婴幼儿食物变态反应在功能性胃肠病发病中的作用

Role of food allergy in the pathogenesis of functional gastrointestinal diseases in infants

目的 探讨食物变态反应在功能性胃肠病发病中的作用.方法 2014年3月至2015年8月佛山市第五人民医院儿科及皮肤科收治怀疑过敏的婴幼儿患儿400例,根据临床表现症状将其分为两组.其中怀疑为食物过敏但表现为胃肠消化道症状如恶心、呕吐、烦躁哭闹、腹痛等特征按罗马Ⅲ诊断标准,归类于功能性胃肠病组,共220例;其余180例主要表现为皮肤过敏症状如湿疹、丘疹、荨麻疹等症状的患儿归类于皮肤过敏组.用酶联免疫吸附法（ELISA）快速试纸条技术测定患儿体内过敏原特异性IgE及化学发光法测定血清总IgE.结果 400例患儿中血清总IgE＜ 100 IU/mL 145例（36.3％）,100～200 IU/mL 83例（20.7％）,＞200 IU/mL 172例（43.0％）;血清总IgE阳性率为63.75％（255/400）,功能性胃肠病组及皮肤过敏组血清总IgE阳性率分别为61.36％（135/220）及66.66％（120/180）,两组比较差异无统计学意义（P＞0.05）.两组患儿血清特异性IgE阳性共检出258例,血清特异性IgE总阳性率为64.5％（258/400）.食物过敏率为鸡蛋（白＋黄）最高,其余从高到低依次为牛奶、牛羊肉、海鲜、坚果、水果.功能性胃肠病组患儿血清特异性IgE阳性共有143例（65.00％）,皮肤过敏组患儿血清特异性IgE阳性共有115例（63.89％）,两组比较差异无统计学意义（P＞0.05）.结论 要幼儿食物过敏除了可引起皮肤过敏症状以外,部分患儿还表现为功能性胃肠病的症状.针对功能性胃肠病患儿,如果考虑与食物过敏相关,需要详细询问膳食史,进行过敏原检测,有利于发现食物过敏病因患儿,对要幼儿进行准确的病因治疗.

Objective To investigate the role of food allergy in the pathogenesis of functional gastro- intestinal disease. Methods Totally 400 patients with suspected allergy in children who were treated in our hospital from March 2014 to August 2015 were divided into two groups according to their clinical symptoms. The suspected food allergy with gastrointestinal symptoms, such as nausea, vomiting, irritability, crying, abdominal pain and other characteristics according to Rome Ⅲ diagnostic criteria, were classified as functional gastrointestinal disease group（220 cases） ; the remaining 180 cases mainly with skin allergy symptoms, such as eczema, papular, nettle rash and other symptoms, were classified as the skin allergy group.ELISA assay was used to determine allergen specific IgE and chemiluminescence method was used to determine the serum total IgE. Results Of the 400 cases, serum total IgE was less than 100 IU/mL in 145 cases, accounting for 36, 25%, 100-200 IU/mL in 83 cases（20.7%）,〉200 IU/mL in 172 cases（43.0%）. The positive rate of serum total IgE was 63.75%（255/400） ,which was 61.36%（135/220） and 66.66%（120/180） reSpectively in functional gastrointestinal diseases group and skin allergy group（P〉0.05）. In the two groups, there were 258 cases of slgE positive serum, the total positive rate of sIgE being 64.5% （258/400）. Food allergy rates were： eggs（white-q-yellow） the highest, followed by milk, beef and mutton, seafood,nuts and fruit in turn. Positive serum slgE was in 143 cases in the group of functional gastrointestinal diseases, and the positive rate of slgE was 65%. There were 115 cases of slgE positive in skin allergic group, and the positive rate of sIgE was 63.89%. There was no significant difference in serum sIgE positive rate between the two groups（P〉0.05）. Conclusion Food allergy can cause skin allergy symptoms, and some of the children also have the symptoms of functional gastrointestinal disease. It is necessary to ask in detail about the diet history and detect allergen in children with functional gastrointestinal disease, if you consider it is related to food allergy. This is helpful in finding the cause of food allergies in children, who can be given etiolog- ical treatment.