CAJ | 학술논문

目的评估牛奶蛋白过敏性直肠结肠炎患儿的营养风险;观察喂养干预方案的变化及疗效,探讨个体化喂养干预方案的选择时机.方法回顾性分析2012年1月至2013年7月湖南省儿童医院确诊为牛奶蛋白过敏性直肠结肠炎的171例患儿临床资料,其中非母乳喂养组139例(81.3％).干预方案:母乳喂养组继续母乳喂养32例,非母乳喂养组中游离氨基酸配方干预36例(21.1％),深度水解配方干预103例(60.2％),观察喂养干预2周的疗效,随访8周、12周、24周时喂养干预配方变化及0、3、6个月营养风险评估情况.结果 171例患儿中,男∶女=1.5∶1.0;平均年龄(4.1±1.3)个月.疗效观察:干预2周共显效147例(86.0％),其中母乳喂养组显效率为79.2％,与游离氨基酸配方组及深度水解配方组比较差异无统计学意义(P＞0.05).随访0.5年内干预配方改变:8周:母乳喂养组30例继续母乳喂养,游离氨基酸配方粉喂养21例(12.3％),深度水解配方粉85例(49.7％),适度水解配方35例(20.5％);12周:母乳喂养23例(13.5％),游离氨基酸配方粉喂养16例(9.4％),深度水解配方粉喂养56例(32.7％),适度水解配方喂养76例(44.4％);24周:母乳喂养21例(12.3％),游离氨基酸配方粉喂养7例(4.1％),适度水解配方喂养13例(7.6％),普通配方喂养130例(76.0％).于0、3、6个月进行营养风险评估(STAMP营养风险评估表),3组在不同时期的风险评分均值比较差异均无统计学意义(P均＞0.05).结论牛奶蛋白过敏性直肠结肠炎患儿营养风险较低,不同的喂养干预方式对患儿的营养状态无明显影响.继续母乳喂养可有效回避牛奶过敏,人工喂养患儿干预后2周左右症状可获缓解,50％左右在3个月以上可获得部分免疫耐受,故可根据其诱导免疫耐受情况进行个体化喂养干预,减轻经济负担.
목적 평고우내단백과민성직장결장염환인적영양풍험;관찰위양간예방안적변화급료효,탐토개체화위양간예방안적선택시궤.방법 회고성분석2012년1월지2013년7월호남성인동의원학진위우내단백과민성직장결장염적171례환인림상자료,기중비모유위양조139례(81.3％).간예방안:모유위양조계속모유위양32례,비모유위양조중유리안기산배방간예36례(21.1％),심도수해배방간예103례(60.2％),관찰위양간예2주적료효,수방8주、12주、24주시위양간예배방변화급0、3、6개월영양풍험평고정황.결과 171례환인중,남∶녀=1.5∶1.0;평균년령(4.1±1.3)개월.료효관찰:간예2주공현효147례(86.0％),기중모유위양조현효솔위79.2％,여유리안기산배방조급심도수해배방조비교차이무통계학의의(P＞0.05).수방0.5년내간예배방개변:8주:모유위양조30례계속모유위양,유리안기산배방분위양21례(12.3％),심도수해배방분85례(49.7％),괄도수해배방35례(20.5％);12주:모유위양23례(13.5％),유리안기산배방분위양16례(9.4％),심도수해배방분위양56례(32.7％),괄도수해배방위양76례(44.4％);24주:모유위양21례(12.3％),유리안기산배방분위양7례(4.1％),괄도수해배방위양13례(7.6％),보통배방위양130례(76.0％).우0、3、6개월진행영양풍험평고(STAMP영양풍험평고표),3조재불동시기적풍험평분균치비교차이균무통계학의의(P균＞0.05).결론 우내단백과민성직장결장염환인영양풍험교저,불동적위양간예방식대환인적영양상태무명현영향.계속모유위양가유효회피우내과민,인공위양환인간예후2주좌우증상가획완해,50％좌우재3개월이상가획득부분면역내수,고가근거기유도면역내수정황진행개체화위양간예,감경경제부담.
Objective To assess nutritional risks in children with allergic proctocolitis induced by cow milk protein,and to observe the effects of the feeding strategies for them with different interventions in feeding,and then to identify the best time and the best way to modify feeding strategies according to different individual.Methods The effectiveness of different feeding interventions was retrospectively analyzed after 2 weeks in 171 cases with allergic proctocolitis induced by cow milk protein in Hunan Children's Hospital during the period of Jan.2012 to Jul.2013.Thirty-two cases received breast feeding (18.7％) and 139 cases received non-breast feeding (81.3％).Intervention methods:32cases with breast feeding received the same feeding method;among 139 babies with non-breast feeding group,36 were plus free amino acid (AAF) (21.1％),and 103 were plus the extensively hydrolyzed formula (eHF).The intervention formula changes were observed in 8,12 and 24 weeks,respectively,and nutritional risks in 0,3,6 months were assessed,respectively.Results There were 171 patients totally,male to female ratio was 1.5 to 1.0,and the average age was (4.1 ± 1.3) months.After 2 weeks,147 cases were notably effective,accounting for 86％,and in the breast feeding group 79.2％ of the patients were notably effective,and there was no significance compared with the AAF group and eHF group (P ＞ 0.05).The intervention formulation changes during the following 6 months were as follows:in 8 weeks,30 cases in the breast feeding group breastfeeding continued,2 cases turned to eHF feeding for the lack of breast milk,21 cases were fed with AAF (12.3％),85 cases with eHF (49.7％),and 35 cases with moderately hydrolyzed formula (20.5％) ;in 12 weeks:23 cases had breast feeding (13.5％),16 cases were fed with free amino acid formula powder (9.4％),56 cases with extensively hydrolyzed formula (32.7％),and 76 cases with moderately hydrolyzed formula (44.4％) ;in 24 weeks:21 cases (12.3％) had breast feeding,7 cases were fed with AAF(4.1％),13 cases with moderately hydrolyzed formula(7.6％),and 130 cases with normal formula(76.0％).The mean levels of the nutritional risks were assessed according to STAMP in 0,3,6 months respectively:breast feeding group [(1.69 ± 0.78) scores,(1.50 ± 0.88) scores,(1.53 ± 0.67) scores,P ＞ 0.05] ; AAF group [(1.72 ± 0.78) scores,(1.53 ± 0.88) scores,(1.53 ± 0.65) scores,P ＞ 0.05] ; eHF group [(1.80 ± 0.69) scores,(1.68 ± 0.68) scores,(1.66 ± 0.65) scores,P ＞ 0.05].Conclusions The nutrition risk levels in children with milk protein allergic proctocolitis are low,and different feeding interventions according to tolerance had no impact on the nutritional status ; Breast feeding could effectively avoid cow milk allergy,and symptoms of the children with allergic proctocolitis would be relieved after 2-week intervention,and more than half of children could gain part of immune tolerance after intervention for 3 months or more,so for the children with allergic proctocolitis induced by cow milk protein,routine formula feeding should be stopped after 3 months,and individualized feeding intervention can be carried out according to immune tolerance to relieve the financial burden.