食物蛋白诱导的直肠结肠炎与沙门菌肠炎临床对比分析

doi:10.12372/jcp.2022.21e1075

摘要/Abstract

摘要：

目的比较食物蛋白诱导的直肠结肠炎（FPIP）和沙门菌肠炎的临床特征差异，为早期鉴别诊断提供依据。方法回顾性分析2013年1月至2019年12月收治的FPIP和沙门菌肠炎患儿的临床资料。结果 FPIP组191例，男106例、女85例，中位发病年龄3.8（1.5~7.4）月；沙门菌肠炎组120例，男75例、女45例，中位发病年龄14.7（9.9~20.0）月。与沙门菌肠炎组相比，FPIP组发病年龄较小，病程较长，湿疹史比例较高，差异有统计学意义（P<0.05）。FPIP组的发病年龄以<6月为主，沙门菌肠炎组以6~24月龄为主，两组间差异有统计学意义（P<0.01）。FPIP全年散发，沙门菌肠炎发病主要分布于夏秋季节（6~10月）。与沙门菌肠炎组比较，FPIP组肉眼血便、黏液便、黏液血便发生率较高，呕吐和发热的发生率较低，差异均有统计学意义（P<0.05）。与沙门菌肠炎组比较，FPIP组C反应蛋白>10 mg/L和贫血比例较低，嗜酸性粒细胞和血小板计数较高，中性粒细胞计数和25羟维生素D水平以及食物过敏原sIgE阳性率较低，差异有统计学意义（P<0.05）。沙门菌肠炎组抗生素使用率高于FPIP组，差异有统计学意义（P<0.01）。结论 FPIP多见于无发热、有血丝便的6月龄以内患儿，可伴有湿疹，嗜酸性粒细胞增多常见；沙门菌肠炎多见于6~24月龄儿童，好发于夏秋季节，常伴有发热、C反应蛋白升高。

关键词: 食物蛋白诱导的直肠结肠炎, 沙门菌肠炎, 儿童

Abstract:

Objective To compare the clinical characteristics of food protein-induced proctocolitis (FPIP) and Salmonella enteritis, and to provide basis for early differential diagnosis. Methods The clinical data of infants with FPIP and Salmonella enteritis in the pediatric ward from January 2013 to December 2019 were retrospectively analyzed. Results There were 191 patients in FPIP group, of 106 males and 85 females, with a median age of 3.8 (1.5-7.4) months. There were 120 cases in the salmonella enteritis group, of 75 males and 45 females, with a median age of 14.7 (9.9-20.0) months. Compared with Salmonella enteritis group, the FPIP group had a younger age of onset, a longer duration of illness, and a higher proportion of eczema history, with statistically significant differences (all P<0.01). The age distribution of onset was significantly different between the two groups (P<0.05). The onset age of FPIP group was <6 months, while that of Salmonella enteritis group was 6-24 months. FPIP occurred throughout the year, while Salmonella enteritis mainly occurred in summer and autumn (June to October). Compared with Salmonella enteritis group, the incidence of gross blood stool, mucinous stool and mucinous blood stool was higher in FPIP group, while the incidence of vomiting and fever was lower; the differences were statistically significant (all P<0.05). Compared with Salmonella enterocolitis group, the proportion of C-reactive protein >10 mg·L^-1 and anemia was lower in FPIP group, and the eosinophil count and platelet count were higher, neutrophil count and 25 hydroxyvitamin D level were lower, and the positive rate of food allergen sIgE was lower in FPIP group; the differences were statistically significant (all P<0.05). The utilization rate of antibiotics in Salmonella enteritis group was higher than that in FPIP group, and the difference was statistically significant (P<0.01). Conclusions FPIP is more common in children less than 6 months of age without fever and with bloody stools, which may be accompanied by eczema and eosinophilia. Salmonella enteritis is more common in children aged 6-24 months, usually occurring in summer and autumn, often accompanied by fever and increased c-reactive protein.

Key words: food protein-induced proctocolitis, Salmonella enteritis, infant

陈凡, 简翠, 舒赛男. 食物蛋白诱导的直肠结肠炎与沙门菌肠炎临床对比分析[J]. 临床儿科杂志, 2022, 40(11): 824-830.

