摘要
背景牛奶蛋白过敏(cow's milk protein allergy,CMPA)患儿建立牛奶口服耐受的影响因素研究较少,目前缺乏针对中国CMPA婴幼儿建立牛奶口服耐受的预测模型。目的分析CMPA婴幼儿建立牛奶口服耐受的影响因素,构建临床预测模型,为CMPA患儿管理、适时再引入牛奶饮食、进行科学饮食指导提供参考。设计前瞻性队列研究。方法以2023年1—12月于吉林大学第一医院儿童风湿免疫过敏科就诊、年龄0~3岁、确诊为CMPA、采用低敏配方奶粉替代喂养的患儿为队列人群,以随访12个月为研究终点。归纳总结患儿临床特征,对建立口服牛奶耐受可能的影响因素进行多因素分析,筛选出有效影响因素构建列线图预测模型,并对预测模型进行评估及验证。主要结局指标牛奶口服耐受的影响因素和预测模型。结果(1)基线信息:共纳入226例CMPA婴幼儿,男132例(58.41%),年龄分布以0~12月龄最多(47.35%);来自城市者占61.5%;早产儿占比11.95%;经剖宫产出生者占62.4%;以人工喂养最多(41.59%),有59.73%患儿推迟添加辅食,67.70%患儿有一级亲属食物过敏史,107例合并其他过敏性疾病。(2)226例CMPA患儿中,IgE介导型48例(轻度28例、中度14例、重度6例),非IgE介导型178例(轻度89例、中度56例、重度33例)。IgE介导型CMPA消化道症状发生率低于非IgE介导型,皮肤症状及呼吸道症状发生率高于非IgE介导型。IgE介导型多系统受累风险高于非IgE介导型。(3)226例CMPA患儿均完成12个月随访。在第3个月、6个月、9个月及12个月随访时,分别有12例、51例、96例、127例患儿经临床评估达口服牛奶耐受。第6个月、9个月及12个月随访时,已建立牛奶口服耐受的患儿中,低敏配方替代喂养>6个月者显著多于低敏配方替代喂养<6个月者。(4)多因素Logistic回归分析显示,0~12月龄、男性、城市出生、IgE介导型CMPA、重度CMPA、剖宫产出生、人工喂养、推迟添加辅食、低敏配方奶粉喂养<6个月、一级亲属食物过敏史是建立牛奶口服耐受的不利影响因素。(5)基于建立牛奶口服耐受的影响因素,构建列线图预测模型。预测模型ROC曲线一致性指数C-index为0.776(95%CI:0.665~0.892),预测效能良好,校准曲线显示预测发生率曲线与实际发生率曲线有良好的一致性。结论对CMPA建立牛奶口服耐受的影响因素进行多因素分析,选择有效影响因素构建CMPA婴幼儿建立牛奶口服耐受的列线图预测模型,为临床CMPA管理、指导科学饮食提供了参考。
Background There is a scarcity of research data on the influencing factors for establishing oral tolerance to milk in patients with cow's milk protein allergy(CMPA).Currently,there is a lack of a predictive model suitable for Chinese infants and young children with CMPA to establish oral tolerance to milk.Objective To analyze the influencing factors of establishing oral milk tolerance in infants and young children with milk protein allergy,and to construct a clinical prediction model,so as to provide references for the management of CMPA patients,the timely reintroduction of milk diet,and the provision of scientific dietary guid-ance.Design A prospective cohort study.Methods The cohort population was composed of children aged 0 to 3 years who vis-ited the Department of Pediatric Rheumatology,Immunology and Allergy of the First Hospital of Jilin University from January to De-cember 2023,were diagnosed with milk protein allergy,and were fed with hypoallergenic formula milk powder instead.The 12-month follow-up was set as the endpoint of the study.The study summarized the clinical characteristics of the patients in this group,conducted a multivariate analysis to identify the possible influencing factors for the establishment of oral milk tolerance,selected the effective influencing factors to construct a nomogram prediction model based on the effective influencing factors,and evaluated and validated the prediction model.Main outcome measures Age,gender,type of CMPA,degree of CMPA,mode of birth,feeding method,whether to delay the addition of complementary foods,duration of feeding with hypoallergenic formula milk,his-tory of food allergy in first-degree relatives.Results(1)Baseline information:A total of 226 infants and young children with CMPA were included,with more males than females.The age distribution was the largest among those aged 0 to 12 months.There were more people from cities than from rural areas.Premature infants accounted for 11.95%.The majority were born by cesarean section.Artificial feeding was the most common(41.59%),59.73%of the children postponed the addition of complementary foods,67.70%of the children had a history of food allergy in first-degree relatives,and 107 cases were combined with other aller-gic diseases.(2)Among the 226 children with CMPA,48 cases were of IgE-mediated type(28 mild cases,14 moderate cases,and 6 severe cases),and 178 cases were of non-IgE-mediated type(89 mild cases,56 moderate cases,and 33 severe cases).The incidence of digestive tract symptoms in IgE-mediated CMPA was lower than that in non-IgE-mediated CMPA,while the incidence of skin symptoms and respiratory tract symptoms was higher than that in non-IGE-mediated CMPA.The risk of multiple system in-volvement in IgE-mediated type was higher than that in non-IgE-mediated type.(3)All 226 children with CMPA completed the 12-month follow-up.During the follow-up in the 3rd month,6th month,9th month and 12th month,12 cases,51 cases,96 cases and 127 cases of children reached oral milk tolerance through clinical assessment respectively.At the follow-up in the 6th,9th and 12th months,among the children who had established oral milk tolerance,those who were fed with hypoallergenic formula replacement for more than 6 months were significantly more than those who were fed with hypoallergenic formula replacement for less than 6 months.(4)Multivariate Logistic regression analysis showed that 0 to 12 months of age,male gender,urban birth,IgE-mediated CMPA,severe CMPA,cesarean section birth,artificial feeding,delayed addition of complementary foods,hypoallergenic formula milk feeding for less than 6 months,and history of food allergy in first-degree relatives were adverse influencing factors for estab-lishing oral milk tolerance.(5)To select the effective influencing factors for establishing oral tolerance to milk and construct a no-mogram prediction model.(6)Evaluation and validation of the prediction model:The consistency index C-index of the ROC curve of the prediction model was 0.776[95%CI:0.665-0.892],indicating good predictive efficacy.The calibration curve showed good consistency between the predicted incidence curve and the actual incidence curve.Conclusion A multivariate analysis was con-ducted on the influencing factors of establishing milk oral tolerance in CMPA,and effective influencing factors were established to construct a nomogram prediction model for establishing milk oral tolerance in infants and young children with CMPA,providing a reference for clinical CMPA management and guiding scientific dietary guidance.
作者
王赫群
宋躐夫
吕姗珊
徐萌
杨思睿
王晶华
WANG Hequn;SONG Liefu;LYU Shanshan;XU Meng;YANG Sirui;WANG Jinghua(Department of Pediatric Rheumatology,Immunology and Allergy,the First Hospital of Jilin University,Changchun 130021,China;Liaoyuan Maternity and Infant Hospital,Liaoyuan 136200,China;Changchun Children's Hospital,Changchun 130051,China)
出处
《中国循证儿科杂志》
北大核心
2025年第4期265-271,共7页
Chinese Journal of Evidence Based Pediatrics
基金
吉林省科技发展计划重点研发资助项目:20210203081SF。
关键词
牛奶蛋白过敏
口服耐受
影响因素
预测模型
Milk protein allergy
Oral tolerance
Influencing factor
Prediction model
