CAJ | 학술논문

目的：总结以类脓毒症为首发症状的新生儿牛奶蛋白过敏（CMPA）的临床特点及诊治经验。方法回顾性分析2009年7月-2013年12月间收治的10例以类脓毒症为首发症状的新生儿CMPA患儿的病史资料、临床表现、实验室检查结果及治疗转归。结果10例中，有家族过敏史者6例。临床表现以皮肤及消化道症状为主，有1例出现过敏性休克。6例血牛奶特异性免疫球蛋白（Ig）E阳性，嗜酸粒细胞（1.40±0.17）×109/L，比例均大于0.05；4例血牛奶特异性IgE阴性，嗜酸粒细胞（0.71±0.08）×109/L，比例0.02～0.03。10例血培养均为阴性，血白细胞（24.5±3.3）×109/L，杆状核粒细胞/中性粒细胞0.161±0.035，血小板计数（655±39）×109/L，血白细胞介素（IL）-60.31～0.93μg/L， C反应蛋白（CRP）85～144 mg/L。10例均予深度水解蛋白奶粉或氨基酸奶粉喂养，临床症状明显好转或消失，各项炎症指标基本恢复正常。结论伴有血小板和嗜酸粒细胞增高的新生儿CMPA应与脓毒症鉴别，新生儿CMPA最重要的治疗是低过敏原性配方奶粉替代治疗。
목적：총결이류농독증위수발증상적신생인우내단백과민（CMPA）적림상특점급진치경험。방법회고성분석2009년7월-2013년12월간수치적10례이류농독증위수발증상적신생인CMPA환인적병사자료、림상표현、실험실검사결과급치료전귀。결과10례중，유가족과민사자6례。림상표현이피부급소화도증상위주，유1례출현과민성휴극。6례혈우내특이성면역구단백（Ig）E양성，기산립세포（1.40±0.17）×109/L，비례균대우0.05；4례혈우내특이성IgE음성，기산립세포（0.71±0.08）×109/L，비례0.02～0.03。10례혈배양균위음성，혈백세포（24.5±3.3）×109/L，간상핵립세포/중성립세포0.161±0.035，혈소판계수（655±39）×109/L，혈백세포개소（IL）-60.31～0.93μg/L， C반응단백（CRP）85～144 mg/L。10례균여심도수해단백내분혹안기산내분위양，림상증상명현호전혹소실，각항염증지표기본회복정상。결론반유혈소판화기산립세포증고적신생인CMPA응여농독증감별，신생인CMPA최중요적치료시저과민원성배방내분체대치료。
Objective To summarize the diagnosis and treatment in neonatal cow’s milk protein allergy (CMPA) with sepsis like initial symptom. Methods CMPA patients with the sepsis like initial symptom (n=10) were selected in our hospital from July 2009 to December 2013. History data, clinical manifestation, laboratory results and the treatment outcome of them were retrospectively analyzed. Results Among these 10 cases, 6 have family history of allergy. Main clinical mani-festations include skin, gastrointestinal symptoms and 1 case of anaphylactic shock. IgE mediated 6 cases with acidophilic cells count of (1.40±0.17)×109/L (5%); The rest 4 cases were not mediated by IgE, with acidophilic cells count of (0.71± 0.08)×109/L (0.02-0.03). Blood cultures were all negative;Blood leukocyte count is (24.5±3.3)×109/L;Rod nucleus granulo-cyte/neutrophils count is (0.161±0.035) ×109/L;The platelet count is (655±39)×109/L;Blood interleukin (IL)-6 is 0.31-0.93μg/L;C reactive protein (CRP) is 85-144 mg/L. All 10 cases were with extensively hydrolyzed formular or amino acid formu-lar feeding. Then their clinical symptoms improved or disappeared significantly and the inflammatory indexes returned to nor-mal. Conclusion It is necessary to make the differential diagnosis between sepsis and neonatal CMPA,which is accompa-nied by increased platelet and acidophil. The most effective treatment of neonatal CMPA is hypoallergenic formular replace-ment therapy.