慢性食物蛋白诱导性小肠结肠炎综合征患儿的临床特征与早期识别

Clinical features and early identification of children with chronic food protein-induced enterocolitis syndrome

目的:研究慢性食物蛋白诱导性小肠结肠炎综合征(food protein-induced enterocolitis syndrome,FPIES)患儿的临床特征和早期识别指标。方法:选择2017年9月至2020年7月安徽省儿童医院消化内科收治的13例慢性FPIES患儿,分析性别、首次发作年龄、诊断时年龄、临床表现、实验室检查及牛奶口服耐受年龄等,另选择同期的15例急性FPIES患儿作对照,比较两组患儿的临床特征、实验室检查指标、内镜下表现、病理结果及治疗方案。对慢性FPIES患儿外周血CRP水平与IL-6水平进行Pearson相关性分析。结果:13例慢性FPIES患儿中,男7例,女6例,首次发作中位年龄为28(2~60)d,诊断时中位年龄为140(57~180)d,牛奶口服耐受中位年龄为20(11~32)个月。15例急性FPIES患儿中,男7例,女8例,首次发作中位年龄为90(22~480)d,诊断时中位年龄为230(123~630)d。与急性FPIES患儿比较,慢性FPIES患儿常见腹泻、血便、发热、体重增长不良,中性粒细胞计数、CRP、IL-6水平明显升高,总蛋白、白蛋白、血红蛋白等明显下降(P均<0.05)。相关性分析显示,慢性FPIES患儿外周血CRP水平与IL-6水平呈正相关(r=0.90,P<0.001)。结论:对于慢性胃肠道症状的患儿伴发热、贫血、体重增长不良及中性粒细胞计数、CRP、IL-6水平升高者,应考虑慢性FPIES的可能。

Objective:To investigate the clinical features and early identification indexes of children with chronic food protein-induced enterocolitis syndrome(FPIES).Methods:Thirteen children with chronic FPIES who were admitted to the Department of Gastroenterology,Anhui Children′s Hospital from September 2017 to July 2020,were selected to analyze gender,age at first onset,age at diagnosis,clinical manifestations,laboratory tests,and milk oral tolerance age.In addition,15 children with acute FPIES during the same period were selected as controls,and the clinical characteristics,laboratory test indexes,endoscopic findings,pathological results and treatment plans between the two groups were compared.Pearson correlation analysis was performed on peripheral blood C-reaction protein(CRP)levels and IL-6 levels in children with chronic FPIES.Results:Among the 13 children with chronic FPIES,there were 7 boys and 6 girls,the median age were 28(2-60)days for onset,140(57-180)days for diagnosis,and 20(11-32)months for oral tolerance of milk.Meanwhile,among the 15 children with acute FPIES,there were 7 boys,8 girls,the median age were 90(22-480)days for onset and 230(123-630)days for diagnosis.It is found that diarrhea,bloody stool,fever and poor weight gain are common manifestaion in the chronic FPIES group;in addition,the neutrophil count,CRP and IL-6 were significantly increased,whereas total protein,albumin and hemoglobin were decreased(all P<0.05).Based on Pearson correlation analysis,there was a linear correlation between CRP level and IL-6 level(r=0.90,P<0.001)in children with chronic FPIES.Conclusion:The chronic FPIES should be considered when presenting the fever,anemia,poor weight gain,as well as the increase of neutrophil count,CRP and IL-6 in patients.