目的 监测牛奶蛋白过敏(CMPA)婴幼儿临床治疗过程中血小板及相关指标的动态变化,为CMPA的进一步诊断和治疗提供线索。 方法 选取2022年8—11月门诊就诊的1月龄~3岁诊断CMPA的儿童,共59例为CMPA组,同期健康体检儿童29例为对照组,比较两组血小板相关指标的差异,并绘制受试者工作特征(ROC)曲线分析其对CMPA的诊断价值。 结果 CMPA组治疗前血小板计数(PLT)均值为(374.68±113.21)×109/L、血小板压积(PCT)均值为0.37±0.10,均显著高于对照组[PLT均值为(271.07±40.32)×109/L,PCT均值为0.26±0.05],差异具有统计学意义(t=6.27、6.43,P＜0.001)。CMPA组治疗后PLT均值为(316.39±94.68)×109/L,PCT均值为0.31±0.10,较治疗前显著降低,差异有统计学意义(t=4.32、4.75,P＜0.05)。ROC曲线分析显示,PLT及PCT诊断CMPA的曲线下面积(AUC)分别为0.811、0.823,最佳截断值分别为304.5×109/L、0.305。 结论 CMPA婴幼儿PLT和PCT高于健康对照人群,PLT、PCT在CMPA诊断中可能有临床参考价值。
Abstract
Objective To dynamically monitor and analyze the changes of platelets and related indicators in infants with cow's milk protein allergy (CMPA) during clinical treatment, in order to provide clues for further diagnosis and treatment of CMPA. Methods From August to November in 2022, 59 children aged from 1 month to 3 years old with CMPA in the pediatric outpatient clinic were selected as the CMPA group, and 29 healthy children who took physical examination were selected as the control group. The differences in platelet related indicators from a routine blood test were compared between the two groups, and their diagnostic value for CMPA was analyzed by receiver operating characteristic (ROC) curves. Results The mean platelet count (PLT) and plateletcrit (PCT) at baseline in the CMPA group were (374.68±113.21)×109/L and 0.37±0.10, significantly higher than those in control group[(271.07±40.32)×109/L, 0.26±0.05] (t=6.27, 6.43, P<0.001). In the CMPA group, after treatment, the mean PLT level was (316.39±94.68)×109/L, and the mean PCT level was 0.31±0.10, indicating a statistically significant decrease in PLT and PCT levels after treatment compared to baseline (t=4.32,4.75,P<0.05). The diagnostic performance, indicated by the area under the curve (AUC), for PLT and PCT in diagnosing CMPA was 0.811 and 0.823, respectively. The cutoff values for PLT and PCT were determined to be 304.5×109/L and 0.305, respectively. Conclusion The PLT and PCT levels in children with CMPA are found to be higher than those in healthy controls, suggesting their potential diagnostic value in the diagnosis of CMPA.
关键词
血小板 /
牛奶蛋白过敏 /
血小板压积
Key words
platelets /
cow's milk protein allergy /
plateletcrit
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Flom JD, Sicherer SH. Epidemiology of cow's milk allergy[J]. Nutrients, 2019, 11(5):1051.
[2] Mehaudy R, Jáuregui MB, Vinderola G, et al. Cow's milk protein allergy; New knowledge from a multidisciplinary perspective[J]. Arch Argent Pediatr, 2022, 120(3): 200-206.
[3] Yue M, Hu M, Fu F, et al. Emerging roles of platelets in allergic asthma[J]. Front Immunol, 2022, 13: 846055.
[4] Mandel J, Casari M, Stepanyan M, et al. Beyond hemostasis: Platelet innate immune interactions and thromboinflammation[J].Int J Mol Sci,2022, 23(7):3868.
[5] Venter C, Brown T, Meyer R, et al. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline[J]. Clin Transl Allergy, 2017, 7: 26.
[6] Fox A, Brown T, Walsh J, et al. An update to the milk allergy in primary care guideline[J]. Clin Transl Allergy, 2019, 9: 40.
[7] 孙晋波, 杜军保, 李在玲. 白细胞介素10受体1在食物过敏儿童外周血T淋巴细胞中的表达[J].中国实用儿科杂志,2019,34(2):120-125.
Sun JB,Du JJ,Li ZL.Expression of IL-10R1 in T lymphocytes in peripheral blood of children with food allergy[J]. Chinese Journal of Practical Pediatrics, 2019,34(2):120-125.(in Chinese)
[8] Schmitt J, Langan S, Deckert S, et al. Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation[J].J Allergy Clin Immunol, 2013, 132(6): 1337-1347.
[9] Ballmer-Weber BK. Food allergy in adolescence and adulthood[J].Chem Immunol Allergy, 2015, 101: 51-58.
[10] Hansen MM, Nissen SP,Halken S,et al.The natural course of cow's milk allergy and the development of atopic diseases into adulthood[J].Pediatr Allergy Immunol,2021,32(4):727-733.
[11] Vandenplas Y, Bajerova K, Dupont C, et al. The cow's milk related symptom score: The 2022 update[J]. Nutrients, 2022, 14(13):2682.
[12] Vandenplas Y.Prevention and management of cow's milk allergy in non-exclusively breastfed infants[J].Nutrients, 2017, 9(7):731.
[13] Agache I, Rogozea L. Asthma biomarkers: Do they bring precision medicine closer to the clinic?[J].Allergy Asthma Immunol Res,2017,9(6):466-476.
[14] Liu Z,Perry LA,Morgan V.The association between platelet indices and presence and severity of psoriasis:A systematic review and Meta-analysis[J]. Clin Exp Med, 2023,23(2):333-346.
[15] Obseo D,Mera-Berriatua L,Rodriguez-Coira J,et al.Mutiomics analysis points to altered platelet function in severe food-associated respiratory allergy[J].Allergy,2018,73(11):2137-2149.
[16] Topal E, Celiksoy MH, Catal F, et al. The platelet parameters as inflammatory markers in preschool children with atopic eczema[J]. Clin Lab, 2015, 61(5-6): 493-496.
[17] Li L, Xu P, Zhang Z, et al. Platelets can reflect the severity of Crohn's disease without the effect of anemia[J].Clinics (Sao Paulo), 2020, 75: e1596.
[18] McGrath FM, Francis A, Fatovich DM, et al. Genes involved in platelet aggregation and activation are downregulated during acute anaphylaxis in humans[J].Clin Transl Immunology, 2022, 11(12): e1435.
[19] Korniluk A,Koper-Lenkiewicz OM,Kamińska J, et al.Mean Platelet Volume (MPV): New perspectives for an old marker in the course and prognosis of inflammatory conditions[J].Mediators Inflamm, 2019, 2019: 9213074.
PDF(694 KB)
