慢性迁延性腹泻儿童食物过敏的特征及近期预后分析

摘要

目的 探讨慢性迁延性腹泻儿童食物过敏的特征及近期预后.方法 采用ELISA法,检测患儿血清中14种食物过敏原特异性IgG抗体浓度及血清总IgE水平,根据IgG浓度结果采取"安全进食"、"轮替"进食和"忌食"等不同的健康饮食指导,观察患儿症状改善及食物耐受的情况.3～6个月后复测食物过敏原特异性IgG抗体浓度.结果 112例慢性迁延性腹泻患儿中,有99例有1～12种不等的食物过敏原特异性IgG升高,阳性率88.4%,而对照组阳性率仅为26.7%(χ2=48.58,P＜0 001);腹泻组中对牛奶、蛋清/黄敏感性最高,分别为75.8%和59.6%.腹泻组与正常儿童的血清总IgE水平差异无统计学意义(t=1.359,P>0.10).53.3%病人经过健康饮食指导治疗2周内症状明显缓解,总有效率为80.8%.19.2%的病人症状在3个月后无改善.食物过敏患儿1年、2年和3年后的耐受率分别为46.5%、78.9%和92.0%.结论 慢性迁延性腹泻儿童食物过敏常见,并以多种食物过敏为主,主要为 IgG介导的迟发型变态反应起主要作用.慢性迁延性腹泻患儿的大部分致敏食物可较短时间内获得耐受.%Objective To investigate the characteristics of food allergy and short - term prognosis in children with chronic persistent diarrhea Methods Serum levels of specific IgG antibody to 14 kinds of food and total serum IgE levels were detected using ELISA. The patients received a diet treatment based on the different results of food specific IgG antibody detection. Improvement of symptoms and food tolerance situation were observed. Food allergen specific IgG antibody levels after 3 months to 12 months were retested. Results Of the 112 patients with chronic persistent diarrhea, 99 (88.4％ ) had increased specifiC IgG levela for 1 to 12 kinds of 14 food compared to 8 ( 26. 7％ ) of the cantrols (X2 = 48. 58 ,P ＜ 0. 001 ) . The majority of patients showed increased specific IgG levels for milk ( 75. 8％ ) and egg (59. 6％ ) . The serum total IgE level showed no significant difference ( t = 1. 359 , P ＞0. 10) . The symptoms were improved in 53 patients (53. 3％ ) after 2 weeks of diet treatment,and the total effective rate was 80. 8％. Only 19. 2％ of the patient's symptoms had no improvement after 3 months of diet treatment. Children with food allergy could develop tolerance after 1 , 2 and 3 years,and the tolerance rates were 46. 5％ , 78.9％ and 92.0％ , respectively. Conclusion Food allergy is a common occurrence in children with chronic persistent diarrhea. The majority of patients were allergic to a variety of food. IgG - mediated delayed type hypersensitivity plays a major role.Food allergens in children with chronic persistent diarrhea can produce tolerance in short time after food allergy occurs.