CAJ | 학술논문

目的：总结新生儿牛奶蛋白过敏症（ CMPA）的临床表现及最佳诊治方案。方法回顾性分析西安医学院第二附属医院新生儿科自2012年2月至2013年3月收治的40例CMPA患儿的临床表现及治疗方案。结果40例CMPA中（排除了消化道畸形及其他原因所致病变），表现为消化道症状者18例，皮肤湿疹者8例，呼吸系统症状者3例，哭闹、拒乳者11例。确诊时平均日龄为（9．6±3．7）d。牛奶蛋白回避试验和双盲食物激发试验均为阳性。确诊过敏患儿在基础治疗上，持续使用游离氨基酸配方粉（ AAF）或深度水解配方奶粉（ eHF）喂养7～14天后，病情均得到显著缓解。出院后每2周电话随访或门诊复查进一步指导喂养及治疗。经随访后发现22．5％患儿症状反复出现，原因主要为家长依从性不佳。结论新生儿牛奶蛋白过敏症发生在日龄10天左右，临床表现多样化，且缺乏特异性，容易误诊或漏诊。在保证患儿安全，并有紧急抢救过敏性休克等措施下行牛奶蛋白激发试验是确诊的金标准。治疗上轻至中度过敏可以从使用深度水解配方开始，而重度过敏症使用游离氨基酸配方才是最佳方案，并可以达到诊断、治疗二合一的效果。家长的依从性同样对治疗起着重大作用。
목적：총결신생인우내단백과민증（ CMPA）적림상표현급최가진치방안。방법회고성분석서안의학원제이부속의원신생인과자2012년2월지2013년3월수치적40례CMPA환인적림상표현급치료방안。결과40례CMPA중（배제료소화도기형급기타원인소치병변），표현위소화도증상자18례，피부습진자8례，호흡계통증상자3례，곡료、거유자11례。학진시평균일령위（9．6±3．7）d。우내단백회피시험화쌍맹식물격발시험균위양성。학진과민환인재기출치료상，지속사용유리안기산배방분（ AAF）혹심도수해배방내분（ eHF）위양7～14천후，병정균득도현저완해。출원후매2주전화수방혹문진복사진일보지도위양급치료。경수방후발현22．5％환인증상반복출현，원인주요위가장의종성불가。결론신생인우내단백과민증발생재일령10천좌우，림상표현다양화，차결핍특이성，용역오진혹루진。재보증환인안전，병유긴급창구과민성휴극등조시하행우내단백격발시험시학진적금표준。치료상경지중도과민가이종사용심도수해배방개시，이중도과민증사용유리안기산배방재시최가방안，병가이체도진단、치료이합일적효과。가장적의종성동양대치료기착중대작용。
Objective To summarize the clinical manifestations and best diagnosis and treatment of neonates with cow ’ s milk protein allergies ( CMPA) .Methods Retrospective analysis was conducted on the clinical manifestations and treatment scheme of CMPA in 40 cases admitted in neonatology department of the Second Affiliated Hospital of Xi ’ an Medical College in the period of February 2012 to March 2013.Results Among 40 cases of CMPA (excluding digestive tract deformities and lesions due to other reasons ), 18 cases were found with digestive tract symptoms , 8 cases with skin eczema , 3 cases with respiratory symptoms , and 11 case with crying and milk refusal.The average age of the neonates was 9.6 ±3.7 day.Milk protein avoidance experiment and double-blind food provocation test were positive .With foundation treatment , children diagnosed with allergies were fed with free amino acid formula ( AAF) or extensive hydrolysate formula (eHF) for 7-14 days, and all of them were significantly mitigated .Telephone follow-up every 2 weeks after discharge from hospital or outpatient review provided further guidance on feeding and treatment .Follow-up found that 22.5% neonates had symptoms again , and the major reason was poor compliance of parents .Conclusion Neonatal CMPA occurs around the age of 10 days.The clinical manifestations are diversified and lack specificity , which may lead to misdiagnosis or missed diagnosis .Under the condition of guaranteeing children security and emergency measures , milk protein provocation test is gold standard for confirmed diagnosis .For mild to moderate allergies eHF can be used .But for severe allergy , AAF is the best solution , and both diagnosis and treatment can be obtained .Compliance of parents also plays an important role in the treatment .