牛奶蛋白过敏致婴儿嗜酸细胞性胃肠炎24例临床分析

The clinical, endoscopic and pathologic characteristics of eosinophilic gastroenteritis of 24 cases infants resulted from milk protein allergy

目的研究牛奶蛋白过敏(CMPA)致婴儿嗜酸细胞性胃肠炎(EG)的临床特征、治疗及预后,以提高CMPA致婴儿EG的诊断及治疗水平。方法以该院2010年6月-2014年1月住院诊治的24例CMPA引起的婴儿EG患儿为研究对象,回顾分析CMPA致婴儿EG的临床表现、内镜下特点、组织病理学改变、治疗及预后。结果呕吐24例(100.00%),阵发性哭吵24例(100.00%),腹胀24例(100.00%),呕血23例(95.83%),便血1例(4.17%),伴湿疹17例(70.83%),轻度-中度贫血21例(87.50%),重度贫血1例(4.17%),其中外周血嗜酸性粒细胞(Eos)升高19例(79.17%),血清免疫球蛋白E(Ig E)升高8例(33.33%),血清幽门螺杆菌抗体检测阳性4例(16.67%);食物过敏原特异性Ig E抗体检测对CMPA 3例(12.50%),镜下表现胃、十二指肠黏膜充血、水肿、糜烂和溃疡,其中胃炎24例(100.00%),十二指肠球炎5例(20.83%),十二指肠球部溃疡1例(4.17%),24例组织病理提示胃和/或十二指肠球部有Eos浸润[>20个/HPF(每高倍视野)],均伴有肥大细胞浸润;所有患儿经制酸、保护胃肠黏膜和牛奶蛋白回避等治疗取得满意疗效,24例患儿经口服普通配方牛奶激发试验证实CMPA,其中3例患者8~12周后复查胃镜示胃、十二指肠黏膜光滑,Eos均<5个/HPF,肥大细胞均<8个/HPF。结论 CMPA致婴儿EG的临床表现和内镜下表现均无特异性,胃肠黏膜组织中Eos异常浸润且同时均伴有肥大细胞浸润;黏膜型不需要使用糖皮质激素,牛奶蛋白回避等治疗可取得满意疗效,但明确诊断需依靠活组织病理检查及Eos计数,并结合牛奶蛋白回避和牛奶蛋白激发试验进一步确诊,但激发试验应至少观察患儿10 d,并仔细记录症状,以免漏诊迟发型CMPA。

Objective By studying clinical features, treatment and prognosis of eosinophilic gastroenteritis of infants resulted from milk protein allergy an, to improve the diagnosis and treatment level of eosinophilic gastroenteritis. Methods 24 cases of infants which diagnosed eosinophilic gastroenteritis were chosen from June of 2010 to January of 2014 in children＇s Hospital of XX province and By retrospective analysis clinical manifestations, endoscopic features, histopathology, treatment and prognosis of the 24 cases. Results The 24 cases who were vomiting, paroxysmal crying, abdominal distension （100.00%）, which accompanied by haematemesis 23 cases （95.83%）, lcase （4.17%） hematochezia, 17cases （70.83%） eczema, 21 cases （87.50%） mild to moderate anemia, 1 cases （4.17%） severe anemia, 19 cases （79.17%） the increasing of peripheral blood eosinophil cells, 8 cases （33.33%）the increasing of IgE of the serum and 4 cases （16.67%） the test of antibody of the Helicobacter pylori in Serum was positive; 3 cases （12.50%） were milk protein allergy by the detecting of food allergen- specific IgE antibodies, the endoscopic characteristics were hyperemia, edema, erosion, ulcer of gastric and duodenal mucosa. Among them, 24 cases （100.00%） were gastritis, 5 cases （20.83%） duodenitis and 1 cases （4.17%） duodenal ulcer. The histopathology of the 24 cases revealed that there were gastric or duodenal eosinophils infiltration （〉 20/HPF） and were all associated with mast cell infiltration; By antisecretory, protection of the gastrointestinal mucosa and the obviating of milk protein had a satisfactory treatment effect, 24 cases of children with oral general formula milk test confirmed that the milk protein allergy, The 3 cases of the patients were reviewed by 8-12 weeks after gastroscope, and the mucosa of the duodenum was smooth, Eosinophils were/HPF 〈 8, mast cells were/HPF 〈 5. Conclusion There are no specific clinical and endoscopic manifestations in eosinophilic gastroenteritis of infants resulted from milk protein allergy, gastrointestinal mucosa eosinophil infiltration and simultaneously are accompanied by abnormal mast cell infiltration; Mucosal type without the use of corticosteroids, through milk protein avoidance treatment can achieve satisfactory results, But definite diagnosis must rely on biopsy and eosinophils, combined with avoidance stimulation test of milk protein can further confirmed, But the excitation test should be at least 10 days of observation of children, and carefully recorded symptoms, so as not to delay the missed diagnosis of CMPA.