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【目的】探讨牛奶蛋白过敏(cow’s milk protein allergy,CMPA)患儿的临床表现及诊治方法。【方法】回顾性总结66例CMPA患儿的临床资料,分析患儿的临床表现、实验室检查和治疗方法。【结果】66例CMPA临床表现复杂多样,在皮肤表现为湿疹、荨麻疹、皮肤瘙痒等,消化道表现为恶心、呕吐、腹泻、便血等,呼吸道表现为喷嚏、流涕、咳嗽、喘息等,全身表现为消瘦和营养不良等;本组CMPA轻中度、重度患儿分别为56例和10例;皮肤过敏原点刺试验牛奶蛋白阳性66例(100%),其中46例还有蛋黄、蛋白、豆制品、鱼虾等多项阳性;本组患儿血清牛奶特异性IgE升高18例(27.3%),血常规嗜酸细胞增高48例(72.7%);牛奶回避及营养干预后患儿症状缓解或消失;营养干预喂养1个月后总有效率为80.3%,喂养3个月后总有效率达97.0%,二者总有效率比较差异有显著统计学意义(P<0.01)。【结论】CM-PA患儿的临床表现以皮炎、消化道、呼吸道症状和全身症状为主,根据患儿临床表现、血清牛奶特异性IgE、皮肤点刺试验、牛奶回避及激发试验可以明确诊断,治疗上应采取家长健康教育、环境控制、饮食回避、营养干预和药物治疗等综合措施。
【Objective】 To investigate the clinical manifestations and diagnosis and treatment of cow’s milk protein allergy (CMPA). 【Methods】 The clinical data of 66 children with CMPA were retrospectively reviewed. The clinical manifestations, laboratory tests and treatment methods were analyzed. 【Results】 The clinical manifestations of 66 cases of CMPA were complicated and varied. The skin manifestations were eczema, urticaria and pruritus. The gastrointestinal manifestations were nausea, vomiting, diarrhea and blood in the stool. The respiratory manifestations were sneezing, runny nose, cough and wheezing, The body showed wasting and malnutrition, etc .; the group of mild to moderate, severe and severe CMPA were 56 cases and 10 cases; skin irritation prick test milk protein positive 66 cases (100%), of which 46 cases also have egg yolk, protein , Soy products, fish and shrimp and many other positive; serum IgM in this group of patients with elevated serum IgE in 18 cases (27.3%), blood eosinophils in 48 cases (72.7%); milk avoidance and nutritional intervention in children Symptoms were relieved or disappeared. The total effective rate was 80.3% after nutrition intervention for 1 month and 97.0% after 3 months of feeding. The total effective rate was significantly different (P <0.01). 【Conclusion】 The clinical manifestations of children with CM-PA are mainly dermatitis, digestive tract, respiratory symptoms and systemic symptoms. According to the clinical manifestations of children, serum-specific IgE, skin prick test, milk avoidance and provocation test can confirm the diagnosis , Treatment should take parental health education, environmental control, diet avoidance, nutritional interventions and drug treatment and other comprehensive measures.