新生儿牛奶蛋白过敏45例临床分析

Clinical analysis of 45 cases of milk protein allergy in newborns

目的:分析新生儿牛奶蛋白过敏(CMPA)的临床表现及食物回避性试验干预效果。方法:回顾性分析2018年1月—2020年12月在安徽医科大学附属省儿童医院住院治疗的45例新生儿CMPA的临床资料,根据患儿胎龄将45例新生儿CMPA分为早产儿组(15例)和足月儿组(30例)两组,均采用食物回避性试验干预。总结两组临床表现和临床分度,比较两组组间干预后临床效果,以及两组组内干预前后体重及实验室指标血红蛋白、白蛋白、嗜酸粒细胞、牛奶蛋白特异性免疫球蛋白(sIgE)。结果:早产儿组呕吐7例(46.7%),腹胀9例(60.0%),腹泻5例(33.3%),血便4例(26.7%),咳喘1例(6.7%),湿疹和皮炎1例(6.7%),拒乳及体重不增2例(13.3%)。足月儿组呕吐9例(30.0%),腹胀7例(23.3%),腹泻15例(50.0%),血便16例(53.3%),咳喘2例(6.7%),湿疹和皮炎3例(10.0%),拒乳及体重不增1例(3.3%)。早产儿组轻、中度8例(53.3%),重度7例(46.7%);足月儿组轻、中度24例(80.0%),重度6例(20.0%)。干预后,两组显效率和总有效率比较,差异无统计学意义(P>0.05)。早产儿组sIgE阳性1例(6.7%),足月儿组sIgE阳性3例(10.0%)。两组组内干预前后体重、血红蛋白、白蛋白、嗜酸粒细胞比较,差异均有统计学意义(P<0.05)。结论:新生儿CMPA胃肠道反应位于首位,其次为皮肤与呼吸道反应,早产儿与足月儿临床表现有显著差异。食物回避性试验干预后,早产儿与足月儿临床效果无显著差异,但干预前后两组组内体重和实验室指标存在显著差异。

Objective To summarize the clinical characteristics of neonatal milk protein allergy(CMPA)and the effect of food avoidance test intervention.Methods Clinical data of neonatal CMPA hospitalized in the Department of Neonatology,Children's Hospital Affiliated to Anhui Medical University,from January 2018 to December 2020 were retrospectively analyzed.45 cases of neonatal CMPA were divided into preterm group(15 cases)and term group(30 cases)according to gestational age,and food avoidance test was used to intervene in both groups.The clinical manifestations and clinical grading of the two groups were summarized,and the clinical effects after intervention between the two groups were compared,as well as body weight and laboratory indicators of hemoglobin,albumin,eosinophils and milk protein-specific immunoglobulin(sIgE)between before and after intervention of the two groups.Results In the preterm infants group,there were 7 cases(46.7%)of vomiting,9 cases(60.0%)of abdominal distension,5 cases(33.3%)of diarrhea,4 cases(26.7%)of blood stool,1 case(6.7%)of cough and wheezing,1 case(6.7%),of eczema and dermatitis 2 cases(13.3%)of rejection of milk and loss of body mass.In the group of full-term infants,there were 9 cases(30.0%)of vomiting,7 cases(23.3%)of abdominal distension,15 cases(50.0%)of diarrhea,16 cases(53.3%)of bloody stool,2 cases(6.7%)of cough and panting,3 cases(10.0%)of eczema and dermatitis,1 case(3.3%)of milk rejection and no weight gain.In the preterm group,8 cases(53.3%)were mild to moderate,and 7 cases(46.7%)were severe.In the group of full-term infants,24 cases(80.0%)were mild to moderate and 6 cases(20.0%)were severe.After intervention,there was no significant difference in the significant efficiency and total effective rate between the two groups(P>0.05).There were 1 positive case(6.7%)of sIgE in preterm infants and 3 positive cases(10.0%)in term infants.There were statistically significant differences in body mass,hemoglobin,albumin and eosinophils between before and after intervention of preterm infants and full-term infants(P<0.05).Conclusions Gastrointestinal reaction of neonatal CMPA is the first,followed by cutaneous and respiratory reactions.There are some differences in clinical manifestations between preterm infants and full-term infants.After the intervention of food avoidance test,there is no difference in clinical effect between preterm infants and full-term infants,but there are some differences in body weight and laboratory indexes between the two groups before and after the intervention.