牛奶蛋白激发试验在消化道牛奶蛋白过敏症中的临床意义

Cow＇s milk challenges in gastrointestinal cow＇s milk allergic diseases

目的 了解儿童消化道牛奶蛋白过敏症的临床表现,并评估牛奶蛋白激发试验对消化道牛奶蛋白过敏症的诊断意义.方法 以2009年1月至2012年12月在浙江大学医学院附属儿童医院消化科收治的50例行牛奶蛋白激发试验患儿为研究对象,其中男25例、女25例,年龄1.6～20.0个月,其中＜6个月36例,6～12个月12例,＞12个月2例.分析50例患儿的临床特点、激发试验结果,采用配对t检验比较激发试验前后血常规的变化,分析血清牛奶蛋白特异性IgE抗体测定的关系.结果 （1）临床表现：以腹泻（27例,54％）及血便（25例,50％）最常见,其他主诉包括呕吐、呕血、拒奶及腹胀.（2）牛奶蛋白激发试验结果：激发试验阳性29例（58％）,阴性21例（42％）.29例激发试验阳性的患儿中出现迟发反应26例（90％）,速发反应3例（10％）.迟发反应主要表现为腹泻（19例,73％）,其中3例伴有呕吐,1例伴有腹胀;而速发反应表现为血管性水肿、呕吐拒奶及皮疹.（3）实验室检查结果：牛奶蛋白激发试验阳性组与阴性组比较,无论是激发前还是激发后,阳性组白细胞总数、中性粒细胞数、血小板总数均较阴性组高,但差异无统计学意义（P均＞0.05）,牛奶蛋白激发试验阳性组激发后中性粒细胞较激发前明显增高[（3.8±2.8）×109/L比（2.5±1.3）×109/L],差异有统计学意义（t=2.912,P=0.007）,而白细胞总数[（10.4±3.8）×109/L比（9.9±2.5）×109/L]、血小板总数[（426±115）×109/L比（434±136）× 109/L]差异无统计学意义（P均＞0.05）;（4）牛奶血清特异性IgE抗体检测结果：47例患儿行牛奶血清特异抗体检测,5例阳性,其中4例牛奶蛋白激发试验阳性,且均表现为迟发反应.结论 儿童牛奶蛋白过敏的消化道表现主要为腹泻及血便,牛奶蛋白性直肠炎是最常见的牛奶蛋白过敏性消化道疾病,临床上对消化道牛奶蛋白过敏症患儿应予牛奶蛋白激发试验.

Objective To understand the clinical features of gastrointestinal cow＆#39;s milk allergy in children,and to assess the importance of cow＆#39;s milk challenge.Method An analysis was performed on the clinical manifestations and the challenge results of 50 children who received cow＆#39;s milk challenges after admission to the department of gastroenterology,Children＆#39; s Hospital of Zhejiang University School of Medicine from January,2009 to December,2012.The value of immunoglobulin E antibody was also analyzed among the 50 children,25 cases were male and the other 25 were female.The youngest subject was 1.6 months old,and the oldest was 20 months,most of the cases were younger than 6 months （36 cases）.Result （1） Diarrhea （27 cases,54%） and hematochezia （25 cases,50%） were the most common clinical features,vomiting,hematemesis and abdominal distention were rare.（2）Cow＆#39;s milk challenges failed in 58% of the cases,90% of whom showed delayed allergy.Diarrhea （19 cases,73%） was the major later presentation,whereas the immediate hypersensitivity showed angio-edema,gastrointestinal symptom and rash.（3）The neutrophil count （（3.8 ±2.8） × 109/L vs.（2.5 ± 1.3） × 109/L） was higher after challenge among children who failed the challenge.The change in the count of blood cell,neutrophil and platelet was studied,however,there were no statistical differences between the challenge-failed children and the passed ones.（4） Forty-seven cases had milk specific immunoglobulin E antibody test,and 5 showed positive results,4 of whom were seen among the challenge-failed children.Conclusion Diarrhea and hematochezia was the most common clinical manifestation,and cow＆#39;s milk protein induced proctocolitis was the most common disease in practice.It is important and necessary to perform cow＆#39;s milk challenge.