目的 分析婴幼儿牛奶蛋白过敏临床特征及相关治疗效果,旨在提高牛奶蛋白过敏(CMPA)临床诊治水平。方法 收集2018年1月-2019年12月在空军军医大学唐都医院儿科门诊、住院部以及儿童保健科确诊的139例CMPA婴幼儿临床资料。结果 1)139例婴幼儿中,临床表现为消化道症状患儿98例,皮肤症状患儿80例,呼吸道症状患儿21例,其余包括贫血患儿10例和烦躁不安患儿24例。2)139例婴幼儿治疗4周和8周的总有效率分别为68.3%和81.3%;其中31例患儿在8周治疗中添加益生菌,益生菌组和对照组总有效率分别为90.3%和78.3%,差异无统计学意义(χ2=2.219,P=0.136);益生菌组呕吐、拒食、便血和湿疹症状均显著好转(P<0.05),对照组仅呕吐和湿疹症状显著好转(P<0.05)。结论 CMPA临床表现无特异性,临床诊疗中应制定个性化CMPA饮食及治疗方案,eHF是CMPA轻-中度患儿的首选替代配方,重症患儿则首选AAF,治疗期间添加益生菌对症状恢复可能有帮助,尚需进一步研究。
Abstract
Objective To analyze the clinical characteristics and therapeutic effect of cow's milk protein allergy(CMPA) in infants, in order to improve the clinical diagnosis and treatment of CMPA. Methods A total of 139 infants with CMPA in Tangdu Hospital of Air Force Military Medical University were enrolled in this study from January 2018 to December 2019, and their clinical manifestations and therapeutic effects were analyzed. Results 1) Among these 139 cases of CMPA, there were 98 cases with gastrointestinal tract symptoms, 80 cases with skin symptoms, 21 cases with respiratory symptoms, 10 cases with anemia and 24 cases with restlessness.2) The total effective rates of treatment for 4 weeks and 8 weeks in 138 CMPA cases were 68.3% and 81.3%, respectively.31 cases were treated with probiotics for 8 weeks, the total effective rate of probiotic group and control group was 90.3% and 78.3%,respectively, the difference was not significant(χ2=2.219,P=0.136).However, infants in probiotic group had showed significant improvement in symptoms of vomiting, antifeedant, bloody stool and eczema(P＜0.05), while significant improvements were only seen in vomiting and eczema in control group (P＜0.05). Conclusions The clinical manifestations of CMPA are diverse.Clinical diagnosis and treatment should be based on the condition of children.Besides, extensively hydrolysed formula(eHF) remains the recommended and preferred therapeutic choice, and amino acid formula(AAF) is reserved for the severe cases.The supplementation of probiotics during treatment may be helpful for elimination of the symptoms, and further studies are warranted.
关键词
牛奶蛋白过敏 /
婴幼儿 /
深度水解蛋白配方粉 /
游离氨基酸配方粉 /
益生菌
Key words
cow's milk protein allergy /
infant /
extensively hydrolysed formula /
amino acid formula /
probiotics
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基金
空军军医大学科技发展基金(2019XC060)
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