食物过敏患儿特异性抗体及细胞免疫因子变化特点及其氨基酸乳品联合益生菌干预效应研究

发布时间：2018-03-25 10:57

本文选题：食物过敏　切入点：特异性抗体IgE　出处：《安徽医科大学》2013年硕士论文

【摘要】：食物过敏(Food Allergy, FA)是机体对一种或多种食物蛋白抗原产生的由免疫介导的不良反应。按介导途径不同分为IgE介导的和(或)非IgE介导的变态反应。食物过敏多见于小年龄儿童，可以引起多器官系统受累，最常见的是消化系统、皮肤黏膜和呼吸系统。其中消化系统症状可表现为腹痛、腹泻、腹胀、便秘、消化道出血、恶心、呕吐、拒奶、溢乳、喂养困难、肛瘘等，上述症状若迁延不愈将造成患儿的生长发育受限、缺铁性贫血、低蛋白血症、水肿等并发症。消化道症状和并发症均为非特异性，且以非IgE介导为主，极易误诊。近年来食物过敏的患者日益增多，已成为2l世纪人们日益关注的食品安全和公共卫生问题。全世界范围内儿童食物过敏性疾病的发病率持续上升，据统计，，约有5%～8%的儿童患有食物过敏症,已严重影响到儿童的生长发育，也给家庭和社会造成极大的负担，尤其是因食物过敏出现消化系统症状的患儿，被误诊和滥用抗生素的情况依然存在，寻找有效的、安全的食物过敏防治措施迫在眉睫。目的通过对以消化道症状为主要表现的食物过敏(Food Allergy, FA)患儿血清食物过敏原特异性抗体、淋巴细胞亚群以及CD23检测，观察FA患儿在过敏状态下部分免疫学指标的变化，氨基酸配方奶粉治疗，益生菌治疗观察治疗前后机体免疫学指标变化，做出分析评价，为临床采取合理的诊疗措施提供科学依据。通过研究，期望获得出更安全、有效的FA治疗方案，来进一步探讨临床干预意义。方法临床疑似为FA的住院患儿50例，通过食物回避试验和酶联免疫吸附法（ELISA）检测食物过敏原特异性抗体，分为单一过敏组和多种过敏组，两组均为15例，分别采用流式细胞术检测淋巴细胞亚群以及CD23指标水平，并与20例阴性组做对照，同时26例确诊为牛奶蛋白过敏的患儿，分为氨基酸组和联合组，分别予以氨基酸配方奶粉治疗和氨基酸配方奶粉联合益生菌（双歧杆菌四联活菌片：6个月内：0.5bid；6个月～1岁：1.0bid；1岁以上：1.0tid）治疗6个月，检测两组患儿治疗前后淋巴细胞亚群水平。观察各组治疗前后对照其免疫指标变化，对结果进行统计学分析。结果 1.FA患儿单一过敏组和多种过敏组中CD3~+CD8~+以及CD3~+CD4~+/CD3~+CD8~+淋巴细胞百分比较阴性组明显降低，差异有统计学意义(P＜0.01)；单一过敏组和多种过敏组中CD3~-/CD19~+淋巴细胞百分比较阴性组（11.676.25）%明显升高，差异有统计学意义(P＜0.01)。 2.FA患儿IgG阳性组中CD3~+CD8~+淋巴细胞百分比（15.502.88）%较阴性组（29.488.69）%明显下降，差异有统计学意义(P＜0.01)；而IgE阳性组中CD19~+CD23~+淋巴细胞百分比（13.455.87）%较阴性组（2.481.20）%明显上升，差异有统计学意义(P＜0.01)。 3.牛奶蛋白过敏患儿应用氨基酸配方奶粉治疗6月后，CD3~+CD4~+/CD3~+CD8~+与CD3~-/CD19~+水平均得到改善，联合益生菌对氨基酸乳品治疗未见具有相加或协同作用。结论 FA患儿体内部分免疫指标发生改变，FA患儿特异性体液及细胞免疫因子变化存在差异,应用氨基酸配方奶粉可改善FA患儿免疫水平,联合益生菌对氨基酸乳品治疗未见具有相加或协同作用。
[Abstract]:Food allergy (Food Allergy FA) is an immune mediated adverse reaction of the body to produce one or more food. According to the protein antigen mediated pathway is divided into IgE mediated allergic reaction and (or) non IgE mediated food allergy. More common in younger children, can lead to multiple organ systems the most common is the involvement of the digestive system, respiratory system and skin mucous membrane. The digestive system symptoms were abdominal pain, diarrhea, abdominal distension, constipation, gastrointestinal bleeding, nausea, vomiting, refusing milk, milk, feeding difficulties, anal fistula and other symptoms, if delayed healing will cause the growth restriction of children, iron deficiency anemia, hypoalbuminemia, edema and other complications. Gastrointestinal symptoms and complications are nonspecific, and non IgE mediated, easily misdiagnosed.
In recent years the increasing number of food allergic patients has become food safety and public health problem 2l century people pay more attention to the worldwide. The incidence of children's food allergic disease rate continues to rise, according to statistics, there are about 5% to 8% of children have a food allergy, has seriously affected the growth and development of children, but also caused a great burden to the family and society, especially for food allergies appear digestive symptoms in children misdiagnosed and abuse of antibiotics still exist, to find effective, imminent food allergy prevention measures for safety.
objective
