孕期因素与婴儿牛奶蛋白过敏的关系

doi:10.19723/j.issn.1671-167X.2024.01.022

摘要/Abstract

摘要：

目的: 初步探讨孕期因素与婴儿牛奶蛋白过敏的关系。方法: 数据来自一项“中国儿童对牛奶蛋白过敏的遗传易感性研究”的子队列，包括2020年3月1日至12月31日在北京大学人民医院出生的婴儿，根据随访至1岁时有无牛奶蛋白过敏(cow’s milk protein allergy，CMPA)，分为病例组(CMPA组)和对照组。回顾性收集婴儿及其母亲孕前和孕期的临床资料，分析孕期多因素与婴儿牛奶蛋白过敏的相关性。结果: 共纳入278例婴儿，CMPA患儿52例，对照组226例；男性婴儿143例，女性婴儿135例，其中男性婴儿在CMPA组比例(69.2%)高于对照组(47.3%)，差异有统计学意义(P=0.004)；CMPA患儿和对照组在出生体质量、出生胎龄、低出生体重儿、早产、脐带绕颈、新生儿窒息分布上差异无统计学意义(P＞0.05)。母亲孕期合并免疫性疾病、贫血者以及孕期存在抗生素暴露者在CMPA组比例均高于对照组，两组之间差异有统计学意义(P＜0.05)；其他妊娠期合并症，如子痫/子痫前期、慢性高血压/妊娠期高血压、糖尿病/妊娠期糖尿病、甲状腺疾病等在两组分布差异无统计学意义(P＞0.05)。CMPA组与对照组孕期多项血常规指标总体分布差异无统计学意义(P＞0.05)。多因素Logistic回归分析发现男性婴儿、母亲妊娠合并免疫性疾病、妊娠合并贫血以及孕期抗生素暴露是CMPA发生的独立危险因素。结论: 男性婴儿、母亲妊娠合并免疫性疾病、妊娠合并贫血以及孕期抗生素暴露是CMPA发生的独立危险因素。

关键词: 牛奶蛋白过敏, 危险因素, 婴儿, 妊娠期

Abstract:

Objective: To preliminarily explore the association of pregnancy factors with cow's milk protein allergy in infants. Methods: This study was based on data from a subcohort of a study called genetic susceptibility to cow's milk allergy in Chinese children, including infants born in Peking University People's Hospital between March 1, 2020, and December 31, 2020. The infants were divided into a cow's milk protein allergy (CMPA) group and a control group according to whether they had developed cow's milk protein allergy at the age of 1 year. We retrospectively collected the clinical data of infants and their mothers before and during pregnancy, and analyzed the association of multiple factors during pregnancy with cow's milk protein allergy in infants. Results: A total of 278 infants were enrolled in this study, including 52 infants with CMPA and 226 infants without CMPA. Among them, there were 143 boys and 135 girls. The proportion of male infants in the CMPA group (69.2%) was higher than that in the control group (47.3%), and the difference was statistically significant (P=0.004). There were no significant differences in the distribution of birth weight, gestational age at birth, low-birth-weight infants, premature, umbilical cord entangle neck, and neonatal asphyxia between the CMPA group and the control group (P>0.05). The proportion of mothers complicated with autoimmune diseases, anemia or antibiotics exposure during pregnancy in the CMPA group was higher than that in the control group, and there were statistical differences between the two groups (P < 0.05). There was no significant difference in the distribution of other pregnancy complications between the two groups (P>0.05), such as eclampsia/preeclampsia, chronic hypertension/gestational hypertension, diabetes/gestational diabetes, thyroid diseases, and so on. There was no significant difference in the overall distribution of some blood routine indexes during pregnancy between the CMPA group and the control group (P>0.05). Multivariate Logistic regression analysis showed that male infant, mothers complicated with autoimmune diseases or anemia, antibiotic exposure during pregnancy were independent risk factors for cow's milk protein allergy. Conclusion: Male infant, mothers complicated with autoimmune diseases or anemia, antibiotic exposure during pregnancy were independent risk factors for cow's milk protein allergy.

Key words: Cow's milk protein allergy, Risk factors, Infant, Pregnancy

中图分类号:

R723.1

李洋洋,侯林,马紫君,黄山雅美,刘捷,曾超美,秦炯. 孕期因素与婴儿牛奶蛋白过敏的关系[J]. 北京大学学报（医学版）, 2024, 56(1): 144-149.

Yangyang LI,Lin HOU,Zijun MA,Shanyamei HUANG,Jie LIU,Chaomei ZENG,Jiong QIN. Association of pregnancy factors with cow's milk protein allergy in infants[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 144-149.

