| 摘要: |
| 目的:探讨以胃肠道表现为首发症状的婴儿牛奶蛋白过敏的临床特点,以减少误诊。方法:选取2014年3月至2015年3月南京医科大学附属儿童医院消化门诊就诊的224例诊断为婴儿牛奶蛋白过敏的患儿,采用问卷调查法收集临床资料,应用CoMiSS表进行症状量化评估。结果: 224例患儿中,男108例,女116例,发病年龄以0~ 6个月为主。胃肠道首发症状就诊中腹泻50.0%,便血28.6%,反流或呕吐8.9%,阵发性哭闹7.1%,便秘5.3%。患儿治疗前CoMiSS评分为(10.25±2.61)分,饮食回避2~4周后评分为(3.69±1.18)分,下降>50%以上。224例患儿中误诊病例148例,不同胃肠道首发症状患儿的误诊率为腹泻54.1%,便血29.7%,阵发性哭闹5.4%,反流或呕吐5.4%,便秘5. 4%。既往误诊病例中抗生素使用率达60. 8%。误诊病例中发生营养不良56例,非误诊病例中发生营养不良2例,差异有统计学意义(P<0.05)。结论:胃肠型婴儿牛奶蛋白过敏主要症状为腹泻及便血。因症状缺乏特异性,临床实践中误诊发生率较高。CoMiSS症状评分法有助于临床医师对该病轻中度患儿的诊断和疗效观察。 |
| 关键词: 婴儿 牛奶蛋白过敏 胃肠道表现 症状评分 误诊 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.10.019 |
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| 基金项目: |
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| Therapeutic Advances in Chronic Granulomatous Disease |
| Li Chunzhen, Jiang Liping |
| (Children's Hospital of Chongqing Medical University, Chongqing 400014, China) |
| Abstract: |
| Objective: To analyze the clinical characteristics of infant milk protein allergy in the gastrointestinal tract as the first symptom, in order to reduce mistakes in misdiagnosis. Methods: From March 2014 to March 2015, 224 cases in our hospital were diagnosed as cow milk protein allergy. A questionnaire survey was used to collect clinical data and to evaluate the symptoms of CoMiSS symptom score. Results: Two hundreds and twenty four children were selected including 108 boys and 116 girls, with the age of 0 to 6 months. Different gastrointestinal first symptoms of children were including diarrhea (50.0%), blood in the stool 28.6%, paroxysmal crying 7.1%, constipation 5.3%. Before treatment, the mean CoMiSS score was 10.25±2.61, the mean value after feeding intervention was 3.69±1.18. There were 148 cases of misdiagnosed in 224 cases, the misdiagnose rate of different children with gastrointestinal symptoms started as follows: diarrhea (54.1%), bloody (29.7%), paroxysmal crying (5.4%), reflux or vomiting (5.4%), constipation (5.4%). The use rate of antibiotics in the past misdiagnosed cases was 60.8%. Fifty six cases of malnutrition occurred in misdiagnosed cases and 2 cases of malnutrition in non misdiagnosis cases. Conclusion: Diarrhea and hematochezia were the main symptoms of infant milk protein allergy. Because of the lack of specificity, the misdiagnose rate is high in clinical practice. CoMiSS symptom score method is helpful to the clinical physicians to identify and observe the symptoms of the disease. |
| Key words: infant cow milk protein allergy gastrointestinal tract manifestation symptom score misdiagnose |
