目的 通过分析婴儿过敏性直肠结肠炎的临床特征，为早期诊断和有效治疗提供科学依据。方法 回顾性调查 2011 年 9 月至 2013 年 3 月期间 96 例婴儿过敏性直肠结肠炎病例，对其临床特征进行分析。结果 患儿临床表现以腹泻最常见。电子结肠镜检查发现 40%患儿表现为多发性小结节，26%患儿表现为灶性红斑、黏膜变脆，25%患儿表现为多发浅表糜烂，9%的患儿表现为溃疡表面渗出。病变部位：87%累及乙状结肠，24%累及直肠，13% 累及降结肠，8% 累及横结肠、升结肠及回盲部。组织病理学检查显示黏膜各层嗜酸性粒细胞浸润，89%患儿为轻中度，12% 患儿为重度和极重度。治疗上母亲和患儿都回避致敏食物，其中 43% 继续母乳喂养，45% 予深度水解蛋白奶粉喂养，13% 予游离氨基酸营养粉喂养。所有患儿经治疗后症状完全缓解。结论 婴儿过敏性直肠结肠炎临床表现无特异性，电子结肠镜及组织病理学检查可提高早期诊断率。治疗采用回避致敏食物，人工喂养患儿给予深度水解配方或氨基酸配方疗效显著。
Abstract
Objective To study the clinical characteristics of hospitalized infants with allergic proctocolitis, and to provide a scientific basis for early diagnosis and effective treatment of allergic proctocolitis. Methods The clinical data of 96 infants with allergic proctocolitis between September 2011 and March 2013 were reviewed retrospectively.Descriptive analysis was performed to assess the clinical characteristics of allergic proctocolitis. Results The most common clinical manifestation was diarrhea in the 96 infants. The electronic colonoscopy results indicated that 40% of the infants had multiple small nodules, 26% showed focal erythema and brittle mucous membranes, 25% showed multiple superficial erosion, and 9% showed ulcers with surface exudates. The affected areas included the sigmoid colon（87%), rectum（24%), descending colon（13%), and transverse colon ascending colon and ileocecal junction（8%). Histopathologic examination showed eosinophilic infiltration of mucosal layers, the condition of which was mild to moderate in 89% and severe and extremely severe in 12% of the infants. To treat the allergic proctocolitis, mothers and infants were suggested to avoid allergenic foods; 43% of them continued breastfeeding, 45% switched to highly hydrolyzed protein formula, and 13% were prescribed amino acid-based elemental formula. All infants were in complete remission at discharge. Conclusion As the clinical manifestations of allergic proctocolitis in infants lack specificity, the electronic colonoscopy and mucosal histopathologic examination are helpful for early and differential diagnosis. The best treatment is to avoid allergenic foods. Formula-feeding infants should be prescribed highly hydrolyzed protein formula or amino acid-based elemental formula.
关键词
过敏性直肠结肠炎 /
临床特征 /
婴儿
Key words
Allergic proctocolitis /
Clinical characteristics /
Infant
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参考文献
[1] 陈静, 廖艳, 张红忠, 等.三城市两岁以下儿童食物过敏现状调查 [J].中华儿科杂志, 2012, 50(1): 5-9.
[2] Hwang JB, Park MH, Kang YN, et al.Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis[J].Korean Med Sci, 2007, 22(2): 213-217.
[3] Boyce JA, Assa'ad A, Burks AW, et al.Guidelines for the diagnosis and management of food allergy in the United States:summary of the NIAID -Sponsored expert panel report[J].Jam Diet Assoc, 2011, 111(1): 17-27.
[4] Xanthakos SA, Schwimmer JB, Melin-Aldana H, et al.Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study[J].Pediatr Gastroenterol Nutr, 2005, 41(7): 16-22.
[5] 李中跃, 马鸣, 陈洁.儿童过敏性结肠炎 33 例诊治分析 [J].临床儿科杂志, 2006, 24(10): 790-793.
[6] Sampson HA.Update on food allergy[J].Allergy Clin Immunol,2004, 113(5): 805-8l9.
[7] Gomes L, Dias JA.A consistent Pattern of minor immunodeficiency and subtle enteropathyin children with multiple food allergy[J].Pediatr Gastroenterol Nutr, 2004,39(1): 101-102.
[8] 刘捷, 丁艳, 梅红.纯母乳喂养婴儿少量便血的原因探讨 [J].中国当代儿科杂志, 2011, 13(6): 455-457.
[9] 钟雪梅, 张艳玲, 邓莉, 等.婴儿过敏性直肠结肠炎 13 例临床分析 [J].临床儿科杂志, 2010, 28(10): 946-949.
[10] Sieherer SH.Clinical aspects of gastrointestinal food allergy in childhood[J].Pediatrics, 2003, 111(6): 1609-1616.
[11] 肖凤, 罗智英, 王伴青, 等.食物过敏后消化系统形态学变化的实验研究 [J].中国实验诊断学, 2012, 16(4): 600-601.
[12] Wills-Karp M, Nathan A, Page K, et al.New insights into innate immune mecha-nisms underlying allergenicity[J].Mucosal Immunol, 2010, 3(2): 104-110.
[13] Quack I, Sellin L, Buchner NJ, et al.Eosinophilic gastroenteritis in a young girl-long-term remission under Montelukast[J].BMC Gastroenterol, 2005, 5(1): 24.
[14] Vickery BP, Chin S, Burks AW.Pathophysiology of Food Allergy[J].Pediatr Clin N Am,2011, 58(2): 363-376.
[15] Fisher HR, du Toit G, Lack G.Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?[J].Arch Dis Child, 2011, 96(3): 259-264.
[16] Sicherer SH, Sampson HA.Food allergy[J].Allergy Clin Immunol, 2010, 125(2 Suppl 2): S116-S125.
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