本文選題：食物過敏　切入點：特異性抗體IgE　出處：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：食物過敏(Food Allergy, FA)是機體對一種或多種食物蛋白抗原產(chǎn)生的由免疫介導(dǎo)的不良反應(yīng)。按介導(dǎo)途徑不同分為IgE介導(dǎo)的和(或)非IgE介導(dǎo)的變態(tài)反應(yīng)。食物過敏多見于小年齡兒童，可以引起多器官系統(tǒng)受累，最常見的是消化系統(tǒng)、皮膚黏膜和呼吸系統(tǒng)。其中消化系統(tǒng)癥狀可表現(xiàn)為腹痛、腹瀉、腹脹、便秘、消化道出血、惡心、嘔吐、拒奶、溢乳、喂養(yǎng)困難、肛瘺等，上述癥狀若遷延不愈將造成患兒的生長發(fā)育受限、缺鐵性貧血、低蛋白血癥、水腫等并發(fā)癥。消化道癥狀和并發(fā)癥均為非特異性，且以非IgE介導(dǎo)為主，極易誤診。 近年來食物過敏的患者日益增多，已成為2l世紀人們?nèi)找骊P(guān)注的食品安全和公共衛(wèi)生問題。全世界范圍內(nèi)兒童食物過敏性疾病的發(fā)病率持續(xù)上升，據(jù)統(tǒng)計，，約有5%～8%的兒童患有食物過敏癥,已嚴重影響到兒童的生長發(fā)育，也給家庭和社會造成極大的負擔(dān)，尤其是因食物過敏出現(xiàn)消化系統(tǒng)癥狀的患兒，被誤診和濫用抗生素的情況依然存在，尋找有效的、安全的食物過敏防治措施迫在眉睫。 目的 通過對以消化道癥狀為主要表現(xiàn)的食物過敏(Food Allergy, FA)患兒血清食物過敏原特異性抗體、淋巴細胞亞群以及CD23檢測，觀察FA患兒在過敏狀態(tài)下部分免疫學(xué)指標的變化，氨基酸配方奶粉治療，益生菌治療觀察治療前后機體免疫學(xué)指標變化，做出分析評價，為臨床采取合理的診療措施提供科學(xué)依據(jù)。通過研究，期望獲得出更安全、有效的FA治療方案，來進一步探討臨床干預(yù)意義。 方法 臨床疑似為FA的住院患兒50例，通過食物回避試驗和酶聯(lián)免疫吸附法（ELISA）檢測食物過敏原特異性抗體，分為單一過敏組和多種過敏組，兩組均為15例，分別采用流式細胞術(shù)檢測淋巴細胞亞群以及CD23指標水平，并與20例陰性組做對照，同時26例確診為牛奶蛋白過敏的患兒，分為氨基酸組和聯(lián)合組，分別予以氨基酸配方奶粉治療和氨基酸配方奶粉聯(lián)合益生菌（雙歧桿菌四聯(lián)活菌片：6個月內(nèi)：0.5bid；6個月～1歲：1.0bid；1歲以上：1.0tid）治療6個月，檢測兩組患兒治療前后淋巴細胞亞群水平。觀察各組治療前后對照其免疫指標變化，對結(jié)果進行統(tǒng)計學(xué)分析。 結(jié)果 1.FA患兒單一過敏組和多種過敏組中CD3~+CD8~+以及CD3~+CD4~+/CD3~+CD8~+淋巴細胞百分比較陰性組明顯降低，差異有統(tǒng)計學(xué)意義(P＜0.01)；單一過敏組和多種過敏組中CD3~-/CD19~+淋巴細胞百分比較陰性組（11.676.25）%明顯升高，差異有統(tǒng)計學(xué)意義(P＜0.01)。 2.FA患兒IgG陽性組中CD3~+CD8~+淋巴細胞百分比（15.502.88）%較陰性組（29.488.69）%明顯下降，差異有統(tǒng)計學(xué)意義(P＜0.01)；而IgE陽性組中CD19~+CD23~+淋巴細胞百分比（13.455.87）%較陰性組（2.481.20）%明顯上升，差異有統(tǒng)計學(xué)意義(P＜0.01)。 3.牛奶蛋白過敏患兒應(yīng)用氨基酸配方奶粉治療6月后，CD3~+CD4~+/CD3~+CD8~+與CD3~-/CD19~+水平均得到改善，聯(lián)合益生菌對氨基酸乳品治療未見具有相加或協(xié)同作用。 結(jié)論 FA患兒體內(nèi)部分免疫指標發(fā)生改變，F(xiàn)A患兒特異性體液及細胞免疫因子變化存在差異,應(yīng)用氨基酸配方奶粉可改善FA患兒免疫水平,聯(lián)合益生菌對氨基酸乳品治療未見具有相加或協(xié)同作用。
[Abstract]:Food allergy (Food Allergy FA) is an immune mediated adverse reaction of the body to produce one or more food. According to the protein antigen mediated pathway is divided into IgE mediated allergic reaction and (or) non IgE mediated food allergy. More common in younger children, can lead to multiple organ systems the most common is the involvement of the digestive system, respiratory system and skin mucous membrane. The digestive system symptoms were abdominal pain, diarrhea, abdominal distension, constipation, gastrointestinal bleeding, nausea, vomiting, refusing milk, milk, feeding difficulties, anal fistula and other symptoms, if delayed healing will cause the growth restriction of children, iron deficiency anemia, hypoalbuminemia, edema and other complications. Gastrointestinal symptoms and complications are nonspecific, and non IgE mediated, easily misdiagnosed.
In recent years the increasing number of food allergic patients has become food safety and public health problem 2l century people pay more attention to the worldwide. The incidence of children's food allergic disease rate continues to rise, according to statistics, there are about 5% to 8% of children have a food allergy, has seriously affected the growth and development of children, but also caused a great burden to the family and society, especially for food allergies appear digestive symptoms in children misdiagnosed and abuse of antibiotics still exist, to find effective, imminent food allergy prevention measures for safety.
objective
