以急性坏死性肠炎收入院的婴儿牛奶蛋白过敏4例

Infantile cow′s milk protein allergy with acute necrotic enteritis symptom

目的总结以急性坏死性肠炎收入院的婴儿牛奶蛋白过敏(CMPA)的临床特点及诊治经验。方法回顾性分析2013年6月至2016年6月天津市儿童医院以急性坏死性肠炎收入院的4例CMPA患儿的病史资料、临床表现、实验室检查及治疗转归。结果 4例临床表现均以消化道症状为主,其中2例伴有中重度脱水,1例曾罹患新生儿坏死性小肠结肠炎;2例血牛奶蛋白特异性免疫球蛋白E(IgE)阳性,2例血IgE阴性;4例血常规白细胞(27.9±3.2)×10~9/L,血小板(563±48)×10~9/L;血白细胞介素-6(IL-6)0.43～34.67μg/L,C反应蛋白(CRP)21～165 mg/L;1例便常规镜检阴性,3例便常规潜血呈阳性或弱阳性,镜检:红细胞(0～5)个/高倍视野,白细胞(3～6)个/高倍视野;4例培便养均为阴性,其中2例粪便钙卫蛋白<50μg/g(正常值范围),另外2例粪便钙卫蛋白为65～231.1μg/g。4例均予深度水解蛋白奶粉或氨基酸粉喂养,临床症状明显好转或消失,腹部影像学检查及各项炎症指标基本恢复正常。结论以消化系统症状为主要表现的CMPA可能会被误诊为急性坏死性肠炎,应做好鉴别诊断。

Objective To summarize the diagnosis and treatment in infantile cow′s milk protein allergy(CMPA)with acute necrotic enteritis symptom.Methods 4 CMPA patients with acute necrotic enteritis symptom were selected in our hospital from June 2013 to June 2016.History data,clinical manifestation,laboratory results and the treatment outcome of them were retrospectively analyzed.Results Main clinical manifestation of these 4 cases were digestive tract symptom,2 case with moderate or severe dehydration,1 case with neonatal necrotic enterocolitis once.IgE mediated 2 cases,the rest 2 cases were not mediated by IgE.Blood leukocyte count was(27.9±3.2)×10^9/L.The platelet count was(563±48)×10^9/L.Blood interleukin-6(IL-6)was 0.43-34.67μg/L.C reactive protein(CRP)was 21-165 mg/L.Microscopic examination of 3 cases,occult blood present positive or weakly positive,RBC(0-5)/HPF,WBC(3-6)/HPF,while the rest 1 case was normal.All of their stool cultures were negative.Fecal calprotectin tesets of 2 cases were<50μg/g(normal),the rest 2 cases were 65-231.1μg/g.All 4 cases were with extensively hydrolyzed formular or amino acid formular feeding,then their clinical symptoms improved or disappeared significantly,the imageological examination of abdomen and inflammatory indexes returned to normal.Conclusion The CMPA patients whose clinical manifestations were digestive tract symptom could be misdiagnosed as acute necrotic enteritis.