天津医药

• 临床研究 • 上一篇    下一篇

以类脓毒症为首发症状的新生儿牛奶蛋白过敏

刘洋1,巴爽1,张称1,宋莉莉2,孙超1,王丹3,郭静1   

  1. 1. 天津市儿童医院
    2. 天津市儿童医院新生儿科
    3. 儿童医院内科
  • 收稿日期:2014-03-17 修回日期:2014-04-18 出版日期:2014-08-15 发布日期:2014-08-15
  • 通讯作者: 刘洋

Neonatal Cow’s Milk Protein Allergy with Sepsis Like Initial Symptom

LIU Yang 1,BA Shuang2,ZHANG Chen 1,SONG Lili 1,SUN Chao 1,WANG Dan 1,GUO Jing 1   

  1. 1.
    2. Tianjin Children‘s Hospital
  • Received:2014-03-17 Revised:2014-04-18 Published:2014-08-15 Online:2014-08-15
  • Contact: LIU Yang

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摘要： 【摘要】 目的   总结以类脓毒症为首发症状的新生儿牛奶蛋白过敏（CMPA）的临床特点及诊治经验。方法   回顾性分析2009年7月—2013年12月间收治的10例以类脓毒症为首发症状的新生儿CMPA患儿的病史资料、临床表现、实验室检查结果及治疗转归。结果   10例患儿中，有家族过敏史者6例。临床表现以皮肤及消化道症状为主，有1例出现过敏性休克。6例免疫球蛋白（Ig）E介导，嗜酸细胞（1.40±0.17）×109/L，比例均大于5%，4例非IgE介导，嗜酸细胞（0.71±0.08）×109/L，比例2-3%。10例患儿血培养均为阴性，血白细胞（24.5±3.3）×109/L，杆状核粒细胞/中性粒细胞(0.161±0.035)，血小板计数（655±39）×109/L，血白细胞介素（IL）-6 0.31～0.93 μg/L，C反应蛋白（CRP）85～144 mg/L。10例患儿予深度水解蛋白奶粉或氨基酸奶粉喂养，临床症状明显好转或消失，各项炎症指标基本恢复正常。结论   伴有血小板和嗜酸细胞增高的新生儿CMPA应与脓毒症鉴别，新生儿CMPA最重要的治疗是低过敏原性配方奶粉替代治疗。

关键词: 乳类过敏反应, 脓毒症, 婴儿, 新生, 诊断, 鉴别, 牛奶蛋白过敏

Abstract: [Abstract] Objective   To Summarize the clinical characteristics and the experience of diagnosis and treatment in the neonatal cow's milk protein allergy(CMPA) with the original symptom similar to sepsis. Methods   10 patients with neonatal cow's milk protein allergy(CMPA) with the original symptom similar to sepsis hospitalized in our hospital from July 2009 to December 2013.The history data, clinical manifestation, laboratory examination results and the treatment outcome of them were retrospectively analyzed. Results   In 10 cases,6 cases have a family history of allergy. Main clinical manifestations in the skin and gastrointestinal symptoms, including 1 case of anaphylactic shock. IgE mediated 6 cases, acidophilic cells count (1.40±0.17)×109/L,the percentage was greater than 5%;4 cases of non IgE mediated, acidophilic cells count (0.71±0.08)×109/L,the percentage was 2-3%. Blood cultures were all negative, blood leukocyte count (24.5±3.3)×109/L,rod nucleus granulocyte/neutrophils (0.161±0.035),the platelet count (655±39)×109/L, blood interleukin (IL)-6,0.31-0.93 ug/L,C reactive protein (CRP),85-144mg/L.10 cases with extensively hydrolyzed formular or amino acid formular feeding, the clinical symptoms improved or disappeared significantly, the inflammatory indexes returned to normal. Conclusion   It is necessary to make the differential diagnosis between sepsis and neonatal CMPA，which accompanied by increased platelet and acidophil. The most important treatment of neonatal CMPA is hypoallergenic formular replacement therapy.

Key words: milk hypersensitivity, sepsis, newborn, diagnosis, differential, cow's milk protein allergy