食物蛋白诱导的婴儿小肠结肠炎综合征5例临床特点并文献复习  

Food protein-induced enterocolitis syndrome:a clinical analysis of 5 cases and literature review

作　　者：李迪 沈惠青[1] 徐樨巍[1] 张晶[1] 李东丹[1] 赵春娜[1] 郭景[1] Li Di;Shen Huiqing;Xu Xiwei;Zhang Jing;Li Dongdan;Zhao Chunna;Guo Jing(Department of Gastroenterology,Beijing Children′s Hospital of Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心(北京),首都医科大学附属北京儿童医院消化科,100045

出　　处：《中华实用儿科临床杂志》2021年第17期1344-1348,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析食物蛋白诱导的小肠结肠炎综合征(FPIES)的临床特点。方法收集2018年7月至2019年9月首都医科大学附属北京儿童医院消化科确诊的5例FPIES患儿的病史及随访资料,总结分析其临床特点。结果5例FPIES患儿均为婴儿。其中女3例,男2例。确诊前曾在多科室就诊,平均就诊次数3次。5例患儿牛奶蛋白过敏4例,鸡蛋白过敏1例。具有典型急性呕吐[5例(100%)]、腹泻[4例(80%)]及早期休克表现[5例(100%)],伴一过性发热[2例(40%)],血白细胞升高[3例(60%)],C-反应蛋白升高[1例(20%)],大便白细胞(+)[2例(40%)]、潜血(+)[1例(20%)]。4例行食物过敏原特异性IgE检测,其中牛奶蛋白IgE(+)2例(40%)。予规避过敏原,3例(60%)静脉补液,2例(40%)口服补液治疗,病情恢复快。3例(60%)就诊过程中曾应用抗生素。4例(80%)一级亲属有明确过敏史。确诊前FPIES患儿家庭对此病认知度低,确诊后严格规避过敏原,未再发生类似过敏反应,并在医师指导下逐步添加辅食,2例存在多重食物过敏。监测生长发育,2例生长发育迟缓患儿体质量、身长均较前有所追赶。结论FPIES是临床上易误诊的、严重的食物过敏相关的消化道疾病,确诊需要综合家族及个人过敏史、饮食记录、疾病发作的特征性表现、饮食回避后效果并进行必要鉴别诊断,确诊后长期管理也非常重要。Objective To summarize and analyze the clinical features of food protein-induced enterocolitis syndrome(FPIES).Methods The medical history and follow-up data of 5 children with FPIES diagnosed in Department of Gastroenterology,Beijing Children′s Hospital of Capital Medical University from July 2018 to September 2019 were collected,and their clinical characteristics were summarized and analyzed.Results Five children with FPIES were all infants,including 3 females and 2 males.Before the onset of the disease,the cases visited multiple departments and the average number of visits before diagnosis was 3.There were 4 cases of milk protein allergy and 1 case of egg white allergy.The patients had acute vomiting[5 cases(100%)],diarrhea[4 cases(80%)],early shock symptoms[5 cases(100%)],transient fever[2 cases(40%)].Hematogenous leukocytes were increased in 3 cases(60%),C-reactive protein was increased in 1 case(20%),faecal leukocytes(+)[2 cases(40%)],occult blood(+)[1 case(20%)].Four cases were tested for food allergen specific IgE,of which 2 cases(40%)were positive for milk protein.After avoiding allergens,3 patients(60%)needed intravenous rehydration treatment and 2 cases(40%)received oral rehydration treatment.The above 5 cases recovered quickly.Three patients(60%)used antibiotics.Four cases(80%)of the first-degree relatives of FPIES had a clear history of allergy.Families of children with FPIES had low awareness of the disease before the diagnosis was made,and the allergens were strictly avoided according to the doctor′s instructions after the diagnosis was made.Similar allergic reactions did not occur again,and complementary foods were gradua-lly added under the guidance of the doctor.Two patients had multiple food allergies.The body weight and length of 2 children with growth retardation were catching up with each other.Conclusions FPIES is a serious food allergy related gastrointestinal disease which is easy to be misdiagnosed clinically.The diagnosis requires a combination of the family and personal allergy his

关 键 词：食物蛋白诱导的小肠结肠炎综合征 牛奶蛋白 鸡蛋白 儿童 

分 类 号：R725.7[医药卫生—儿科]