Based on the gastrointestinal symptoms as the main manifestation of food allergy (Food Allergy, FA) with serum food allergen specific antibody, lymphocyte subsets and CD23 detection, observing the changes of FA in children with allergic state some immunity index, amino acid formula for probiotics in the treatment of immunological changes in the body changes before and after treatment, and make analysis evaluation, provide scientific basis for clinical diagnosis and treatment to take reasonable measures. Through research, expect to get a more safe and effective FA therapy, to further explore the clinical significance of intervention.
Method
The clinical suspected FA in 50 cases of patients, through food avoidance test and enzyme-linked immunosorbent assay (ELISA) detection of food allergen specific antibody, divided into single and multiple group allergy allergy group, two groups of 15 cases, flow cytometric detection of lymphocyte subsets and CD23 index respectively. And 20 cases of the control group and negative, 26 cases were diagnosed as milk protein allergy were divided into amino acid group and combination group were given treatment of amino acid formula and amino acid formula combined with probiotics (Bifidobacterium Tetravaccine tablets: 6 months: 0.5bid; 6 months to 1 years: 1.0bid; 1 years old: 1.0tid) for 6 months. The two groups were detected before and after treatment the level of lymphocyte subsets. Observe the changes of immune index in control group before and after treatment, the results were statistically analyzed.
Result
CD3~+CD8~+ and CD3~+CD4~+/CD3~+CD8~+ lymphocyte percentage in 1.FA negative group with single allergy group and various allergic group were significantly decreased, the difference was statistically significant (P < 0.01); single allergy group and various allergic group CD3~-/CD19~+ lymphocyte percentage (11.676.25%) negative group was significantly increased, the difference was statistically significant (P < 0.01).
The percentage of CD3~+CD8~+ lymphocytes in patients with 2.FA IgG positive group (15.502.88)% compared with negative group (29.488.69)% was significantly decreased, the difference was statistically significant (P < 0.01); and the IgE positive group, the percentage of CD19~+CD23~+ lymphocytes (13.455.87)%% compared with the negative group (2.481.20) increased significantly, the difference was statistically significant (P < 0.01).
3., after the application of amino acid formula milk powder in the treatment of children with milk protein allergy, the level of CD3~+CD4~+/CD3~+CD8~+ and CD3~-/CD19~+ were improved after June. There was no synergistic or synergistic effect of probiotics on amino acid dairy products.
conclusion
The changes of some immune indexes in children with FA are different. There are differences in the specific humoral and cellular immune factors in FA children. Amino acid formula milk powder can improve the immune level of children with FA. Combined with probiotics, there is no additive or synergistic effect on amino acid dairy products.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.9

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