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

Abstract

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

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.

Figures/Tables 4

References 29

[1]	Kotloff KL, Nasrin D, Blackwelder WC, et al. The incidence, aetiology, and adverse clinical consequences of less severe diarrhoeal episodes among infants and children residing in low-income and middle-income countries: a 12-month case-control study as a follow-on to the Global Enteric Multicenter Study (GEMS)[J]. Lancet Glob Health, 2019, 7(5): e568-e584. doi: 10.1016/S2214-109X(19)30076-2
[2]	中华医学会儿科学分会消化学组. 食物过敏相关消化道疾病诊断与管理专家共识[J]. 中华儿科杂志, 2017, 55(7): 487-492.
[3]	Odze RD, Wershil BK, Leichtner AM, et al. Allergic colitis in infants[J]. J Pediatr, 1995, 126(2): 163-170. doi: 10.1016/S0022-3476(95)70540-6
[4]	王卫平, 孙锟, 常立文, 等. 儿科学[M]. 9版. 北京: 人民卫生出版社, 2018.
[5]	中华预防医学会微生态学分会儿科微生态学组. 关于儿童粪菌移植技术规范的共识[J]. 中国微生态学杂志, 2016, 28(4): 479-481.
[6]	郑丽娟, 高若飞, 郭亚琼. 110例婴儿过敏性直肠结肠炎临床分析[J]. 广州医药, 2020, 51(1): 105-108.
[7]	王庭庭, 徐飞, 李玫, 等. 儿童沙门菌感染临床特点及耐药模式[J]. 临床儿科杂志, 2016, 34(4): 246-248.
[8]	Vassallo MF, Banerji A, Rudders SA, et al. Season of birth and food allergy in children[J]. Ann Allergy Asthma Immunol, 2010, 104(4): 307-313. doi: 10.1016/j.anai.2010.01.019
[9]	Ke Y, Lu W, Liu W, et al. Non-typhoidal Salmonella infections among children in a tertiary hospital in Ningbo, Zhejiang, China, 2012-2019 [J]. PLoS Negl Trop Dis, 2020, 14(10): e8732.
[10]	Yang Y, Khoo WJ, Zheng Q, et al. Growth temperature alters Salmonella Enteritidis heat/acid resistance, membrane lipid composition and stress/virulence related gene expression[J]. Int J Food Microbiol, 2014, 172:102-109. doi: 10.1016/j.ijfoodmicro.2013.12.006 pmid: 24368153
[11]	Koletzko S, Niggemann B, Arato A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines[J]. J Pediatr Gastroenterol Nutr, 2012, 55(2): 221-229. doi: 10.1097/MPG.0b013e31825c9482
[12]	Gal-Mor O, Boyle EC, Grassl GA. Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ[J]. Front Microbiol, 2014, 5: 391. doi: 10.3389/fmicb.2014.00391 pmid: 25136336
[13]	Calvani M, Anania C, Cuomo B, et al. Non-IgE- or mixed IgE/non-IgE-mediated gastrointestinal food allergies in the first years of life: old and new tools for diagnosis[J]. Nutrients, 2021, 13(1): 226. doi: 10.3390/nu13010226
[14]	Moore LE, Stewart PH, Deshazo RD. Food allergy: what we know now[J]. Am J Med Sci, 2017, 353(4): 353-366. doi: S0002-9629(16)30624-3 pmid: 28317623
[15]	Chen H, Wang Y, Su L, et al. Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy[J]. Pediatr Neonatol, 2013, 54(3): 147-152. doi: 10.1016/j.pedneo.2013.01.010
[16]	Lozinsky AC, Morais MB. Eosinophilic colitis in infants[J]. J Pediatr (Rio J), 2014, 90(1): 16-21. doi: 10.1016/j.jped.2013.03.024
[17]	Cetinkaya PG, Kahveci M, Karaatmaca B, et al. Predictors for late tolerance development in food protein-induced allergic proctocolitis[J]. Allergy Asthma Proc, 2020, 41(1): e11-e18. doi: 10.2500/aap.2020.41.190017
[18]	Page C, Pitchford S. Platelets and allergic inflammation[J]. Clin Exp Allergy, 2014, 44(7): 901-913. doi: 10.1111/cea.12322 pmid: 24708345
[19]	Idzko M, Pitchford S, Page C. Role of platelets in allergic airway inflammation[J]. J Allergy Clin Immunol, 2015, 135(6): 1416-1423. doi: 10.1016/j.jaci.2015.04.028 pmid: 26051948
[20]	Vassallo MF, Banerji A, Rudders SA, et al. Season of birth and food-induced anaphylaxis in Boston[J]. Allergy, 2010, 65(11): 1492-1493. doi: 10.1111/j.1398-9995.2010.02384.x pmid: 20456318
[21]	Foong RX, Meyer R, Dziubak R, et al. Establishing the prevalence of low vitamin D in non-immunoglobulin-E mediated gastrointestinal food allergic children in a tertiary centre[J]. World Allergy Organ J, 2017, 10(1): 4. doi: 10.1186/s40413-016-0135-y
[22]	Wang JW, Kuo CH, Kuo FC, et al. Fecal microbiota transplantation: Review and update[J]. J Formos Med Assoc, 2019, 118 (Suppl 1): S23-S31. doi: 10.1016/j.jfma.2018.08.011
[23]	Liu S, Li Y, Dai W, et al. Fecal microbiota transplantation induces remission of infantile allergic colitis through gut microbiota re-establishment[J]. World J Gastroenterol, 2017, 23(48): 8570-8581. doi: 10.3748/wjg.v23.i48.8570
[24]	朱忠生, 郑跃杰, 蔡华波, 等. 粪菌移植治疗幼儿严重食物过敏性胃肠病1例并文献复习[J]. 临床儿科杂志, 2017, 35(4): 247-252.
[25]	Buyuktiryaki B, Kulhas Celik I, Erdem SB, et al. Risk factors influencing tolerance and clinical features of food protein-induced allergic proctocolitis[J]. J Pediatr Gastroenterol Nutr, 2020, 70(5): 574-579. doi: 10.1097/MPG.0000000000002629
[26]	Netea SA, Messina NL, Curtis N. Early-life antibiotic exposure and childhood food allergy: a systematic review[J]. J Allergy Clin Immunol, 2019, 144(5): 1445-1448. doi: 10.1016/j.jaci.2019.08.001
[27]	Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 20144[J]. J Pediatr Gastroenterol Nutr, 2014, 59(1): 132-152. doi: 10.1097/MPG.0000000000000375
[28]	中华医学会儿科学分会消化学组, 中华儿科杂志编辑委员会. 中国儿童急性感染性腹泻病临床实践指南[J]. 中华儿科杂志, 2016, 54(7): 483-488.
[29]	Shane AL, Mody RK, Crump JA, et al. 2017 Infectious diseases society of america clinical practice guidelines for the diagnosis and management of infectious diarrhea[J]. Clin Infect Dis, 2017, 65(12): e45-e80. doi: 10.1093/cid/cix669

