母乳胃肠肽表达与其过敏症的临床分析

Clinical Feature in Infants of Breast Feeding Allergy and Its Possible Relation with Gastrointestinal Peptide Change in Breast Milk

目的分析母乳过敏症患儿的临床特征及母乳中生长抑素(SST)及胃动素(MTL)的含量变化,探讨母乳过敏的可能原因。方法收集23例母乳过敏症患儿临床资料,总结临床表现,分析临床实验室检查结果。并收集患儿大便及母乳,以23例正常婴儿作对照,放射免疫法检测大便及母乳中SST与MTL含量。结果大便中SST与MTL含量(pg/mg)分别为:患儿组32.6±8.9,2.3±3.7;对照组56.2±12.7,21.6±4.7;两组间差异有统计学意义(P<0.05)。母乳中SST、MTL含量(pg/mg)分别为:患儿组236.7±28.9,159.4±36.7;对照组412.6±36.7,216.8±59.7;两组间差异有统计学意义(P<0.05)。患儿中有腹泻的占91.3%(20/23),呕吐的占86.9%(21/23),血便的占69.6%(16/23)。其中95.7%(22/23)有C-反应蛋白(CRP)增高,87.0%(20/23)大便隐血阳性,73.9%(17/23)外周血相升高,39.1%(9/23)有大便白细胞。胃肠镜下以表浅糜烂渗血多见,肠镜下83.3%(10/12)有淋巴增生及浸润,嗜酸粒细胞浸润占25.0%(3/12)。结论对临床上消化道症状迁延不愈的纯母乳喂养婴儿,要警惕母乳过敏症的可能。母乳中SST与MTL含量的降低可能是母乳过敏的原因之一。

Objective To investigate clinical features in infants of breast milk allergy（BMA）, and the possible relationship with the changes of somatostatin （SST） and motilin （MTL） in breast milk. Methods Twenty three cases of pure breast feeding infants with allergic gastroenteritis were collected, while another 23 normal infants with pure breast feeding were enrolled as normal controls. Samples of infant stools and breast milk were collected for the measurement of SST and MTL levels detected by by radioimmunity. Results The levels of SST and MTL in stool samples （pg/mg） were 32.6±8.9, 2.3±3.7 in BMA group and 56.2±12.7, 21.6±4.7 in normal control group, respectively. Those in breast milk （pg/mg） were 236.7±28.9, 159.4±36.7 in BMA group and 412.6±36.7, 216.8±59.7 in normal control group, respectively. All the differences were statistically significant （ P〈0.05）. In BMA infants, the clinical features were 91.3% （20/23） of diarrhea, 86.9% （21/23） of vomiting, 69.6% （16/23） of hematochezia, 95.7% （22/23） of C-reactive protein （CRP） increasing, 87.0% （20/23） of occult blood in stools, 73.9% （17/23） of neutrophil increasing, 39.1% （9/23） of WBC in stools. Conclusion For those infants of breast feeding with persisting and repeated gastrointestinal symptoms, allergy for breast milk should be considered. Deficiency of SST and MTL in breast milk may be a possible cause for food allergy.