食物蛋白诱导性小肠结肠炎综合征诊治中的临床问题

Clinical problems in the diagnosis and treatment of food protein-induced enterocolitis syndrome

食物蛋白诱导性小肠结肠炎综合征(FPIES)是非IgE介导的食物过敏,主要见于婴幼儿期。急性发作表现为反复呕吐、腹泻,严重者可出现脱水、嗜睡、低体温及休克等,慢性发作甚至会导致生长发育迟缓。FPIES主要通过病史、回避可疑过敏原后症状改善、口服激发试验(OFC)阳性明确诊断。但由于FPIES临床表现及实验室检查缺乏特异性,加之临床医师对该疾病认识不足,常导致延迟诊断或误诊,造成不必要的检查及治疗。现对FPIES诊治中的临床问题展开讨论,以提高临床医师的诊疗水平。

Food protein-induced enterocolitis syndrome(FPIES)is a non-IgE mediated food allergy in infants and young children.Acute stage is manifested as repeated vomiting and diarrhea,and severe cases can appear dehydration,lethargy,hypothermia and shock.Chronic stage can even lead to growth retardation.The diagnosis of FPIES was mainly determined by clinic history,symptom improvement after avoidance of suspected allergens,and positive oral food challenge.However,due to lacking of specific clinical manifestations and laboratory tests of FPIES,and insufficient understanding by clinicians,it often leads to delayed diagnosis or misdiagnosis,which may result in unnecessary examination and treatment.The related clinical problems of FPIES are discussed to improve the diagnosis and treatment.