龙云?张猛?李传应?吴成

【摘要】食物蛋白诱导性小肠结肠炎综合征（FPIES）是一种非IgE介导的食物过敏性胃肠病。该文报告2例婴儿重度FPIES的诊治经过，病程均迁延1个月，以呕吐、腹泻、发热为早期症状，其后表现为重度脱水、代谢性酸中毒、贫血、营养不良;实验室检查白细胞、中性粒细胞、血小板、CRP明显升高，血红蛋白下降，先后诊断“脓毒症、急性肠炎、坏死性小肠结肠炎”，经回避牛奶饮食，给予氨基酸配方奶粉后症状缓解。该两例提示临床医师应重视重度FPIES的临床表现，对其早期诊断、治疗和改善患儿预后有重要意义。

【关键词】重度;牛奶蛋白过敏;食物蛋白诱导性小肠结肠炎;氨基酸配方奶粉

Severe food protein-induced enterocolitis syndrome： report of two cases Long Yun， Zhang Meng， Li Chuanying， Wu Cheng. Department of Gastroenterology of Anhui Provincial Childrens Hospital，Hefei 230051，China

Corresponding author， Wu Cheng， E-mail： wucheng0706@126.com

【Abstract】Food protein-induced enterocolitis syndrome（FPIES）is a non-IgE-mediated food allergic gastrointestinal disease. Here， this article reported the diagnosis and treatment of two cases of severe FPIES. The course of disease of them endured for one month. Vomiting， diarrhea and fever were the early symptoms， followed by severe dehydration， metabolic acidosis， anemia and malnutrition. Laboratory examination showed that the white blood cell， neutrophil， platelet and C-reactive protein levels were significantly increased， whereas the hemoglobin level was decreased. The diagnosis of sepsis， acute enteritis and necrotizing enterocolitis was made successively. After avoiding milk diet and feeding by amino acid formula powder， relevant symptoms were relieved. These two cases prompt that clinicians should divert extensive attention to clinical manifestations of severe FPIES， which is of significance for early diagnosis and treatment and enhancing clinical prognosis.

【Key words】Severe; Milk protein allergy; Food protein-induced enterocolitis;Amino acid formula powder

食物蛋白誘导性小肠结肠炎综合征（FPIES）是由非IgE介导的一种食物过敏性胃肠病，最早出现于婴儿期，甚至在出生后的数小时内即可发生[1]。其常被误诊为脓毒症、严重的胃肠炎、肠旋转不良及坏死性小肠结肠炎等外科急腹症。本文报道了我院消化科2例以间断呕吐、腹泻及发热为首发症状的重度FPIES患儿的临床资料，以期为FPIES的早期诊断、干预提供依据。

病例资料

例1，患儿男，2个月16 d，因反复呕吐、腹泻1个月，发热1周于2017年9月25日入院。患儿生后1个月出现腹泻， 4 ～ 5次/日，黄色稀水便，有黏液，无血便，有时呕吐，2 ～ 3次/日，为少量奶样物，未见胆汁样物。近1周发热，最高体温39.2℃，且腹泻加剧，10余次/日，黄色稀水样便;呕吐较频，4 ～ 5次/日，病中无皮疹。当地医院诊断“急性肠炎”给予“头孢曲松”抗感染治疗，仍发热、腹泻，且呕吐加剧，腹胀明显，精神萎靡，尿量减少故转入我院收住消化内科。……