Based on the gastrointestinal symptoms as the main manifestation of food allergy (Food Allergy, FA) with serum food allergen specific antibody, lymphocyte subsets and CD23 detection, observing the changes of FA in children with allergic state some immunity index, amino acid formula for probiotics in the treatment of immunological changes in the body changes before and after treatment, and make analysis evaluation, provide scientific basis for clinical diagnosis and treatment to take reasonable measures. Through research, expect to get a more safe and effective FA therapy, to further explore the clinical significance of intervention.
Method
The clinical suspected FA in 50 cases of patients, through food avoidance test and enzyme-linked immunosorbent assay (ELISA) detection of food allergen specific antibody, divided into single and multiple group allergy allergy group, two groups of 15 cases, flow cytometric detection of lymphocyte subsets and CD23 index respectively. And 20 cases of the control group and negative, 26 cases were diagnosed as milk protein allergy were divided into amino acid group and combination group were given treatment of amino acid formula and amino acid formula combined with probiotics (Bifidobacterium Tetravaccine tablets: 6 months: 0.5bid; 6 months to 1 years: 1.0bid; 1 years old: 1.0tid) for 6 months. The two groups were detected before and after treatment the level of lymphocyte subsets. Observe the changes of immune index in control group before and after treatment, the results were statistically analyzed.
Result
CD3~+CD8~+ and CD3~+CD4~+/CD3~+CD8~+ lymphocyte percentage in 1.FA negative group with single allergy group and various allergic group were significantly decreased, the difference was statistically significant (P < 0.01); single allergy group and various allergic group CD3~-/CD19~+ lymphocyte percentage (11.676.25%) negative group was significantly increased, the difference was statistically significant (P < 0.01).
The percentage of CD3~+CD8~+ lymphocytes in patients with 2.FA IgG positive group (15.502.88)% compared with negative group (29.488.69)% was significantly decreased, the difference was statistically significant (P < 0.01); and the IgE positive group, the percentage of CD19~+CD23~+ lymphocytes (13.455.87)%% compared with the negative group (2.481.20) increased significantly, the difference was statistically significant (P < 0.01).
3., after the application of amino acid formula milk powder in the treatment of children with milk protein allergy, the level of CD3~+CD4~+/CD3~+CD8~+ and CD3~-/CD19~+ were improved after June. There was no synergistic or synergistic effect of probiotics on amino acid dairy products.
conclusion
The changes of some immune indexes in children with FA are different. There are differences in the specific humoral and cellular immune factors in FA children. Amino acid formula milk powder can improve the immune level of children with FA. Combined with probiotics, there is no additive or synergistic effect on amino acid dairy products.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R725.9

【參考文獻】

相關(guān)期刊論文 前7條

1 孫建琴;;嬰幼兒食物過敏診斷與營養(yǎng)防治研究進展[J];中國兒童保健雜志;2011年06期

2 李凱文;邵潔;;雞蛋過敏原與嬰幼兒雞蛋過敏的研究進展[J];臨床兒科雜志;2011年04期

3 黃鈺君;伍紹國;鄺婉儀;林愛君;黃裕游;;食物過敏患兒食物變應(yīng)原檢測及外周血一般免疫指標分析[J];熱帶醫(yī)學(xué)雜志;2011年06期

4 唐文靜;黃娟;鐘燕;周侃;陳兵;;益生菌干預(yù)對卵清蛋白過敏幼鼠模型的免疫調(diào)節(jié)作用[J];上海交通大學(xué)學(xué)報(醫(yī)學(xué)版);2010年01期

5 陳Z

本文編號：1662818