婴幼儿中牛奶与鸡蛋血清特异性IgE变化趋向回顾性分析

目的 了解婴幼儿牛奶和鸡蛋血清特异性IgE(sIgE)检测结果的变化趋向及临床意义。方法 回顾性分析复旦大学附属儿科医院4年间临床诊断为过敏性疾病、高度怀疑牛奶和（和）鸡蛋过敏的1～36月龄婴幼儿，考察婴幼儿牛奶与鸡蛋血清sIgE变化趋向时，按月龄分为6组：≤6月龄，～12月龄，～18月龄，～24月龄，～30月龄和～36月龄组。考察不同年龄段不同疾病鸡蛋和牛奶血清sIgE平均水平变化时，按月龄分为≤12月龄和～36月龄两组。使用UniCAP系统检测牛奶和鸡蛋血清sIgE。结果 共纳入855例，鸡蛋血清sIgE阳性率为50.1%（396/791）,牛奶血清sIgE阳性率为43.0%（324/754）。鸡蛋血清sIgE阳性率在各月龄组均接近50%，≤6月龄组略低；牛奶血清sIgE的阳性率在≤6月龄组较低（31.5%），随月龄的增长而逐渐上升，18个月后达50%左右。湿疹患儿鸡蛋血清sIgE阳性率较高，在≤6月龄组即可检测出较高的阳性率（70.6%），之后阳性率在50%左右，～36月龄组再次达到71.4%；湿疹患儿牛奶血清sIgE阳性率≤6月龄组为20.9%，随月龄增长而升高，～36月龄组达50.0%。喘息性疾病患儿较多，≤6月龄组鸡蛋和牛奶血清sIgE阳性率均较低（16.7%和15.4%），随月龄增长至24月龄升高，之后又降低。肺炎患儿牛奶和鸡蛋血清sIgE在≤6月龄组和～12月龄组阳性率均为30%左右，～24月龄组分别升至55.0%和57.9%，～36月龄组分别升至64.3%和71.4%，随月龄增长肺炎患儿牛奶和鸡蛋血清sIgE阳性率增高。鸡蛋血清sIgE阳性值主要分布于0.59～2.67 kUA·L-1（第25~75百分位数），5%的患儿sIgE达26.90 kUA·L-1。牛奶血清sIgE阳性值主要分布于0.53～2.19 kUA·L-1（第25~75百分位数），5%的患儿sIgE达7.76 kUA·L-1。鸡蛋和牛奶血清sIgE水平随月龄变化呈下降趋势，≤6月龄组牛奶血清sIgE均值为4.05 kUA·L-1，12月龄后sIgE在1.5～2 kUA·L-1。≤6月龄组鸡蛋血清sIgE均值为16.84 kUA·L-1， ～12月龄和～36月龄组分别为6.80和1.49 kUA·L-1。223例鸡蛋和牛奶血清sIgE均阳性患儿，鸡蛋和牛奶血清sIgE水平呈正相关。结论 在不同月龄段和不同疾病类型，根据过敏性疾病的临床诊断检测鸡蛋和牛奶血清sIgE的阳性率不同，临床检测鸡蛋和牛奶血清sIgE对婴幼儿过敏性疾病的诊断具有重要参考价值；婴幼儿期肺炎患儿鸡蛋和牛奶血清sIgE阳性率较高，原因有待进一步研究；婴幼儿期鸡蛋和牛奶血清sIgE水平总体偏低，随月龄增长sIgE水平降低，这是婴幼儿期鸡蛋和牛奶过敏的重要特征，机制有待深入研究。鸡蛋和牛奶血清sIgE水平呈正相关，提示婴幼儿对鸡蛋和牛奶过敏与机体免疫应答状况有关。

The characteristics of serum specific IgE of egg and cow milk in clinical application during infancy

Objective This study focused on the diverse characteristics and the clinical significance of serum specific IgE of egg and cow milk in infants with allergic disease. Methods The results of egg and (or) cow milk serum sIgE of 855 infants(less than 36 months of age) were reviewed and statistically analysed.All of the infants were diagnosed as suffering from allergic diseases from Nov.2003 to Nov.2007 in Children' Hospital of Fudan University. Results The positive rate of egg sIgE was 50.1%（396/791）, and that of cow milk sIgE was 43.0%（324/754） for all tested cases. The positive rates of egg sIgE were all around 50% in every stage of age, but in the stage of ≤6 months it was lower than the others(44%); The positive rate of cow milk sIgE in the earlier period of infancy was low (31.5%), but it was ascendant with the age increasing, it was about 50% after 18 months. A higher positive rate of egg sIgE in the infants with eczema, especially in the stage of ≤6 months(70.6%) was detected, then dropped to 45.0% and approached to 71.4% at 36 months age; the positive rate of cow milk sIgE was 20% in infants with eczema in the stage of age ≤6 months, reached 50% in the stage of 36 months.In wheezing disease, the positive rates of egg and cow milk sIgE were relatively low (16.7%,15.4%) in the stage of age≤6 months,and increased in the stage of age 24 months, then decreased. The positive rates of egg and cow milk sIgE in infants with pneumonia were about 30% in the stage of age <12 months, and increased to 50% to 60% in the period of 12 months to 24 months, then hit 60% 70% in the period of 24 months to 36 months. The levels of serum sIgE of egg were distributed from 0.59 kUA·L-1 to 2.67 kUA·L-1 (25-75 percentiles), only 5% of the infants reached to 26.90 kUA·L-1. The levels of serum sIgE of cow milk were distributed from 0.53 to 2.19 kUA·L-1(25-75 percentiles), 5% of the infants reached to 7.76 kUA·L-1. There was a descending tendency of serum sIgE of egg levels in age dependent, the mean of serum sIgE levels of cow milk was 4.05kUA/L, then up to an extent from 1.5 kUA·L-1 to 2.0 kUA·L-1 after 12 months. The mean of serum sIgE levels of egg was 16.84 kUA·L-1 and became lower in 12 to 36 months(6.80 kUA·L-1to 1.49 kUA·L-1). There was a positive correlation between the serum sIgE levels of egg and cow milk in 233 infants with both egg and cow milk sIgE positive. Conclusions The positive rates of egg and cow milk serum sIgE were different according to the months of age and kind of disease during infancy. It was helpful for the diagnosis of allergic diseases by detection of egg and cow milk sIgE in infants. The positive rates of egg and cow milk sIgE were high in infants with pneumonia and needed to further study. Generally, the levels of egg and cow milk sIgE were lower in infants and showed an age dependent decrease, this is a remarkable feature of egg and cow milk allergy in infants. The levels of sIgE between egg and cow milk displayed a positive correlation, and suggested that the allergic response was partially dependent on individual immune status at least.