Ultrasonographic study of intestinal Doppler blood flow in infantile non-IgE-mediated gastrointestinal food allergy
Ultrasonographic study of intestinal Doppler blood flow in infantile non-IgE-mediated gastrointestinal food allergy
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婴儿非IgE介导的胃肠道食物过敏中肠多普勒血流的超声研究
DOI：
10.1016/j.alit.2018.08.010
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发表时间：
2019
影响因子：
6.8
通讯作者：
Shimizu T
中科院分区：
文献类型：
--
作者：
Jimbo K;Ohtsuka Y;Kono T;Arai N;Kyoudo R;Hosoi K;Aoyagi Y;Kudo T;Asai N;Shimizu T
背景资料：尽管非IgE介导的胃肠道食物过敏在日本迅速增加，但少数报告评估了婴儿胃肠道牛奶过敏急性期的B型和多普勒超声检查结果。本研究的目的是比较超声检查结果和实验室过敏数据在非IgE介导的婴儿胃肠道牛奶过敏中的诊断效用。经食物消除试验和口服食物激发试验（OFCT）确诊的活动性非IgE介导的婴幼儿胃肠道牛奶过敏16例（A组），急性病毒性胃肠炎（AGE）15例（B组），对照组（C组）15例。1)B型腹部超声检查结果，2）实验室过敏数据，包括嗜酸性粒细胞计数（Eos），血清IgE，和抗原特异性淋巴细胞增殖试验（ALPT）对牛奶蛋白，和3）血管密度（VD）间接量化的胃肠多普勒血流在空肠，回肠，乙状结肠粘膜进行了评估和比较。A组小肠壁增厚、扩张、肠系膜增厚和扩张不良分别为100%、62.5%、93.7%和100%。A组Eos、IgE、ALPT和VD的阳性率分别为25.0%、0%、87.5%和100%。小肠VD A组显著高于B组（空肠p<. 001;回肠P<. 001)C（空肠p<. 001;回肠P<. B组和C组之间无显著差异（空肠：p=. 001）。74;回肠：p=. 73）。结论：腹部多普勒超声检查和小肠VD在症状状态下可以支持诊断和评估非IgE介导的婴儿胃肠道牛奶过敏，症状为呕吐，腹泻和无法茁壮成长。
Background: Although non-IgE-mediated gastrointestinal food allergy has increased rapidly in Japan, a small number of reports has evaluated B-mode and Doppler ultrasonographic findings in the acute phase of infantile gastrointestinal milk allergy. The aim of the present study was to compare the diagnostic utility of ultrasonographic findings and laboratory allergic data in non-IgE-mediated infantile gastrointestinal milk allergy.Methods: Sixteen cases of active non-IgE-mediated infantile gastrointestinal milk allergy, diagnosed by food elimination tests and oral food challenge tests (OFCTs)(group A), 15 cases of acute viral gastroenteritis (AGE)(group B), and 15 controls (group C) were enrolled. 1) B-mode abdominal ultrasound findings, 2) laboratory allergic data including eosinophil counts (Eos), serum IgE, and the antigen-specific lymphocyte proliferation test (ALPT) against milk protein, and 3) vessel density (VD) indirectly quantified by gastrointestinal Doppler flow at jejunum, ileum, and sigmoid colonic mucosae were evaluated and compared among the groups.Results: In the small intestine, wall thickening, dilation, mesenteric thickening, and poor peristalsis were found in 100%, 62.5%, 93.7%, and 100%, respectively, in group A. Eos, IgE, ALPT, and VD were positive in 25.0%, 0%, 87.5%, and 100%, respectively, in group A. Small intestinal VD was significantly greater in group A than in groups B (jejunum p<. 001; ileum p<. 001) and C (jejunum p<. 001; ileum p<. 001), with no significant differences between groups B and C (jejunum: p=. 74; ileum: p=. 73).Conclusions: Abdominal Doppler ultrasonography and small intestinal VD at symptomatic state can support the diagnosis and evaluation of non-IgE-mediated infantile gastrointestinal milk allergy with symptoms of vomiting, diarrhea, and failure to thrive.