食物蛋白诱导性小肠结肠炎综合征诊治中的临床问题

doi:10.12372/jcp.2022.22e1019

临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (11): 807-812.doi: 10.12372/jcp.2022.22e1019

食物蛋白诱导性小肠结肠炎综合征诊治中的临床问题

颜伟慧, 吴青青

上海交通大学医学院附属新华医院儿消化营养科（上海 200092）

收稿日期:2022-07-25 出版日期:2022-11-15 发布日期:2022-11-10
作者简介:颜伟慧，博士，ORCID：0000-0002-2869-0264，副主任医师，硕士生导师，研究方向：肠道微环境在儿科消化道疾病发生发展中的作用及其机制。兼任中华医学会儿科学分会消化学组青年委员，上海市医学会肠外肠内营养学专科分会青年委员，中国妇幼保健协会儿童健康与保健分会儿科胃肠疾病与保健学组委员，上海市医学会儿科专科委员会消化学组委员。曾赴美国哈佛医学院波士顿儿童医院Lencer实验室访问学习。先后主持国家自然科学基金、上海市自然科学基金、卫计委项目等课题。以第一作者或通信作者在相关领域国内外学术期刊发表论文10余篇。

Clinical problems in the diagnosis and treatment of food protein-induced enterocolitis syndrome

YAN Weihui, WU Qinging

Department of Pediatric Gastroenterology and Nutrition, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092,China

Received:2022-07-25 Online:2022-11-15 Published:2022-11-10

摘要/Abstract

摘要：

食物蛋白诱导性小肠结肠炎综合征（FPIES）是非IgE介导的食物过敏，主要见于婴幼儿期。急性发作表现为反复呕吐、腹泻，严重者可出现脱水、嗜睡、低体温及休克等，慢性发作甚至会导致生长发育迟缓。FPIES主要通过病史、回避可疑过敏原后症状改善、口服激发试验（OFC）阳性明确诊断。但由于FPIES临床表现及实验室检查缺乏特异性，加之临床医师对该疾病认识不足，常导致延迟诊断或误诊，造成不必要的检查及治疗。现对FPIES诊治中的临床问题展开讨论，以提高临床医师的诊疗水平。

关键词: 食物蛋白诱导性小肠结肠炎综合征, 饮食回避, 过敏原, 口服激发试验

Abstract:

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy in infants and young children. Acute stage is manifested as repeated vomiting and diarrhea, and severe cases can appear dehydration, lethargy, hypothermia and shock. Chronic stage can even lead to growth retardation. The diagnosis of FPIES was mainly determined by clinic history, symptom improvement after avoidance of suspected allergens, and positive oral food challenge. However, due to lacking of specific clinical manifestations and laboratory tests of FPIES, and insufficient understanding by clinicians, it often leads to delayed diagnosis or misdiagnosis, which may result in unnecessary examination and treatment. The related clinical problems of FPIES are discussed to improve the diagnosis and treatment.

Key words: food protein-induced enterocolitis syndrome, food avoidance, allergen, oral food challenge

颜伟慧, 吴青青. 食物蛋白诱导性小肠结肠炎综合征诊治中的临床问题[J]. 临床儿科杂志, 2022, 40(11): 807-812.

YAN Weihui, WU Qinging. Clinical problems in the diagnosis and treatment of food protein-induced enterocolitis syndrome[J]. Journal of Clinical Pediatrics, 2022, 40(11): 807-812.

图/表 2

参考文献 35

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食物蛋白诱导性小肠结肠炎综合征诊治中的临床问题

Clinical problems in the diagnosis and treatment of food protein-induced enterocolitis syndrome

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1）主要标准
在进食可疑食物后1~4小时内出现呕吐，且无典型的IgE介导的过敏性皮肤或呼吸道相关症状
2）次要标准
（1）进食同样可疑的食物后再次或多次出现反复呕吐；
（2）进食不同食物后1-4小时内出现反复呕吐；
（3）病程中伴极度嗜睡；
（4）病程中伴皮肤明显苍白；
（5）需要至医院急诊就诊；
（6）需要静脉输液支持治疗；
（7）进食后24小时（通常5~10小时）出现腹泻；
（8）病程中伴低血压；
（9）病程中伴低体温

1）主要标准
呕吐1~4小时后摄入可疑的食物，且无典型的IgE介导的过敏皮肤或呼吸道症状
2）次要标准
（1）嗜睡；（2）皮肤苍白；
（3）进食5~10小时出现腹泻；（4）低血压；
（5）低体温；（6）中性粒细胞增加（>1 500个/μL）