婴儿乳糖不耐受的临床特点、治疗及大便pH值的诊断意义  

Clinical characteristics and treatment of infantile lactose intolerance and evaluation of the diagnostic value of fecal pH

作　　者：张小娇 姜毅[1] 张艳玲[2] 李正红[3] 王君[4] 刘黎黎[1] 侯新琳[1] Zhang Xiaojiao;Jiang Yi;Zhang Yanling;Li Zhenghong;Wang Jun;Liu Lili;Hou Xinlin(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Gastroenterology,Capital Institute of Pediatrics,Beijing 100020,China;Department of Pediatrics,Peking Union Medical University Hospital,Beijing 100730,China;Department of Pediatrics,Chian-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京大学第一医院儿科,100034 [2]首都儿科研究所消化内科,北京100020 [3]北京协和医院儿科,100730 [4]中日友好医院儿科,北京100029

出　　处：《中华实用儿科临床杂志》2019年第19期1467-1471,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家科技支撑计划(2012BAI03B02)。

摘　　要：目的研究婴儿乳糖不耐受的临床特点、诊断方法、治疗效果,并对大便pH值诊断意义进行评价。方法收集2012年6月至2015年6月北京4家三甲医院收治的1岁以内单纯腹泻、无感染症状患儿的临床资料,根据尿半乳糖测定、乳糖耐量试验、大便pH值测定诊断乳糖不耐受,并对乳糖耐受组和乳糖不耐受组临床特点、治疗效果及检测方法进行分析,对大便pH值的诊断意义进行评价。结果共纳入217例患儿,其中男113例,女104例;年龄3~330 d,其中≤6个月174例(80.2%)。乳糖不耐受组156例(71.9%);乳糖不耐受组年龄中位数90.0 d(3~330 d),乳糖耐受组51.5 d(3~300 d);≤6个月患儿乳糖不耐受发生率为70.7%;>6个月患儿乳糖不耐受发生率为76.7%。临床特点:乳糖不耐受患儿纯母乳喂养率明显高于乳糖耐受患儿[73/156例(46.8%)比16/61例(26.2%)],差异有统计学意义(χ2=7.666,P<0.05);乳糖不耐受患儿稀水便伴或不伴泡沫发生率明显高于乳糖耐受患儿[67/156例(42.9%)比15/61例(24.6%)],差异有统计学意义(χ2=6.287,P<0.05);乳糖不耐受患儿腹泻持续时间为30 d(1~210 d),乳糖耐受患儿为30 d(1~300 d);乳糖不耐受患儿腹泻次数>10次/d比例为9.0%(14/156例),乳糖耐受组为6.6%(4/61例);乳糖不耐受患儿合并感染比例与乳糖耐受组相近[32/165例(20.5%)比17/61例(27.9%)]。应用免乳糖配方奶腹泻停止时间为2 d(1~60 d),乳糖酶腹泻停止时间为4 d(2~25 d),仅应用益生菌及蒙脱石散腹泻停止时间中位数2 d(1~5 d)。大便pH值特点:乳糖不耐受患儿与乳糖耐受患儿大便pH值及pH<5.5比例比较,差异均无统计学意义(均P>0.05);≤6个月患儿与>6个月患儿大便pH值及大便pH<5.5患儿比例比较,差异均无统计学意义(均P>0.05)。纯母乳喂养患儿与非纯母乳喂养、感染性腹泻与无感染性腹泻患儿大便pH平均值和pH<5.5患儿比例比较,差异均无统计学意义(均P>0.05)。结论乳糖不耐受患儿大便多伴�Objective To investigate the clinical characteristics,diagnostic approach,and treatment of infantile lactose intolerance,and to evaluate the diagnostic value of fecal pH.Methods The feces and clinical data of all infants(less than 1 year old)diagnosed with simple diarrhea but without signs of infection were collected,who were treated at 4 GradeⅢ-Class-A hospitals within the period of June 2012 to June 2015 in Beijing were collected.Lactose intolerance was diagnosed based on urine galactose level,lactose tolerance test,and fecal pH.The clinical characteristics,therapeutic effects and detection methods of lactose tolerance group and intolerance group were analyzed.Then the diagnostic value of fecal pH was evaluated.Results A total of 217 infants were enrolled in the study,consisting of 113 boys and 104 girls.Their age ranged from 3 to 330 days,174 infants(80.2%)were less than 6 months old.Among them,156 infants were diagnosed with lactose intolerance(71.9%),their median age 90.0 days(3-330 days),while the median age of the lactose tolerant group was 51.5 days(3-300 days).The incidence of lactose intolerance in infants less than 6 months old was 70.6%,and 76.7%in those older than 6 months.Clinical characteristics showed that more infants in the lactose intolerant group were breastfed compared with the lactose tolerant group[73/156 cases(46.8%)vs.16/61 cases(26.2%),χ2=7.666,P<0.05],the occurrence of loose foamy feces was higher in the lactose intolerant group[67/156 cases(42.9%)vs.15/61 cases(24.6%),χ2=6.287,P<0.05],the median duration of diarrhea in the lactose intolerant group was 30 days(1-210 days),and that in the lactose tolerant group was 30 days(1-300 days).The incidence of diarrhea more frequent than 10 times per day in the lactose intolerant group was 9.0%(14/156 cases),while that in the lactose tolerant group was 6.6%(4/61 cases).The rate of infection in the lactose intolerant group was similar to that in the lactose tolerant group[32/165 cases(20.5%)vs.17/61 cases(27.9%)].The median time of recovery by

关 键 词：乳糖不耐受 临床特点 治疗 大便pH值 

分 类 号：R72[医药卫生—儿科]