon（87%）, rectum（24%）, descending colon（13%）, and transverse colon ascending colon and ileocecal junction（8%）. Histopathologic examination showed eosinophilic infiltration of mucosal layers, the condition of which was mild to moderate in 89% and severe and extremely severe in 12% of the infants. To treat the allergic proctocolitis, mothers and infants were suggested to avoid allergenic foods; 43% of them continued breastfeeding, 45% switched to highly hydrolyzed protein formula, and 13% were prescribed amino acid-based elemental formula. All infants were in complete remission at discharge. Conclusions As the clinical manifestations of allergic proctocolitis in infants lack specificity, the electronic colonoscopy and mucosal histopathologic examination are helpful for early and differential diagnosis. The best treatment is to avoid allergenic foods. Formula-feeding infants should be prescribed highly hydrolyzed protein formula or amino acid-based elemental formula.