牛奶蛋白过敏致婴儿嗜酸细胞性胃肠炎24例临床分析

发布时间：2018-06-30 01:31

本文选题：婴儿 + 牛奶蛋白过敏　；参考：《中国内镜杂志》2017年01期

【摘要】：目的研究牛奶蛋白过敏(CMPA)致婴儿嗜酸细胞性胃肠炎(EG)的临床特征、治疗及预后,以提高CMPA致婴儿EG的诊断及治疗水平。方法以该院2010年6月-2014年1月住院诊治的24例CMPA引起的婴儿EG患儿为研究对象,回顾分析CMPA致婴儿EG的临床表现、内镜下特点、组织病理学改变、治疗及预后。结果呕吐24例(100.00%),阵发性哭吵24例(100.00%),腹胀24例(100.00%),呕血23例(95.83%),便血1例(4.17%),伴湿疹17例(70.83%),轻度-中度贫血21例(87.50%),重度贫血1例(4.17%),其中外周血嗜酸性粒细胞(Eos)升高19例(79.17%),血清免疫球蛋白E(Ig E)升高8例(33.33%),血清幽门螺杆菌抗体检测阳性4例(16.67%);食物过敏原特异性Ig E抗体检测对CMPA 3例(12.50%),镜下表现胃、十二指肠黏膜充血、水肿、糜烂和溃疡,其中胃炎24例(100.00%),十二指肠球炎5例(20.83%),十二指肠球部溃疡1例(4.17%),24例组织病理提示胃和/或十二指肠球部有Eos浸润[20个/HPF(每高倍视野)],均伴有肥大细胞浸润;所有患儿经制酸、保护胃肠黏膜和牛奶蛋白回避等治疗取得满意疗效,24例患儿经口服普通配方牛奶激发试验证实CMPA,其中3例患者8~12周后复查胃镜示胃、十二指肠黏膜光滑,Eos均5个/HPF,肥大细胞均8个/HPF。结论 CMPA致婴儿EG的临床表现和内镜下表现均无特异性,胃肠黏膜组织中Eos异常浸润且同时均伴有肥大细胞浸润;黏膜型不需要使用糖皮质激素,牛奶蛋白回避等治疗可取得满意疗效,但明确诊断需依靠活组织病理检查及Eos计数,并结合牛奶蛋白回避和牛奶蛋白激发试验进一步确诊,但激发试验应至少观察患儿10 d,并仔细记录症状,以免漏诊迟发型CMPA。
[Abstract]:Objective to study the clinical features, treatment and prognosis of eosinophilic gastroenteritis (EG) induced by milk protein allergy (CMPA) in order to improve the diagnosis and treatment of infantile eosinophilic gastroenteritis (EG) induced by CMPA. Methods 24 cases of infantile EG caused by CMPA in our hospital from June 2010 to January 2014 were studied retrospectively. The clinical manifestations, endoscopic features, histopathological changes, treatment and prognosis of infantile EG caused by CMPA were analyzed retrospectively. Results there were 24 cases of vomiting (100.00%), 24 cases of paroxysmal crying (100.00%), 24 cases of abdominal distension (100.00%), 23 cases of hematemesis (95.83%), 1 case of stool blood (4.17%), 17 cases of eczema (70.83%), 21 cases of mild to moderate anemia (87.50%), 1 case of severe anemia (4.17%). Serum immunoglobulin E (IgE) was increased in 8 cases (33.33%), positive for Helicobacter pylori antibody in 4 cases (16.67%), and food allergen specific IgE antibody was detected in 3 cases (12.50%) of CMPA. Congestion, edema, erosion and ulceration of duodenal mucosa, 24 cases of gastritis (100.00%), 5 cases of duodenal globulitis (20.83%), 1 case of duodenal ulcer (4.17%) and 24 cases of duodenal bulb ulcer showed Eos infiltration in stomach and / or duodenal bulb [20 / HPF (per high-power visual field)]. The therapeutic effect of protecting gastrointestinal mucosa and milk protein avoidance was satisfactory. CMPA was confirmed by oral routine milk stimulation test in 24 children, and 3 of them were examined by gastroscopy after 812 weeks. Eos of duodenal mucous membrane were 5 / HPFs, mast cells were 8 / HPFs. Conclusion the clinical and endoscopic manifestations of infantile EG induced by CMPA are not specific. The abnormal infiltration of Eos in gastrointestinal mucosa is accompanied by mast cell infiltration, and there is no need for glucocorticoid in the mucosal type. The treatment of milk protein avoidance can obtain satisfactory curative effect, but the definite diagnosis depends on the pathological examination of living tissues and Eos count, combined with milk protein avoidance and milk protein stimulation test to further confirm the diagnosis. But the stimulation test should observe the children at least 10 days and record the symptoms carefully so as not to miss the diagnosis of delayed CMPA.
【作者单位】：江西省儿童医院消化科;
【分类号】：R725.7

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