摘要
目的探讨婴幼儿食物蛋白诱导的过敏性直肠结肠炎(FPIAP)临床特征,分析影响FPIAP耐受性发展的影响因素。方法回顾性分析2020年9月—2022年9月于成都市妇女儿童中心医院诊断为FPIAP病例资料,随访患儿自然病程,分析影响耐受时间的相关因素。结果共纳入诊断FPIAP患儿294例,发病年龄1.67月(1~3.78月)。牛奶蛋白是最常见的致敏食物。FPIAP患儿最常见的临床表现是便血,其次为腹泻。共76例患儿完善了肠镜及病理检查,所有患儿肠镜均表现黏膜充血水肿,颗粒样或结节样增生,7例患儿黏膜糜烂(9.21%),12例患儿黏膜下出血(15.79%),10例患儿见黏膜表浅溃疡(13.16%)。病理检查多提示肠黏膜固有层可见淋巴细胞浸润,提示慢性炎症,部分见隐窝分支、隐窝扭曲或隐窝密度降低。不同临床表现如腹泻、便血、或腹泻+便血在肠镜下表现无程度上的差异(P=0.351),与嗜酸性粒细胞浸润的分度也无差异(P=0.476)。肠镜下不同的黏膜改变和嗜酸性粒细胞浸润程度与患者耐受时间无明显相关(P>0.05)。288例患儿经食物回避后症状缓解,6例患儿未回避饮食自行缓解。纯母乳喂养或混合喂养者母亲回避致敏食物继续母乳喂养,需配方奶喂养者更换为深度水解或氨基酸配方喂养。87.07%患儿回避饮食后1周内症状缓解,10.54%患儿回避饮食后1~2周之间症状缓解,2.38%患儿2周后症状缓解。共随访患儿186例,对影响耐受性发展时间相关因素做单因素分析,结果提示配方奶喂养、起病时间越早、对多种食物过敏和皮肤点刺试验结果阳性者耐受时间越晚(P<0.05)。经多因素校正其他变量的基础上,起病年龄和致敏食物的数量为影响耐受时间的独立影响因素。在控制过敏原变量的情况下,起病年龄每早一个月,患儿耐受时间平均增加1.173个月;在控制起病年龄变量的情况下,患儿对多种食物过敏比单一食物过敏原耐受时间平均增加3.906个月。结论食物蛋白诱导的过敏性直肠结肠炎好发于婴儿,主要临床表现为腹泻、便血,其主要的治疗手段是饮食回避;影响耐受的主要因素是发病年龄、喂养方式和对多种食物过敏。
Objective To investigate the clinical characteristics of food protein-induced allergic proctocolitis(FPIAP)in infants and analyze the influencing factors of the development of FPIAP tolerance.Methods The data of FPIAP patients diagnosed in Chengdu Women and Children's Central Hospital from September 2020 to September 2022 were retrospectively analyzed.The natural course of disease was followed up to understand when patients were tolerant to allergenic foods,and the related factors affecting the tolerance time were analyzed.Results A total of 294 FPIAP patients were enrolled,with a median age of onset of 1.67 months(interquartile range:1~3.78 months).Milk protein is the most common sensitized food.The most common clinical manifestation was hematochezia,followed by diarrhea.A total of 76 patients had completed colonoscopy and pathological examination.All patients showed mucosal congestion and edema,granular or nodular hyperplasia,mucosal erosion in 7 patients(9.21%),submucosal hemorrhage in 12 patients(15.79%),and superficial mucosal ulcer in 10 patients(13.16%).Pathological examination mostly indicated lymphocyte infiltration in the lamina propria of intestinal mucosa,suggesting chronic inflammation,and crypt branches,crypt distortion or crypt density reduction in part.There was no difference in different clinical manifestations such as diarrhea,hematochezia,or diarrhea or colonoscopy(P=0.351)or eosinophil infiltration(P=0.476).Different colonoscopy mucosal changes and eosinophil infiltration were not significantly associated with the patient tolerance time(P>0.05).Mothers of exclusive breastfeeding or mixed feeding avoid allergenic foods to continue breastfeeding,and those who need formula feeding change to deeply hydrolyzed or amino acid formula feeding.87.07%of the patients had symptoms relieved within 1 week after avoiding diet,10.54%had symptoms relieved within 1~2 weeks after avoiding diet,and 2.38%had symptoms relieved after 2 weeks.A total of 186 patients were followed up.Univariate analysis of factors affecting the development time of tolerance showed that the patients with formula feeding,earlier onset time,multiple food allergies and positive SPT results had a latertolerance time(P<0.05).On the basis of multivariate adjustment for other variables,the age of onset and the amount of sensitized food were independent influencing factors of tolerance time.When the allergen variables were controlled,the tolerance time of the children increased by 1.173 months on average for every month of onset age.The duration of tolerance to multiple food allergies increased by an average of 3.906 months compared with a single food allergen when controlling for age of onset variables.Conclusion Food protein-induced allergic proctocolitis is common in infants,and the mainclinical manifestations are diarrhea and hematochezia.The main treatment is dietaryavoidance.The main factors affecting tolerance are age of onset,feeding mode and multiple food allergies.
作者
蒋茂林
杨静
李静
杜丽娜
商丽红
谢晓丽
熊励晶
JIANG Maolin;YANG Jing;LI Jing;DU Lina;SHANG Lihong;XIE Xiaoli;XIONG Lijing(Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610091,China)
出处
《西部医学》
2025年第8期1220-1226,共7页
Medical Journal of West China
基金
四川省卫生健康委员会医学科技项目(21PJ132)。
关键词
食物蛋白诱导的过敏性直肠结肠炎
婴儿
耐受
腹泻
便血
Food protein-induced allergic proctocolitis
Infants
Tolerance
Diarrhea
Hematochezia