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

Comparison of clinical features of food protein-induced proctocolitis and Salmonella enteritis

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 29

Related Articles 15

Metrics

Comments

Recommended 0

[1]	XU Quan, YUAN Xiaojun. Diagnosis and treatment characteristics and long-term follow-up of 51 cases of infantile neuroblastoma [J]. Journal of Clinical Pediatrics, 2023, 41(9): 680-685.
[2]	LIN Yucong, GAO Liang, ZHENG Zhi. Influencing factors analysis of the occurrence of small for gestational age in late preterm infants [J]. Journal of Clinical Pediatrics, 2023, 41(7): 514-518.
[3]	ZHAO Caiyan, SUN Xuan, CHEN Ling. Advances in studies on risk factors and predictors of patent hemodynamically significant ductus arteriosus in premature infants [J]. Journal of Clinical Pediatrics, 2023, 41(6): 475-479.
[4]	LI Yanjun, ZHANG Yonghong, CHEN Yan, QIU Wenjun, HAN Lianshu, ZHU Tianwen. Clinical and genetic analysis of early onset very long chain acyl-CoA dehydrogenase deficiency: a report of three cases [J]. Journal of Clinical Pediatrics, 2023, 41(5): 381-386.
[5]	WANG Liping, YOU You, YIN Zhanghua, WANG Yiwen, CHEN Sun, XIA Hongping. Pulmonary vein stenosis in extremely premature infants with bronchopulmonary dysplasia: a report of two cases [J]. Journal of Clinical Pediatrics, 2023, 41(4): 289-293.
[6]	ZHU Xingwang, SHI Yuan. Clinical application of non-invasive high-frequency oscillatory ventilation in premature infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 641-645.
[7]	LI Fang, WANG Li. Progress and challenges in clinical research of umbilical cord blood transplantation for the treatment of premature infant diseases [J]. Journal of Clinical Pediatrics, 2023, 41(10): 646-653.
[8]	ZHOU Jianguo. Etiologies of death and preventive strategies in extremely preterm infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 654-657.
[9]	ZHU Wen, ZOU Yunsu, WU Yue, LU Keyu, CHENG Rui, TONG Meiling, YANG Yang. Related factors analysis of clinical outcome after pulmonary hemorrhage in very low birth weight infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 658-664.
[10]	ZHANG Ye, QI Min, SHI Chunyan, YANG Shibing, JIANG Zhou. Analysis of clinical features and risk factors of death in extremely preterm infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 665-669.
[11]	HAO Qingfei, CHEN Jing, LIU Lijun, LI Gaopan, CHEN Haoming, ZHANG Jing, GUO Hongxiang, CHENG Xiuyong. Predictive value of neonatal sequential organ failure assessment score for mortality risk of late-onset sepsis in very/extremely low birth weight infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 670-674.
[12]	LU Xiaoyan, CHEN Shaohong, CHEN Yingying, ZHOU Wenjun, ZHOU Chan, SONG Yan, LI Luquan, TANG Wenyan. Related factors affecting delayed thyroid stimulating hormone elevation in preterm infants with gestational age <34 weeks [J]. Journal of Clinical Pediatrics, 2023, 41(10): 675-679.
[13]	REN Shuying, ZHANG Qin. Influencing factors of respiratory tract microecology and its significance in bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2023, 41(10): 715-720.
[14]	ZHA Xinyi, WANG Yiwen, MAO Pengliang, CHEN Mingyan, JIANG Wei, WANG Huawei, HU Xuefeng, SHI Liping, ZHU Xueping, QIAN Jihong. Efficacy and safety of lactase additive in preterm infants with lactose intolerance: a prospective, multi-center, randomized controlled trial [J]. Journal of Clinical Pediatrics, 2023, 41(1): 34-41.
[15]	WEI Lele, SONG Juan, DONG Huimin, JUE Zhenzhen, LI Wendong, XU Falin, WANG Jun. Risk factors of transfusion-associated necrotizing enterocolitis in very preterm infants [J]. Journal of Clinical Pediatrics, 2022, 40(9): 666-671.