小儿乳糜泻2例并文献复习

摘要/Abstract

参考文献 28

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doi:10.6040/j.issn.1671-7554.0.2024.0778

摘要： 目的回顾性分析2例乳糜泻患儿资料,以期提高儿科医师对本病的认识水平,从而降低误诊、漏诊。方法对山东第一医科大学附属省立医院儿科收治的2例乳糜泻患儿的临床资料及随访结果进行分析,并检索相关文献。患儿1,男,就诊年龄1岁7个月,以进行性腹胀、腹泻、生长迟缓为主要表现。患儿2,男,就诊年龄4岁6个月,以腹泻伴消瘦3月余为主要表现。患儿2食入物过敏原检测示牛奶蛋白特异性抗体IgE及总IgE升高;乳糜泻抗体检测示抗组织谷氨酰胺转移酶抗体、抗肌内膜抗体、抗脱酰胺基麦角蛋白抗体明显升高。以“乳糜泻/牛奶蛋白过敏”“celiac disease” “cows milk protein allergy”为关键词,检索万方、中国知网、中华医学期刊中文数据库及PubMed外文数据库。结果患儿1经牛奶蛋白回避+激发试验确定牛奶蛋白过敏,诊断为乳糜泻合并牛奶蛋白过敏,给予去麸质、规避牛奶蛋白饮食及对症治疗后,腹胀、腹泻症状好转,随访46个月,患儿生长发育良好。患儿2诊断为乳糜泻、牛奶蛋白过敏观察,后患儿转至上海复旦大学儿科医院,随访得知在给予去麸质、规避牛奶蛋白饮食及口服激素等对症治疗后,患儿腹泻症状较前减轻。但消瘦尚未改善。结论对长时间腹胀、腹泻、消瘦、生长迟缓的患儿需警惕乳糜泻可能,并应考虑到乳糜泻合并牛奶蛋白过敏可能,治疗以去麸质及规避牛奶蛋白饮食为主。

关键词: 乳糜泻, 牛奶蛋白过敏, 生长迟缓, 去麸质饮食, 儿童

Abstract: Objective To enhance pediatricians understanding of celiac disease and reduce the rates of misdiagnosis and missed diagnosis by reporting 2 cases of celiac disease. Methods The clinical data and follow-up results of two pediatric patients with celiac disease who were admitted to the Department of Pediatrics at Shandong Provincial Hospital Affiliated to Shandong First Medical University were analyzed. Patient 1 was a male infant aged 1 year and 7 months who presented with progressive abdominal distension, diarrhea, and growth retardation. Patient 2 was a male child aged 4 years and 6 months who presented with persistent diarrhea accompanied by wasting for > 3 months. Both patients exhibited elevated levels of cows milk protein-specific IgE antibodies and total IgE. Celiac antibody testing revealed a significant increase in the levels of anti-tissue transglutaminase, anti-endomysial, and anti-deamidated gliadin peptide antibodies. Wanfang, CNKI, Chinese Medical Journal, and PubMed databases were searched using the keywords "celiac disease" and "cows milk protein allergy". Results Following cows milk protein avoidance and stimulation tests, patient 1 was diagnosed with celiac disease combined with cows milk protein allergy. Subsequent adherence to a gluten-free diet, cows milk protein avoidance, and symptomatic treatment improved abdominal distension and diarrhea during a follow-up period of 46 months with satisfactory growth and development. Patient 2 was diagnosed with celiac disease and suspected cows milk protein allergy and was subsequently referred to the Childrens Hospital of Fudan University for further treatment. Subsequent follow-ups revealed reduced diarrhea symptoms following symptomatic treatment, adherence to a gluten-free diet, cows milk protein avoidance, and oral hormone administration. However, wasting did not improve. Conclusion Children presenting with prolonged abdominal distension, diarrhea, wasting, and growth retardation should be monitored for possible celiac disease. It is crucial to remain alert to the potential coexistence of cows milk protein allergy, and treatment should focus on adhering to a gluten-free and cows milk protein-avoidance diet.

Key words: Celiac disease, Cows milk protein allergy, Growth retardation, Gluten-free diet, Children

中图分类号:

R725

史文新,樊幼君,陈元,刘海燕,孙立锋,郭璐. 小儿乳糜泻2例并文献复习[J]. 山东大学学报 (医学版), 2025, 63(2): 51-57.

SHI Wenxin, FAN Youjun, CHEN Yuan, LIU Haiyan, SUN Lifeng, GUO Lu. Two cases of pediatric celiac disease and literature review[J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 51-57.

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