婴儿牛奶蛋白过敏与胃食管反流病的相关性研究

Relationship between infants cow＇s milk protein allergy and gastroesophageal reflux disease

目的研究婴儿牛奶蛋白过敏（CMPA）与胃食管反流病（GERD）的关系，以及对GERD并CMPA治疗的预后。方法选取第四军医大学唐都医院儿科2015年1月至2016年6月的0～6月龄GERD患儿50例（男24例，女26例），患儿均采用血清牛奶蛋白可溶性IgE（sIgE）检查及牛奶蛋白回避试验，对牛奶蛋白回避试验结果阳性、血清牛奶蛋白sIgE阴性的患儿进行牛奶蛋白激发试验，根据CMPA诊断标准确诊为CMPA患儿，对GERD并CMPA患儿采用饮食治疗1个月后复查血嗜酸性粒细胞比例及24 h食管pH监测。结果50例GERD患儿中有23例（46%）确诊为CMPA，GERD患儿与GERD并CMPA患儿临床症状比较差异有统计学意义（χ2＝22.78，P〈0.05），但患儿个体间症状存在交叉，临床难以准确鉴别。GERD患儿与GERD并CMPA患儿家族过敏史差异无统计学意义（χ2＝3.19，P〉0.05）。对于GERD并CMPA的患儿给予饮食治疗1个月后，呕吐、流涕/喘息/咳嗽及腹泻症状较前缓解，差异有统计学意义（P〈0.05），但由于湿疹治疗需疗程较长且易反复，治疗1个月后较前无明显变化（P〉0.05），血嗜酸性粒细胞比例治疗前为（8.2±2.7）%，治疗后为（2.7±1.8）%，差异有统计学意义（t＝10.006，P〈0.01）；5例患儿复查24 h食管pH监测，结果示反酸指数与反流周期数较前降低，前后差异有统计学意义（均P〈0.05）。结论婴儿GERD的发生部分与CMPA有关，且针对CMPA的治疗可减轻GERD患儿的临床症状。

Objective To investigate the relationship between cow＇s milk protein allergy （CMPA） and gastroesophageal reflux disease （GERD） and the prognosis of GERD combined with CMPA. Methods Fifty patients （24 boys and 26 girls） with GERD were enrolled in this study from January 2015 to June 2016 at Department of Pediatrics, Tangdu Hospital of the Fourth Military Medical University. All children were treated with serum milk protein soluble IgE （slgE） and milk protein avoidance test, and those with positive results of children＇s milk protein by provocation test and those with milk serum protein slgE negative by milk protein provocation tests were diagnosed as CMPA children with GERD according to the CMPA diagnostic criteria and received diet therapy for 1 month and then their blood eosinophil ratio and 24 - hour esophageal pH were monitored. Results Twenty - three cases （46%） of 50 children with GERD were diagnosed as CMPA. There was significant difference in clinical symptoms between GERD group and GERD combined with CMPA group （X2 = 22.78, P 〈 0.05 ）, but there existed cross - symptoms among individual patients, so clinical accurate diagnosis turned out to be difficult. There was no significant difference in family history of allergy between GERD group and GERD combined with CMPA group （X2 = 3.19, P 〉 0.05 ）. For children with GERD combined with CMPA,the patients received dietary treatment for 1 month. There was significant improvement in vomiting, runny nose/wheezing/cough and diarrhea （ P 〈 0.05 ）. However, because the treatment of eczema was long and it could relapse easily, there was no significant change after 1 month of therapy（ P 〉 0. 05 ）. The proportions of blood eosinophils were decreased after treatment compared with those before treatment [ （2. 7 ± 1.8） % vs. （8.2 ± 2.7） %, t = 10. 006, P 〈 0.01 ]. The results of 5 children＇s 24 - hour esophageal pH monitoring showed that the reflux index and the number of acid GERD episodes were lower than before, and the difference was all statistically significant before and after （ all P 〈 0.05）. Conclusions The occurrence of GERD in infants is partly related to CMPA, and the treatment of CMPA can relieve the clinical symptoms of GERD.