不同孕期母亲免疫水平对婴儿牛奶蛋白过敏的影响

目的 探讨不同孕期母亲Th1/Th2免疫水平与婴儿牛奶蛋白过敏（CMPA）之间的关联。方法 选取2016年7月至2018年12月于山东省潍坊市益都中心医院及青州市中医院就诊的单胎健康孕妇及其子代为研究对象。检测母亲孕中期、孕后期的白细胞介素（IL）-2、干扰素-γ（IFN-γ）、IL-4和IL-10水平，并分别于出生后1年内进行CMPA问卷调查，对临床怀疑CMPA的婴儿进行食物回避及牛奶口服激发试验，将符合CMPA的48例婴儿纳入CMPA组，其余977例正常婴儿纳入对照组。对CMPA婴儿进行单因素分析，并采用泊松回归分析不同孕期母亲各Th1/Th2型细胞因子水平与CMPA之间的关联。结果 CMPA的检出率为4.68%，临床表现包括消化系统症状、皮肤表现、呼吸系统症状及其他表现。单因素分析结果显示，CMPA组母亲食物过敏、母亲过敏性疾病史的发生率均明显高于对照组（P < 0.05），母乳喂养率明显低于对照组（P < 0.05）。CMPA组的母亲IL-2（孕中期和孕后期）、IFN-γ（孕后期）较对照组明显降低（P < 0.05）。母亲孕后期低IFN-γ及孕中期、孕后期低IL-2与婴儿CMPA存在显著关联（P < 0.05）；校正母乳喂养、母亲食物过敏及母亲过敏性疾病史等因子后发现，母亲孕后期低IL-2、低IFN-γ与婴儿CMPA仍存在显著关联（P < 0.05）。结论 孕后期母体的Th1型细胞因子水平下降，可能会导致胎儿的免疫改变，从而增加其子代出生后罹患CMPA的风险。

Effect of maternal immune level at different pregnancy stages on cow's milk protein allergy in infants

Objective To study the association between maternal Th1/Th2 immune level at different pregnancy stages and cow's milk protein allergy (CMPA) in infants. Methods The healthy women with a singleton pregnancy, as well as their offspring, who attended Yidu Central Hospital of Weifang and Qingzhou Traditional Chinese Medicine Hospital from July 2016 to December 2018 were enrolled. The maternal levels of interleukin-2 (IL-2), interferon gamma (IFN-γ), interleukin-4 (IL-4), and interleukin-10 (IL-10) at the second and third trimesters of pregnancy were measured. A CMPA questionnaire survey was conducted within one year after birth. Food avoidance and cow's milk oral challenge tests were performed in infants suspected of CMPA. The 48 infants who met the diagnostic criteria for CMPA were included in the observation group, and the remaining 977 normal infants were included in the control group. A univariate analysis was performed on the infants with CMPA. A Poisson regression analysis was used to determine the association between maternal Th1/Th2 immune factors at different pregnancy stages and CMPA. Results The detection rate of CMPA was 4.68%. The clinical manifestations included the symptoms of the digestive system, skin, and respiratory system and other symptoms. The univariate analysis showed that compared with the control group, the observation group had significantly higher incidence rates of maternal food allergy and maternal history of allergic diseases (P < 0.05) and a significantly lower breastfeeding rate (P < 0.05). The observation group had significantly lower maternal levels of IL-2 (second and third trimesters) and IFN-γ (third trimester) than the control group (P < 0.05). Maternal low IFN-γ at the third trimester and maternal low IL-2 at the second and third trimesters were significantly associated with CMPA in infants (P < 0.05). After correction of the factors of breastfeeding, maternal food allergy, and maternal history of allergic diseases, it was found that maternal low IL-2 and IFN-γ at the third trimester were still significantly associated with CMPA in infants (P < 0.05). Conclusions The maternal decrease in Th1 level at the third trimester of pregnancy may lead to the change in fetal immunity and thus increase the risk of CMPA in offspring.