妊娠期宣教及生后适度水解乳清蛋白配方干预预防婴儿过敏性疾病的前瞻性研究

Preventive effect of prenatal education and partially hydrolyzed whey formula on infantile allergy： a prospective study

目的 探讨妊娠期宣教及生后适度水解乳清蛋白配方（partially hydrolyzed whey formula,pHF-W）干预预防婴儿过敏性疾病的作用.方法 选择2011年11月至2013年11月在广东省5家医院足月分娩的健康新生儿1 773例,根据生后4个月内喂养情况分为pHF-W组653例、普通奶粉组246例和单纯母乳组874例.在妊娠期对孕妇进行宣教,告知均衡营养、合理膳食结构.婴儿出生后每次来院时由专人随访,并对产妇情况进行调查,婴儿随访至1岁.分析3组婴儿过敏性疾病发生情况、生长发育指标,检测脐血及3和6月龄血清IgE.采用方差分析、Kruskal-Wallis 检验、x2检验或Bonferroni法进行统计学分析.结果 1 773例新生儿男性893例（50.4％）,542例（30.6％）剖宫产出生,平均出生胎龄（39.0±0.7）周.3组新生儿一般人口学特征差异均无统计学意义（P值均＞ 0.05）.1 773例婴儿过敏总发生率为29.7％ （526/1 773）,发病时间为生后3～8月龄,平均为（6.2±1.5）月龄.婴儿过敏性疾病以皮肤症状、消化道症状和呼吸道症状为主要表现的发生率分别为28.2％（500/1 773）、1.1％ （20/1 773）和0.3％（6/1 773）.3组婴儿过敏的食物依次为鸡蛋（35.0％,7/20）、牛奶（30.0％,6/20）、鱼虾（1 5.0％,3/20）、花生（10.0％,2/20）和豆类（10.0％,2/20）.pHF-W组和单纯母乳组总过敏性疾病和湿疹的发生率低于普通奶粉组[总过敏性疾病：28.6％（187/653）、28.4％（248/874）与37.0％（91/246）,x2=7.356;湿疹：27.3％（178/653）、27.0％ （236/874）与35.0％（86/246）,x2=6.456;P值均＜0.05].生后3个月,pHF-W组和单纯母乳组血清IgE水平均低于普通奶粉组,差异具有统计学意义[M（P25～P75）,1.0（0.1～5.1）、1.0（0.1～6.2）与1.2 （0.3～3.1） U/ml,P＜0.05].但3组婴儿脐血和6月龄血清IgE水平差异无统计学意义.3组婴儿出生时以及1、3、6、9、12月龄时身长、体重和头围差异均无统计学意义.结论 妊娠期宣教及生后适度pHF-W干预能预防及减少婴儿过敏性疾病的发生.

Objective To explore the preventive effect of prenatal education and partially hydrolyzed whey formula （pHF-W） on infantile allergy.Methods We conducted a prospective study of 1 773 term and healthy infants born in five hospitals in Guangdong Province from November 2011 to November 2013.According to different feeding methods within four months after birth, they were divided into pHF-W group （653 cases）, cow＆#39;s milk formula （CMF） group （246 cases） and exclusive breast-feeding group （874 cases）.We publicise maternal education during pregnancy, and inform the importance of balanced nutrition, and dietary structure.All infants and their mothers were followed up for 12 months.The incidences of food allergies, physical growth parameters were analyzed.Umbilical cord blood total IgE and serum total IgE at three and six months after birth were tested.Analysis of variance, Kruskal-Wallis test, Chi-square test or the Bonferroni tests were used for statistical analysis.Results Among the 1 773 infants, there were 893 males （50.4%）, and 542 （30.6%） were born by cesarean section.The average birth age was （39.0± 0.7） gestational weeks.Demographic characteristics among the three groups had no statistically significant difference （all P 〉 0.05）.The overall incidence of allergy in the 1 773 cases was 29.7% （526/1 773）, and the onset of allergy was three to eight months after birth, with an average of （6.2 ± 1.5） months.The incidences of skin symptoms, gastrointestinal symptoms and respiratory symptoms were 28.2% （500/1 773）, 1.1% （20/1 773） and 0.3% （6/1 773）, respectively.Foods of infant allergy were eggs （35.0%, 7/20）, milk （30.0%, 6/20）, fish and shrimp （15.0%, 3/20）, peanut （10.0%, 2/20） and legumes （10.0%, 2/20）.Incidences of allergic manifestation and atopic dermatitis in pHF-W group[28.6%（187/653） and 27.3%（178/653）]and breast-feeding group[28.4% （248/874） and 27.0%（236/874）] was lower than that in CMF group [（37.0%（91/246） and 35.0%（35/246）, x2=7.356 and 6.456, all P 〈 0.05].The median levels of serum total IgE [M（P25～P75）] at three months after birth of pHF-W group and breast-feeding group were lower than that of CMF group [1.0 （0.1-5.1）, 1.0 （0.1-6.2） vs 1.2 （0.3-3.1） U/ml, all P 〈 0.05].The length, weight and head circumference at one, three, six, nine and 12 months after birth of the three groups had no statistical difference （all P 〉 0.05）.Conclusion Prenatal education and partially hydrolyzed whey formula reduces the incidence of allergic disease in infants.