临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (8): 603-.doi: 10.3969/j.issn.1000-3606.2020.08.011

• 综合报道 • 上一篇    下一篇

牛奶相关症状评分在婴儿牛奶蛋白过敏早期识别中的评价:多中心调查分析

李伟艳 1*, 周少明 2*, 王少华 3*, 隋凤轩 4*, 高武红 5*, 刘清 6*, 张纪泳 1, 蔡华波 2, 蒋红英 1, 代东伶 2, 王丽婷 1, 朱忠生 2, 李丽 6, 赵 伟 6, 应晶 4, 吴潜珍 1, 翁碧霞 1, 董国庆 1, 曾永梅 1   

  1. 1.南方医科大学附属深圳市妇幼保健院(广东深圳 518028);2.深圳市儿童医院(广东深圳 518038); 3.深圳市福田区妇幼保健院(广东深圳 518048);4.深圳市龙华新区人民医院(广东深圳 518109); 5.深圳市南山区妇幼保健院(广东深圳 518052);6.深圳市罗湖区妇幼保健院(广东深圳 518019)
  • 出版日期:2020-08-15 发布日期:2020-08-11
  • 通讯作者: 曾永梅 电子信箱:zymdoctor2006@126.com
  • 基金资助:
    深圳市卫生计生系统科研项目(No.201601045);深圳市三名工程(No.SZSM201812056)

Assessment of cow’s milk-related symptom scores in early identification of cow’s milk protein allergy in infants in Shenzhen: a multi-center survey analysis

 LI Weiyan1, ZHOU Shaoming2, WANG Shaohua3, SUI Fengxuan4, GAO Wuhong5, LIU Qing6, ZHANG Jiyong1, CAI Huabo2, JIANG Hongying1, DAI Dongling2,WANG Liting1, ZHU Zhongsheng1, LI Li6, ZHAO Wei6, YING Jing4, WU Qianzhen1, WENG Bixia1, DONG Guoqing1 , ZENG Yongmei1   

  1. 1. Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, Guangdong, China; 2. Department of Pediatrics, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China; 3. Department of Pediatrics, Women and Children Health Institute Futian Shenzhen, Shenzhen 518048, Guangdong, China; 4. Department of Pediatrics, The People’s Hospital of Longhua, Shenzhen, Shenzhen 518109, Guangdong, China; 5. Department of Pediatrics, Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen 518052, Guangdong, China; 6. Department of Pediatrics, Shenzhen Luohu Maternity and Child Healthcare Hospital, Shenzhen 518019, Guangdong, China
  • Online:2020-08-15 Published:2020-08-11

摘要: 目的 评价牛奶相关症状评分(CoMiSS)在早期识别婴儿牛奶蛋白过敏(CMPA)中的作用。方法 2016年6 月至2017年5月对6家儿科门诊疑似CMPA的210例婴儿进行CoMiSS评分,通过开放性食物激发试验(OFC)明确或排除 CMPA诊断。同期选取96例健康体检婴儿为对照组。通过ROC曲线评估CoMiSS识别CMPA的灵敏度和特异度,评价其在 早期识别婴儿CMPA中的作用。结果 210例疑似CMPA婴儿中,男114例、女96例,中位年龄4.5个月(1~12个月);其中 82例确诊CMPA,中位CoMiSS为7.0分(6.0~8.3分);128例非CMPA婴儿的中位CoMiSS为4.0分(3.0~5.0分)。96例对 照组中,男42例、女54例,中位年龄4.1个月(1~12个月);中位CoMiSS为 3.0分(2.0~4.0分)。 三组间CoMiSS差异有统 计学意义(H=152.58, P<0.01)。CoMiSS的ROC曲线下面积(AUC)为0.90,最佳诊断界值为5.5,灵敏度为87.8%,特异 度为78.1%。结论 CoMiSS评分临床可操作性强,适合儿科推广。建议以CoMiSS≥6分作为早期识别CMPA标准。

关键词: CoMiSS; 口服激发试验; 牛奶蛋白过敏; 食物过敏; 婴儿

Abstract: Objective To explore the prevalence of cow’s milk allergy in infants in Shenzhen, China and to evaluate Cow’s milk-related Symptom Scores (CoMiSS) in predicting cow’s milk protein allergy (CMPA) in infants. Methods A total of 210 infants with suspected CMPA (114 boys and 96 girls) with median age of 4.5 months old (1-12 months) from 6 hospitals including two municipal hospitals and four district hospitals were enrolled to calculate CoMiSS and eliminate food during June 2016 to May 2017. The 210 infants were diagnosed as CMPA or exclude CMPA by oral food challenge (OFC) test. Sensitivity and specificity of CoMiSS by ROC curve were determined, and CoMiSS in predicting CMPA in infants was evaluated as well. Results The median CoMiSS were 7.0 (6.0~8.3), 4.0 (3.0~5.0) and 3.0 (2.0~4.0) in CMPA group, non-CMPA group and control, respectively, which showed significant differences among three groups(H=152.58, P<0.01). Calculated by ROC curve, the area under curve of ROC was 0.90. The cut-off was 5.5. The sensitivity of CoMiSS was 87.8%, while its specificity was 78.1%. Conclusion CoMiSS is an easy, safe tool to predict CMPA which is suitable for application in pediatric clinic and digestive clinic. It needs more multi-center studies to evaluate the criterion of integral CoMiSS≥6 in recognition of CMPA or add some scores of bloody stool.

Key words:  CoMiSS; oral food challenge; cow’s milk protein allergy; food allergy; infant