重庆地区儿童食物过敏的临床诊治现状探讨  

Current situation of diagnosis and treatment of children food allergy in Chongqing

作　　者：王丽[1] 胡燕[2] 王念蓉[1] Wang Li;Hu Yan;Wang Nianrong(Department of Child Health Care,Chongqing Health Center for Women and Children;Department of Child Health Care,Children’s Hospital Affiliated to Chongqing Medical University)

机构地区：[1]重庆市妇幼保健院儿童保健科,重庆401147 [2]重庆医科大学附属儿童医院儿童保健科,重庆400014

出　　处：《重庆医科大学学报》2020年第12期1747-1750,共4页Journal of Chongqing Medical University

基　　金：重庆市卫计委医学科研资助项目(编号:2017HBRC017)。

摘　　要：目的:探讨儿童食物过敏的临床诊治现状,剖析存在的问题,为提高儿童食物过敏临床诊疗水平提供参考。方法:采用自制调查问卷对重庆市40家妇幼保健机构儿童食物过敏诊断及治疗开展情况进行现状调查。包括采用的食物过敏诊断治疗方法、诊治面临的问题及需求等方面。结果:40家市级及区县级妇幼保健机构中有24家(60%)开展了食物过敏诊断,其中有19家(79.17%)开展了过敏原皮肤点刺试验(skin prick test,SPT),21家单位(87.50%)开展了特异性IgE(specific IgE,sIgE)检测,5家单位(20.83%)开展了IgG的检测;7家单位(29.17%)开展了食物回避试验,1家开展了开放性食物激发试验。全市妇幼保健机构2018年共进行SPT检测19641例;sIgE检测1922例。对医师的调查显示,91.9%的区县妇幼保健院儿保医师认为病史询问最重要;69.80%的基层医师认为阳性的SPT或sIgE结果加上相关症状可诊断食物过敏;89.5%的医师认为阴性的SPT和sIgE结果提示无食物过敏;65.08%的医师认为IgG对食物过敏诊断有意义。95%的家长认为SPT/sIgE阴性结果就是不过敏。治疗方面如患儿考虑为牛奶蛋白过敏,11.11%的医师建议母乳喂养儿停止母乳喂养;25.40%的医师建议配方奶喂养儿改用部分水解配方。如患儿考虑为鸡蛋过敏,7.94%的医师建议停鸡蛋的同时使用部分水解配方;26.98%的医师建议用深度水解配方。部分医师在进行食物回避或食物替代过程中,对于食物回避时间长短不一。基层医师对食物过敏规范化的诊疗培训、具体操作流程等有较高的期望。结论:儿童食物过敏诊治在基层医疗机构不规范。需要加强医师对现有食物过敏指南及共识的掌握,分层分级进行食物过敏诊治培训,规范食物过敏诊断治疗,从而提高食物过敏诊断治疗水平。Objective:To explore the current situation of clinical diagnosis and treatment of children food allergy,and to analyze existing problems,so as to provide reference for improving levels of diagnosis and treatment of children food allergy.Methods:Self-designed questionnaires were used to investigate the situation of diagnosis and treatment of children food allergy in 40 maternal and child health hospitals in Chongqing,including the diagnostic criteria,diagnostic methods,treatment methods,problems and demands.Results:Among the 40 maternal and child health hospitals,24 hospitals(60%)conducted the diagnosis of children food allergy,19(79.17%)hospitals carried out the skin prick test,21 hospitals(87.5%)carried out detection of specific IgE,5 hospitals(20.83%)carried out detection of IgG,7 hospitals(29.17%)carried out elimination diets and 1 hospital conducted the open food stimulation test.In 2018,a total of 19641 cases of SPT tests and 1922 cases of sIgE were conducted in Chongqing maternal and child health care institutes.The survey of doctors revealed:91.9%doctors of child health care thought that patient’s clinical history was the most important in diagnosis of food allergy;69.80%primary doctors thought that positive SPT or sIgE results combined with symptoms of skin or digestive tract(whether closely related to food or not)could diagnose food allergy without elimination diets and food challenge;89.5%doctors thought that negative SPT and sIgE results suggested non-food allergy;65.08%doctors believed that IgG was significant in the diagnosis of food allergy.Ninety-five percent parents didn’t know SPT/sIgE and thought that the negative results were not allergic.If the child was considered to be cow’s milk protein allergy,11.11%doctors would advise mothers to stop breastfeeding;25.40%doctors suggested to change to partial hydrolysis formula.If the children were allergic to eggs,7.94%doctors advised the use of partial hydrolysis formula while stopping eggs,and 26.98%doctors advised the use of deep hydrolysis form

关 键 词：食物过敏 诊断 治疗 

分 类 号：R72[医药卫生—儿科]