CHEN Fan, JIAN Cui, SHU Sainan. Comparison of clinical features of food protein-induced proctocolitis and Salmonella enteritis[J]. Journal of Clinical Pediatrics, 2022, 40(11): 824-830.

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项目	FPIP组(n=191)	沙门菌肠炎组(n=120)	统计量	P
男性[n(%)]	106（55.5）	75（62.5）	χ²=1.49	0.223
入院年龄[M(P₂₅~P₇₅)]/月	5.7（3.2~8.8）	15.0（10.3~20.0）	Z=10.72	<0.001
发病年龄[M(P₂₅~P₇₅)]/月	3.8（1.5~7.4）	14.7（9.9~20.0）	Z=12.04	<0.001
发病年龄分布[n(%)]			χ²=129.19	<0.001
<6月	126（66.0）	8（6.7）
~12月	48（25.1）	40（33.3）
~24月	13（6.8）	53（44.2）
~36月	4（2.1）	19（15.8）
病程[M(P₂₅~P₇₅)]/月	1.0（0.5~2.0）	0.1（0.0~0.2）	Z=12.32	<0.001
纯母乳喂养[n(%)]	104（54.5）	61（50.8）	χ²=0.39	0.534
湿疹史[n(%)]	44（23.0）	8（6.7）	χ²=14.18	<0.001
特应性疾病家族史[n(%)]	10（5.2）	2（1.7）	χ²=1.66	0.198

项目	FPIP组(n=191)	沙门菌肠炎组(n=120)	统计量	P
腹泻类型			χ²=144.41	<0.001
急性腹泻	31（16.2）	101（84.2）
迁延性腹泻	94（49.2）	12（10.0）
慢性腹泻	47（24.6）	0（0.0）
无腹泻	19（9.9）	7（5.8）
血便	124（64.9）	40（33.3）	χ²=29.50	<0.001
黏液便	124（64.9）	61（50.8）	χ²=6.07	0.014
黏液血便	85（44.5）	27（22.5）	χ²=15.48	<0.001
呕吐	17（8.9）	21（17.5）	χ²=5.08	0.024
腹痛	3（1.6）	6（5.0）	χ²=1.99	0.159
腹胀	5（2.6）	0（0.0）	-	0.161¹⁾
营养不良	5（2.6）	0（0.0）	-	0.161¹⁾
发热	0（0.0）	113（94.2）	χ²=282.51	<0.001

项目	FPIP组(n=191)	沙门菌肠炎组(n=120)	统计量	P
CRP>10 mg·L^-1[n(%)]	3（1.6）	87（72.5）	χ²=180.30	<0.001
WBC[M(P₂₅~P₇₅)]×10⁹·L^-1	10.8（8.9~13.2）	10.9（7.9~14.3）	Z=0.09	0.928
NEU[M(P₂₅~P₇₅)]×10⁹·L^-1	2.2（1.6~3.0）	5.0（3.0~8.0）	Z=10.20	<0.001
EOS[M(P₂₅~P₇₅)]×10⁹·L^-1	0.4（0.3~0.6）	0.1（0.0~0.1）	Z=11.36	<0.001
EOS>0.5×10⁹·L^-1[n(%)]	68（35.6）	7（5.8）	χ²=35.69	<0.001
PLT[M(P₂₅~P₇₅)]/×10⁹·L^-1	401.5（339.0~477.0）	308.0（246.0~404.5）	Z=6.03	<0.001
PLT>500×10⁹·L^-1[n(%)]	36（18.8）	9（7.5）	χ²=7.67	0.006
贫血[n(%)]	26（13.6）	27（22.5）	χ²=4.12	0.042
ALT升高[n(%)]	12（6.3）	9（7.5）	χ²=0.173	0.677
AST升高[n(%)]	19（9.9）	12（10.0）	χ²=0.00	0.988
粪便红细胞[n(%)]	58（30.4）	58（48.3）	χ²=10.17	0.001
粪便白细胞[n(%)]	117（61.3）	95（79.2）	χ²=10.98	0.001
粪便红细胞+白细胞[n(%)]	55（28.8）	58（48.3）	χ²=12.16	<0.001
25羟维生素D¹⁾[M(P₂₅~P₇₅)]/ng·mL^-1	30.5（22.2~39.9）	36.5（28.1~44.8）	Z=2.00	0.046
维生素D缺乏[n(%)]	18（19.1）	5（13.9）	χ²=0.50	0.482