摘要
目的探讨婴儿过敏性直肠结肠炎的临床特点及肠镜、肠黏膜病理特点。方法回顾性分析2016年1月—2018年12月我院收治的110例婴儿过敏性直肠结肠炎的临床资料及其结肠镜、肠黏膜病理结果、食物过敏原特异度IgG、血常规、粪常规、血清总IgE检测及治疗情况。结果110例过敏性直肠结肠炎中男67例,女43例,<6月龄98例;单纯母乳喂养26例,单纯牛奶喂养19例,混合喂养65例;临床表现均有腹泻,大部分患儿伴有血便(93例),部分患儿伴湿疹(23例)、排便哭闹(67例)、夜眠不安稳(61例)、呕吐(8例)、营养不良(6例);血嗜酸性粒细胞升高63例;血清总IgE升高21例;食物过敏原特异度IgG检测结果,牛奶103例,鸡蛋62例;内镜下病变均累及降结肠、乙状结肠、直肠,累及横结肠76例、升结肠47例、回盲部18例;最常表现为疱疹样改变(106例)、糜烂(97例)、溃疡(13例),组织病理学表现为肠黏膜嗜酸性粒细胞浸润91例,隐窝炎、隐窝增生21例,淋巴滤泡形成18例、浅表溃疡形成4例;18例经母亲规避饮食后好转,8例经先换用氨基酸奶粉喂养1周、再逐渐引入母乳后好转;19例换用深度水解或氨基酸奶粉喂养后好转;65例经换用深度水解或氨基酸配方奶粉喂养、同时母亲规避饮食后好转。结论婴儿过敏性直肠结肠炎缺乏特异度表现,多数临床经过良好,仅少数并发营养不良;牛奶是最主要的过敏原;腹泻、便血病史、血嗜酸细胞升高、肠镜疱疹样改变、肠黏膜嗜酸细胞浸润,提示过敏性直肠结肠炎可能性大;母亲规避饮食或换用氨基酸或深度水解奶粉治疗有效,也是确诊的标准。
Objective To investigate the clinical features of infantile allergic proctocolitis and its endoscopic lesions and pathological features.Methods A retrospective analysis of 110 cases of infantile allergic proctocolitis admitted to our hospital from January 2016 to December 2018 and its colonoscopy and pathological results,food allergen-specific IgG,blood routine,fecal routine,serum total IgE detection and treatment.Results Among 110 patients with allergic proctocolitis,67 were male and 43 were female,98 were<6 months old;26 were breastfed exclusively,19 were fed milk alone,and 65 were mixed feeding.The clinical manifestations were diarrhea,most of children with bloody stools(93 cases),some children with eczema(23 cases),defecation and crying(67 cases),restless sleep(61 cases),vomiting(8 cases),malnutrition(6 cases);blood eosinophils increased in 63 cases,serum total IgE increased in 21 cases.Food allergen-specific IgG test results:103 cases of milk,62 cases of eggs.Endoscopic lesions involved the descending colon,sigmoid colon,rectum,76 cases of transverse colon,47 cases of ascending colon and 18 cases of ileocecal.Most common manifested as herpes-like changes(106 cases),erosion(97 cases),ulcers(13 cases).Histopathology showed 91 cases of intestinal mucosal eosinophil infiltration,21 cases of cryptitis and crypt hyperplasia,18 cases of lymphoid follicle formation and 4 cases of superficial ulcer formation.18 cases were improved after the mother evaded diet.8 cases were improved by feding with amino acid milk powder for one week,and then breast milk was gradually introduced;19 cases were improved after switching to deep hydrolysis or amino acid milk powder.65 cases were improved after switching to deep hydrolysis or amino acid milk powder and simultaneously the mother evaded diet.Conclusion Infantile allergic proctocolitis lack of insufficient specific manifestations,most of the clinical cases are good,only a few are complicated by malnutrition.Milk is the most important allergen.Diarrhea,history of blood in the stool,elevated blood eosinophils,intestinal herpes-like changes,bowel mucosal eosinophil infiltration,are suggesting a high possibility of allergic proctocolitis.Mothers avoiding diet or switching to amino acids or deep hydrolyzed milk powder treatment is also effective,and this is also the standard of diagnosis of proctocolitis.
作者
郑丽娟
高若飞
郭亚琼
ZHENG Lijuan;GAO Ruofei;GUO Yaqiong(Gastroenterology Department,Children's Hospital Affiliated to Zhengzhou University(Henan Children's Hospital,Zhengzhou Children's Hospital),Zhengzhou 450000,China)
出处
《广州医药》
2020年第1期105-108,共4页
Guangzhou Medical Journal
关键词
过敏性直肠结肠炎
临床分析
肠镜
病理
Allergic proctocolitis
Clinical analysis
Endoscopic lesions
Pathological features
