Intolerance to Casein Hydrolysate Formula:Clinical Aspects
Intolerance to Casein Hydrolysate Formula:Clinical Aspects
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对酪蛋白水解产物配方的不耐受：临床方面
DOI：
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
S. Freier
中科院分区：
文献类型：
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作者：
E. Rosenthal;Yechiel Schlesinger;Y. Birnbaum;R. Goldstein;A. Benderly;S. Freier
婴儿A.P.从出生起就喂食一种改良的牛奶配方奶粉(Maabaroth Pharmtics Products，以色列Kibbuz Maabaroth)。两周后，她因腹泻入院10天。粪便培养呈阴性。怀疑为牛奶不耐受(CMI)，并尝试了一种大豆配方奶粉。腹泻停止。她开始增加体重，但两周后明显出血的腹泻复发。随后怀疑大豆蛋白不耐受，饮食改为NutraMicen“(美国印第安纳州埃文斯维尔的Mead Johnson&Co.)。大便再次好转，出血也停止了。两周后，新鲜血液再次出现在粪便中，但稠度没有变化。空肠活检正常。吞钡和后续检查都是正常的，梅克尔扫描也是如此。直肠镜检查显示4-7厘米处有红色、易碎的粘膜，但活检正常。她不断地喂食Nutramien，出血不断。她的血红蛋白在95-112g/L之间波动，网织红细胞计数升高(2.6%-6%)。在接受NutraMicen治疗的五个月里，她的食欲和体重增加都是正常的，除了大便中有血外，没有腹泻或其他胃肠道不耐受的迹象。她被怀疑对NutraMicen不耐受，因此，从六个月起，她只接受基本配方奶粉Vivonex的喂养(伊顿实验室，诺维奇，美国纽约)。在四天内，血液消失了，但在接下来的几周里，与NutraMicen的挑战导致了24小时内的明显出血。为了定量给药后肠道出血量，我们注射了放射性标记的红细胞。图1显示营养牛奶和牛奶都增加了肠道失血量。患者2接受母乳喂养2个月，之后接受美特纳治疗。在他三个月大的时候，他开始超过Melaena。大量出血持续存在，他每周需要输血两次。在紧急剖腹手术中，怀疑回盲肠交界处有血管畸形，切除了20厘米的肠。黑死病仍在继续，CMI怀疑婴儿的配方奶粉被改为Pregstiil“(美赞臣公司)。大便恢复正常。出院后，他再次接受了修改后的奶粉配方，在7个月大的时候，黑素又出现了。这名婴儿再次接受了Pregstiil的治疗。然而，这一次，他的病情并没有改善，他被重新入院。他在入院的头两天超过了马莱纳，他的血红蛋白继续下降。对他出血来源的广泛调查都是阴性的。抗核因子阳性。免疫球蛋白A、G和M均正常。粪便培养阴性。考虑到对蛋白质水解物不耐受的可能性，他的饮食改为Vivonex。在饮食改变后的一段时间里，所有的大便都是潜血阴性，并停留在
Infant A. P. was fed Materna", a modified cow's milk formula (Maabaroth Pharmaceutical Products, Kibbutz Maabaroth, Israel) from birth. At two weeks she was admitted because of diarrhoea for 10 days. Stool cultures were negative. Cow's milk intolerance (CMI) was suspected and a soybean formula was tried. The diarrhoea ceased. She began to gain weight but diarrhoea with overt blood recurred two weeks later. Soy protein intolerance was then suspected and the diet was altered to Nutramigen" (Mead Johnson & Co., Evansville, Indiana, USA), a casein hydrolysate formula. The stools again improved and bleeding stopped. Two weeks later, fresh blood reappeared in the stools without a change in consistency. Jejunal biopsy was normal. Barium swallow and follow-through were normal as was a Meckel scan. Proctoscopy showed a red, friable, mucosa at 4-7 cm, but the biopsy was normal. She was continuously fed Nutramigen and bleeding persisted. Her haemoglobin fluctuated between 95 and 112 g/l with elevated reticulocyte counts (2.6% to 6%). During the five months on Nutramigen, her appetite and weight gain were normal, there was no diarrhoea nor other signs of gastrointestinal intolerance apart from the presence of blood in her stools. Intolerance to Nutramigen was suspected and as a result, from the age of six months onwards, she was fed solely the elemental formula Vivonex" (Eaton Laboratories, Norwich, New York, USA). Within four days blood disappeared, but challenges with Nutramigen in the following weeks resulted in overt bleeding within 24 hours. In order to quantitate the intestinal blood loss following the administration of Nutramigen, radio-labelled erythrocytes were injected. Fig. 1 shows that both Nutramigen and cow's milk increased the intestinal blood loss. Patient 2 was breast fed 2 months and thereafter received Materna. At the age of three months he started to pass melaena. Brisk bleeding persisted and he required two blood transfusions a week. At emergency laparotomy there was a suspicion of a vascular malformation at the ileo-caecal junction and 20 cm of intestine was removed. The melaena persisted and as CMI was suspected the infant's formula was changed to Pregestimil" (Mead-Johnson Co). The stools became normal. After discharge he was again given the modified milk formula and at the age of seven months melaena reappeared. The infant was again given Pregestimil. This time, however, his condition did not improve and he was readmitted. He passed melaena during the first two days of his admission and his haemoglobin continued t o decline. Extensive investigations for the source of his bleeding were negative. Antinuclear factor was positive. Immunoglobulins A, G , and M were normal. Stool culture was negative. The possibility of an intolerance to the protein hydrolysate was considered and his diet changed to Vivonex. During the period following the change in the diet all stools were negative t o occult blood and stayed