目的 探讨以胃肠道症状为主要表现的婴儿牛奶蛋白过敏（CMPA）的流行病学特点及临床特征。方法 回顾性分析280例临床诊断为以胃肠道症状为主要表现的CMPA住院婴儿的临床资料。结果 280例CMPA患儿中，6月龄以内患儿占72.5%（203例）。表现为腹泻171例（61.1%），血便149例（53.2%），呕吐71例（25.4%），湿疹57例（20.4%），营养不良42例（15%），便秘13例（4.6%）；轻-中度CMPA258例（92.1%），重度CMPA 22例（7.9%）。重度CMPA组营养不良发生率（50.0%）高于轻-中度组（12.0%），血便发生率（22.7%）则低于轻-中度组（55.8%），差异均有统计学意义。母乳喂养CMPA组营养不良发生率（10.3% vs 24.6%）及重度CMPA患儿比例（4.4% vs 18.0%）均低于人工喂养CMPA组，而人工喂养CMPA组的血便发生率（37.7%）则低于母乳喂养CMPA组（56.6%）及混合喂养CMPA组（59.0%），差异均有统计学意义。结论 以胃肠道症状为主要表现的CMPA多发生于6月龄以内婴儿，以腹泻、血便起病多见，病情大多为轻-中度。人工喂养比母乳喂养更易导致重度CMPA，更易引起营养不良。
Abstract：Objective To investigate the epidemiological and clinical features of cow's milk protein allergy (CMPA) in infants presenting mainly with gastrointestinal symptoms. Methods A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms. Results Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants (61.1%), hematochezia in 149 infants (53.2%), vomiting in 71 infants (25.4%), eczema in 57 infants (20.4%), malnutrition in 42 infants (15%) and constipation in 13 infants (4.6%). Of the 280 infants, 258 (92.1%) had mild-to-moderate CMPA and 22 (7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition (50.0% vs 12.0%) and a signifcantly lower incidence rate of hematochezia (22.7% vs 55.8%). The breastfeeding CMPA group had signifcantly lower incidence rates of malnutrition (10.3% vs 24.6%) and severe CMPA (4.4% vs 18.0%) than the artifcial feeding CMPA group, and the artifcial feeding CMPA group had a signifcantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups (37.7% vs 56.6%/59.0%). Conclusions CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artifcial feeding is more likely to cause malnutrition and severe CMPA.
YANG Qing-Hua,ZHENG Bing-Sheng,ZHOU Shao-Ming et al. Clinical features of cow's milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases[J]. CJCP, 2019, 21(3): 271-276.
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