牛奶蛋白诱导的婴儿过敏性直肠结肠炎66例临床分析

Clinical analysis on 66 cases of infantile allergic proctocolitis caused by milk protein

[目的]探讨牛奶蛋白诱导的婴儿过敏性直肠结肠炎（AP）临床特征、有价值的诊断手段、有效的治疗及预后。[方法]对66例牛奶蛋白诱导的AP患儿行末梢血常规及嗜酸细胞检测、便常规＋潜血、便培养、生化全项、食物特异性IgG抗体检测、血清总IgE检测、电子结肠镜检查及肠黏膜病理组织学检查,给予回避牛奶及奶制品等饮食干预,症状缓解后行开放性激发试验确诊,随访中每3-6个月逐步调整饮食配方直至耐受。[结果]牛奶蛋白诱导的婴儿AP以腹泻、便血为主要症状,末梢血嗜酸性粒细胞增高（63.6%）、食物特异性IgG抗体检测显示牛奶阳性者达80.3%[（38＋15）/66],电子结肠镜检查100%均显示阳性结果,结肠镜下结肠及直肠黏膜表现多发充血、水肿、糜烂灶,可见圆形红斑、多发浅小溃疡、出血斑及弥漫性颗粒样隆起,黏膜改变多样,可单一出现,也有混合出现且在肠腔内弥漫分布、波及范围较广,其病理结果显示黏膜慢性炎及嗜酸性粒细胞浸润。给予回避牛奶蛋白以氨基酸奶粉替代,1周缓解率即有效率达96.97%（64例）,随访1年,63例（95.45%）获得耐受。[结论]牛奶蛋白诱导的婴儿AP以慢性反复便血、结肠及直肠黏膜弥漫性改变、嗜酸性粒细胞浸润、末梢血嗜酸细胞升高、牛奶特异性IgG阳性为特征,在去除母乳和患儿食物中牛乳蛋白后48~72h内症状缓解则有助于诊断,治疗以饮食干预最为有效并可逐步获得耐受,预后较好。

[Objective]To investigate the clinical features,diagnostic methods,effective treatment and prognosis of the infants with allergic proctocolitis（AP）induced by milk protein.[Methods]Detect blood routine and eosinophilic cell of capillary blood,stool（routine include occult blood）,stool culture,biochemical complete set,food specific IgG antibody,serum total IgE,Electronic colonoscopy,histopathological examination of intestinal mucosa of 66 infants with AP induced by milk protein.Giving avoidance of milk and dairy products,the diagnosis of open provocation test was performed after the symptoms relieved.Following up every 3to 6 months gradually adjust the diet formula until tolerance.[Results]The main symptoms of infants with AP induced by milk protein are diarrhea,hematochezia.Eosinophilic cell of capillary blood increased（63.6%）.Food specific IgG antibody test showed that the milk positive was up to80.3%[（38＋15）/66].The positive results of Electronic colonoscopy is 100%.Under colonoscopy,the colorectal mucosa showed multiple congestion,edema and erosion,visible erythema,multiple small ulcers,bleeding spots and diffuse granular like uplift,the changes of mucosal diversity,can be a single appearance,there are also mixed in the intestinal cavity filled with a wide range of distribution,the pathological results showed that chronic inflammation and eosinophilic infiltration of mucosa.To avoid milk protein and replace the amino acid formula,1weeks remission rate was 96.97%,（64cases）.Following up for 1years,63cases（95.45%）were tolerant.[Conclusion]The features of infants with AP induced by milk protein is chronic re-current hemafecia,colon and rectum diffuse changes and eosinophil infiltration,eosinophilic cell of capillary blood increased and milk specific IgG positive.After removal of milk protein from breast milk and food 48-72 h,the symptom relief is helpful in the diagnosis.Dietary intervention is the most effective treatment,because of making infants get tolerance gradualy and prognosis better.