婴儿牛奶蛋白过敏的危险因素:多中心调查分析

Risk factors for cow’s milk protein allergy in infants:a multicenter survey

目的通过多中心临床研究了解婴儿牛奶蛋白过敏(CMPA)发生的危险因素。方法以2016年6月至2017年5月于深圳市6家医院儿科门诊就诊的1829例1~12月龄婴儿为调查对象,通过问卷调查,筛选CMPA可疑病例,然后进行食物回避激发试验以确诊CMPA。采用多因素logistic回归分析调查婴儿CMPA发生的危险因素。结果1829例患儿中,82例确诊为CMPA(4.48%)。多因素logistic回归分析显示,母亲食物过敏(OR=4.91,95%CI:2.24~10.76)、母亲孕期使用抗生素(OR=3.18,95%CI:1.32~7.65)、开始添加辅食月龄小于<4个月(OR=3.55,95%CI:1.52~8.27)是CMPA的独立危险因素(P<0.05),而纯母乳喂养(OR=0.21,95%CI:0.08~0.58)和>6个月添加辅食(OR=0.38,95%CI:0.17~0.86)是CMPA的保护因素(P<0.05)。结论小于4月龄添加辅食、母亲食物过敏、母孕期使用抗生素是婴儿CMPA发生的危险因素。

Objective To investigate the risk factors for cow's milk protein allergy(CMPA)among infants through a multicenter clinical study.Methods A total of 1829 infants,aged 1-12 months,who attended the outpatient service of the pediatric department in six hospitals in Shenzhen,China from June 2016 to May 2017 were enrolled as subjects.A questionnaire survey was performed to screen out suspected cases of CMPA.Food avoidance and oral food challenge tests were used to make a confirmed diagnosis of CMPA CMPA.A multivariate logistic regression analysis was used to investigate the risk factors for CMPA.Results Among the 1829 infants,82(4.48%)were diagnosed with CMPA.The multivariate logistic regression analysis showed that maternal food allergy(OR=4.91,95%CI:2.24-10.76,P<0.05),antibiotic exposure during pregnancy(OR=3.18,95%CI:1.32-7.65,P<0.05),and the introduction of complementary food at an age of<4 months(OR=3.55,95%CI:1.52-8.27,P<0.05)were risk factors for CMPA,while exclusive breastfeeding(OR=0.21,95%CI:0.08-0.58,P<0.05)and the introduction of complementary food at an age of>6 months(OR=0.38,95%CI:0.17-0.86,P<0.05)were protective factors.Conclusions The introduction of complementary food at an age of<4 months,maternal food allergy,and antibiotic exposure during pregnancy are risk factors for CMPA in infants.