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Items	CMPA group (n=52)	Control group (n=226)	χ²/t/Z value	P value
Gender, n(%)
Male	36 (69.2)	107 (47.3)	8.106	0.004
Female	16 (30.8)	119 (52.7)
Birth weight/g, $\bar x \pm s$	3 113.4±675.0	3 153.1±533.5	0.46	0.646
Birth weight/g, $\bar x \pm s$	3 113.4±675.0	3 153.1±533.5	0.460	0.646
Low-birth-weight infant, n(%)	9 (17.3)	25 (11.1)	1.536	0.215
Gestational age/weeks, M(P₂₅, P₇₅)	38.9 (37.7, 39.7)	39.1 (37.9, 40.1)	1.366	0.172
Premature, n(%)	12 (23.1)	42 (18.6)	0.545	0.460
Umbilical cord entangle neck, n(%)	1 (1.9)	8 (3.5)	0.025	0.873
Neonatal asphyxia, n(%)	2 (3.8)	4 (1.8)	0.160	0.689

Maternal factors	CMPA group (n=52)	Control group (n=226)	χ²/t value	P value
Age/years, $\bar x \pm s$	33.0±4.1	32.7±4.2	0.446	0.656
Ethnic groups, n(%)
Han	44 (84.6)	205 (90.7)	1.679	0.195
Other ethnic groups	8 (15.4)	21 (9.3)
Prepregnancy BMI/(kg/m²), n(%)
< 18.5	3 (5.8)	28 (12.4)	6.049	0.109
18.5-24.9	42 (80.8)	153 (67.7)
25.0-29.9	3 (5.8)	34 (15.0)
≥30	4 (7.7)	11 (4.9)
Previous pregnancy, n(%)
None	33 (63.5)	117 (51.8)	2.326	0.127
≥1	19 (36.5)	109 (48.2)
Parity^a, n(%)
None	40 (76.9)	149 (65.9)	2.348	0.125
≥1	12 (23.1)	77 (34.1)
Histories of abnormal pregnancy and delivery, n(%)
No	51 (98.1)	212 (93.8)	0.790	0.374
Yes	1 (1.9)	14 (6.2)

Maternal factors	CMPA group (n=52)	Control group (n=226)	χ² value	P value
IVF-ET ^a	8 (15.4)	30 (13.3)	0.160	0.690
Cesarean delivery	14 (26.9)	84 (37.2)	1.944	0.163
Hospitalization frequency ^b
1	39 (75.0)	181 (80.1)	0.663	0.416
≥2	13 (25.0)	45 (19.9)
Eclampsia/preeclampsia	2 (3.8)	19 (8.4)	0.691	0.406
Chronic hypertension/gestational hypertension	9 (17.3)	22 (9.7)	2.447	0.118
Diabetes/gestational diabetes	8 (15.4)	35 (15.5)	0.000	0.985
Thyroid disease	7 (13.5)	36 (15.9)	0.197	0.657
Oligohydramnios	4 (7.7)	22 (9.7)	0.037	0.848
Autoimmune disease	9 (17.3)	18 (8.0)	4.208	0.040
Hypoproteinemia	1 (1.9)	9 (4.0)	0.094	0.760
Anemia	26 (50.0)	65 (28.8)	8.660	0.003
Antibiotics during pregnancy	12 (23.1)	25 (11.1)	5.289	0.021

Maternal factors	CMPA group (n=52)	Control group (n=224)	t/Z value	P value
WBC/(×10⁹/L), $\bar x \pm s$	9.2±2.1	9.1±1.8	0.267	0.789
NE/(×10⁹/L), $\bar x \pm s$	6.8±1.8	6.7±1.5	0.460	0.646
NE/%, $\bar x \pm s$	72.5±6.0	72.2±4.8	0.386	0.700
LY/(×10⁹/L), $\bar x \pm s$	1.8±0.4	1.8±0.4	0.490	0.625
LY/%, $\bar x \pm s$	19.9±5.3	20.1±4.3	0.359	0.720
NLR, $\bar x \pm s$	4.2±1.3	4.0±1.2	0.952	0.342
MO/(×10⁹/L), $\bar x \pm s$	0.57±0.13	0.58±0.14	0.367	0.714
MO/%, $\bar x \pm s$	6.4±1.3	6.4±1.3	0.230	0.818
LMR, $\bar x \pm s$	3.2±0.9	3.3±0.9	0.381	0.703
PLR, $\bar x \pm s$	130.4±44.4	124.6±34.6	1.021	0.308
EO/(×10⁹/L), M(P₂₅, P₇₅)	0.07 (0.03, 0.12)	0.07 (0.05, 0.11)	0.682	0.495
EO/%, M(P₂₅, P₇₅)	0.83 (0.48, 1.19)	0.78 (0.55, 1.19)	0.201	0.841
BA/(×10⁹/L), $\bar x \pm s$	0.03±0.02	0.03±0.01	0.411	0.682
BA/%, $\bar x \pm s$	0.35±0.13	0.39±0.11	0.133	0.894

Risk factors	B	SE	Wald χ²	P	OR	95%CI
Male^a	0.972	0.343	8.011	0.005	2.643	1.348-5.179
Autoimmune disease^b	1.109	0.475	5.442	0.020	3.031	1.194-7.693
Anemia^b	0.899	0.326	7.599	0.006	2.458	1.297-4.657
Antibiotics during pregnancy	0.868	0.416	4.349	0.037	2.383	1.054-5.388