皮肤点刺试验对婴儿食物过敏诊断价值研究  

Diagnostic value of skin prick test in food allergic infants

作　　者：温小丽[1] 廖艳[2] 刘玉玲[2] 骆翠媚[2] 龙晓玲[2] 谢广清[2] 崔碧云[2] 李岚[2] 付四毛[2] 

机构地区：[1]南方医科大学第三临床医学院,广东广州510000 [2]南方医科大学附属中山博爱医院,广东中山528403

出　　处：《中国实用儿科杂志》2014年第7期534-537,共4页Chinese Journal of Practical Pediatrics

基　　金：2011年广东省医学科研基金立项资助[项目编号:A2011749]

摘　　要：目的评价1岁以下食物过敏(FA)婴儿皮肤点刺试验(SPT)疹团平均直径(MD)的诊断意义。方法 2012年5月至9月选择中山市博爱医院儿科及儿保科门诊可疑FA婴儿[平均月龄(7.35±2.94)个月]91例为研究对象,进行家族史询问、SPT及开放性食物激发试验(OFC),测量并记录SPT疹团MD及阳性对照疹团MD。以OFC为金标准,计算SPT疹团MD诊断FA的敏感度、特异度,通过受试者工作特征曲线(ROC)及曲线下面积对其诊断价值进行评价,获取确诊FA的SPT疹团MD临界值,同时计算SPT与OFC符合率,并对不同家族史患儿的上述指标分别进行计算,所有数据均采用SPSS13.0软件包进行统计学分析。结果 91例婴儿共进行128例次OFC,其中OFC阳性109例次、阴性19例次;共79例(86.8%)婴幼儿被确诊为FA。OFC诱发症状主要表现为皮肤症状(70.6%),其次是胃肠道症状(20.2%),其余表现为哭闹、咳嗽、揉眼睛等(9.2%)。当SPT疹团MD≥3mm时,SPT诊断牛奶、蛋黄、蛋白过敏的灵敏度分别为19.0%、60.6%、60.5%;牛奶、蛋黄、蛋白SPT疹团MD的ROC曲线下面积分别为0.718、0.604及0.716;3种食物SPT检测结果与OFC符合率分别为44.4%、53.7%、65.9%,家族史阳性符合率分别为62.5%、58.3%、31.3%;家族史阴性时SPT疹团MD的ROC曲线下面积为0.793;家族史阳性时SPT疹团MD的ROC曲线下面积为0.533。当牛奶、蛋黄、蛋白SPT疹团MD分别≥2.2、5.0、4.7mm或家族史阴性患儿SPT疹团MD≥3.25mm时,SPT对FA诊断特异度可达100%。结论 SPT对诊断FA有一定价值。SPT确诊FA的临界值及与家族史相关性综合分析可提高FA诊断率,避免部分可疑FA婴儿进行OFC,对临床快速诊断FA、减轻患儿及其家庭的风险和负担有重要意义。Objective To investigate the diagnostic value of mean diameter of SPT in food allergic infants.Methods Totally 91 infants suspected with food allergy（median age 7.35±2.94 months）were selected,and all patients received family history inquiry,skin prick test and open food challenge.The mean diameter of SPT was measured,and OFC was performed to confirm food allergy.Diagnostic value of skin prick test,including the sensitivity and specificity,was calculated.In addition,receiver operating characteristic curve（ROC）was plotted and area under the curve（AUC）was calculated to quantify the accuracy of the parameter.The SPSS software package version 13.0 for windows was used for all statistical analysis. Results A total of 128 babies received food challenge test,in which there were 109 times of OFC positive and 19 times negative;totally 79 infants were diagnosed with FA.The induced symptoms of food challenge test included skin symptoms（70.6%）, gastrointestinal symptoms（20.2%）, rest with crying,coughing,rubbing eyes,etc.（9.2%）.When the rash MD was ≥3 mm,the sensitivity of SPT diagnosis milk,egg white and protein allergy was 19%,60.6% and 60.5% respectively;the area under ROC curve of rash MD in the milk,egg white,protein was 0.718,0.604 and 0.716 respectively;the rates of three food SPT test results complying with the OFC were 44.4%,53.7% and 65.9%,the rates being 62.5%,58.3% and 31.3% in positive family history;when family history was negative,the area under the ROC curve of rash MD was 0.793. In the cases with positive family history,the area of ROC curve was 0.533.When rash MD of milk,egg white and protein was ≥2.2,5.0,4.7 mm or the rash MD was ≥3.25mm in children with a negative family history,SPT FA diagnostic specificity could be up to 100%. Conclusion SPT has some value in the diagnosis of FA. By finding the critical value of SPT FA and comprehensive analysis of family history,doctors can improve the diagnostic rate of FA. SPT can prevent some suspicious FA infants from food challenge tes

关 键 词：婴儿 食物过敏 皮肤点刺试验 家族史 开放性食物激发试验 

分 类 号：R72[医药卫生—儿科]