血清IgE测定对牛奶过敏婴儿的临床意义

Clinical significance of determination of serum IgE in infants with milk allergy

摘要:

目的 探讨牛奶蛋白特异性IgE(sIgE)对牛奶蛋白过敏症(CMPA)患儿的临床意义。方法 依据sIgE 检测结果将96 例CMPA 患儿分为IgE⁺ 组(n=26)与IgE^- 组(n=70), 对比分析两组患儿的临床特点;予食物回避和使用深度水解蛋白粉或氨基酸粉干预16 周后, 比较两组患儿的干预效果。结果 CMPA 患儿血清IgE 阳性率为27%。IgE⁺ 组的首次发病年龄低于IgE^- 组(P<0.05);过敏性家族史和呼吸道症状发生率高于IgE^- 组(P<0.05);重度CMPA、消化道症状、体重低下、生长迟缓、贫血和低蛋白血症发生率低于IgE^- 组(P<0.05)。IgE⁺ 组患儿主要临床症状表现为红斑、荨麻疹、呕吐、流涕、咳嗽、喘息和阵发性哭闹, 发生率高于IgE^- 组(P<0.05);IgE^- 组患儿主要临床症状表现为湿疹、便秘和腹泻, 发生率高于IgE⁺ 组(P<0.05)。干预16 周后, 两组间各临床症状缓解率均在80％以上, 且两组间各临床症状缓解率比较差异均无统计学意义(P>0.05)。结论 CMPA患儿血清IgE 阳性率不高。IgE^- 组临床症状更不典型, 多为非过敏性临床表现。早期食物回避和使用深度水解蛋白粉或氨基酸粉干预对IgE⁺ 和IgE^- 患儿均能获益。

Abstract:

Objective To determine the clinical significance of milk protein-specific IgE (sIgE) for infants with cow's milk protein allergy (CMPA). Methods Ninety-six infants with CMPA were divided into IgE⁺ group (n=26) and IgE^- group (n=70) and clinical characteristics were compared between the two groups. Infants were denied allergyinducing food and fed instead extensively hydrolyzed formulas or amino-acid formulas for 16 weeks before the two groups were compared. Results Twenty-seven percent of the infants were sIgE^-seropositive. The first onset age of CMPA was significantly younger in the IgE⁺ group than in the IgE^- group (P<0.05), and the family history of allergy and respiratory symptoms were significantly less common in the IgE^- group than in the IgE⁺ group (P<0.05). Severe CMPA, gastrointestinal symptoms, underweight, growth retardation, anemia, and hypoproteinemia were significantly more common in the IgE^- group than in the IgE⁺ group (P<0.05). Erythema, urticaria, vomiting, nasal discharge, cough, wheezing, and paroxysms of crying were major clinical symptoms of the IgE⁺ group, and their incidences were significantly higher in the IgE⁺ group than in the IgE^- group (P<0.05); eczema, constipation, and diarrhea were major symptoms of the IgE^- group, and their incidences were significantly higher in the IgE^- group than in the IgE⁺ group (P<0.05). The remission rate of each symptom was as high as over 80% in the two groups after 16 weeks of intervention and there was no significant difference in the remission rates between the two groups (P>0.05). Conclusions IgE seropositive rate is not high in infants with CMPA. Atypical signs instead of allergic symptoms are more common in the IgE seronegative infants with CMPA. Avoiding allergy-inducing food and eating extensively hydrolyzed formulas or amino-acid formulas in early age benefit infants with IgE^-mediated or non-IgE^-mediated CMPA.