婴儿早期过敏性疾病的临床研究

目的 探讨早期婴儿过敏性疾病主要表现形式及影响因素。方法 2009年2月至2010年10月对2600例出生后42 d的婴儿进行回访，筛检出有特异性皮炎或有胃肠道过敏症状者，分析婴儿过敏症状与喂养方式、季节、父母过敏史等关系；对120例过敏患儿及110例正常对照儿随访6～12个月，观察发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏等情况，其中部分婴儿随访前后检测血总IgE抗体、吸入过敏原特异抗体(Phadiatop)、食物过敏原特异抗体（Fx5E）、嗜酸粒细胞阳离子蛋白(ECP)，并进行比较。结果 2600例婴儿共检出过敏性疾病婴儿478例，占18.4％，其中特异性皮炎334例、有胃肠道过敏症状患儿453例，分别占12.8、17.4％，二者表现均有的309例，占11.9％。478例过敏婴儿（过敏组）中母乳喂养105例(22.0％)、混合喂养143例(29.9％)，人工喂养230例(48.1％)；母孕期发生过过敏性疾病及父亲有过敏史者分别占31.2％（149例）、15.1％（72例），明显高于无过敏组分别为10.2％(216/2122)、6.0％(127/2122)，均P＜0.01]；发生在春、夏、秋、冬分别为134例(28.0％)、72例(15.1％)、172例(36.0％)、100例(20.9％)，秋季为高发季节。对120例过敏患儿及110例正常对照儿随访6～ 12个月，过敏患儿中分别有29、24例发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏，发生率为24.2％和20.0％；正常对照儿中分别有16、8例发生喘息性支气管炎/急性毛细支气管炎、皮肤过敏，发生率为14.5％、7.3％，过敏患儿呼吸道过敏性疾病或皮肤过敏的发生率明显高于正常对照儿，差异有统计学意义(P＜0.01)。经家长同意随访前后分别检测50、43例过敏婴儿TIgE、ECP、Phadiatop、Fx5E指标，随访后TIgE、ECP水平有升高趋势，尚无统计学意义，Phadiatop阳性率较前升高，Fx5E阳性率降低，差异有统计学意义(P＜0.01)。结论 特异性皮炎、胃肠道过敏症状是婴儿早期过敏性疾病的常见表现，与喂养方式、家族史、季节有关，人工喂养者、母孕期有过敏史、秋季发病率最高。随着年龄增长过敏表现逐渐由皮肤过敏、胃肠道症状转为呼吸道过敏性疾病，IgE介导的免疫机制增强，对呼吸道过敏原的反应增强，对食物过敏原反应减弱。

The clinical study of allergic diseases in infants

0bjective To study the manifestation and affecting factors of allergic diseases in early life.Methods The atopic dermatitis or gastrointestinal allergic manifestations were diagnosed among 2600 infants of return visit at 42-day follow-up. The association between the diseases onsets and the feeding manners, seasons and the allergic history of parents was analyzed. 120 patients were followed up for 6-12 months, observed the onsets of asthmatic bronchitis/acute bronchiolitis, skin allergy. The blood total IgE(TIgE) levels, Phadiatop, Fx5E, eosinophil cationic protein(ECP) of some patients were measured and compared before and after follow up. Results Totally 478 infants( 18.4％ ) with atopic diseases were detected among 2600 infants during 42 days' follow up. The percentage of infants with atopic dermatitis was17.4％ and the percentage of gastrointestinal allergy was 12.8％. 22.0％,29.9％, and 48.1％ of those patients who had breastfeeding, mixed-feeding, bottle-feeding respectively. The allergic diseases occurred much more frequently in Autumn. About 31.2％ of mothers of patients suffered from allergic diseases during gestation periods and 15.1％ of fathers had allergic histories, which was more common than the parents with normal children(P ＜0.05). Among 120 patients, 24.2％ and 20.0％ infants had suffered from asthmatic bronchitis or dermatitis during the follow up period, which was more common than the parents with normal children.The serum levels of TIgE, ECP increased, but the difference was not significant ( P ＞ 0.05 ). The percentage of Phadiatop positivity increased and Fx5E positivity decreased after follow up( P ＜ 0.01 ). Conclusions The atopic dermatitis and gastrointestinal allergic symptoms are common manifestations of the allergic diseases in infants and they are associated with feeding manners, family history and seasons. The skin allergy and gastrointestinal symptoms may change into respiratory allergic diseases.