目的: 探讨粪便钙卫蛋白检测在婴儿牛奶蛋白过敏性肠炎中的诊断价值。方法: 连续纳入2020年1月至2023年1月在杭州市儿童医院消化内科就诊的87例过敏性肠炎婴儿的病例资料进行回顾性分析, 将确诊为牛奶蛋白过敏性肠炎的38例婴儿设为A组, 非牛奶蛋白过敏性肠炎的49例婴儿设为B组, 再收集同期在杭州市儿童医院体检的健康婴儿73例设为C组。收集3组婴儿一般资料, 并采集粪便标本以检测粪便钙卫蛋白水平。采用受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under characteristic, AUC)分析粪便钙卫蛋白对过敏性肠炎以及牛奶蛋白过敏性肠炎的诊断价值, 并采用Pearson法分析嗜酸性粒细胞(eosinophilic granulocytes, EOS)、血小板(platelets, PLT)水平与粪便钙卫蛋白水平的相关性。结果: A、B、C组的EOS水平分别为(0.73±0.21)×10⁹ /L、(0.41±0.10)×10⁹ /L、(0.26±0.05)×10⁹ /L, PLT水平分别为(381.03±46.04)×10⁹ /L、(336.98±52.57)×10⁹ /L、(300.22±23.00)×10⁹ /L, A组EOS、PLT水平均高于B组和C组(P < 0.05), B组EOS、PLT水平均高于C组(P < 0.05)。A、B、C组的粪便钙卫蛋白水平分别为(324.45±174.56)μg/g、(196.12±83.39) μg/g、(143.73±50.54) μg/g, A组粪便钙卫蛋白水平高于B组、C组(P < 0.05), B组粪便钙卫蛋白水平高于C组(P < 0.05)。粪便钙卫蛋白诊断过敏性肠炎、牛奶蛋白过敏性肠炎的AUC值分别为0.758、0.792, 灵敏度分别为0.575、0.711, 特异度分别为0.904、0.861, 最佳截断值分别为202.500μg/g、235.000μg/g, 95%CI分别为0.683~0.833、0.688~0.896。EOS水平与粪便钙卫蛋白水平呈正相关(r=0.325, P < 0.05), PLT水平与粪便钙卫蛋白水平呈正相关(r=0.280, P < 0.05)。结论: 粪便钙卫蛋白在牛奶蛋白过敏性肠炎婴儿中可能有较高的诊断价值, 且EOS、PLT水平与粪便钙卫蛋白水平呈正相关, 粪便钙卫蛋白水平越高, 炎症反应越严重。

Objective: To explore the diagnostic significance of fecal calprotectin detection in infants with milk protein-allergic enteritis, and to provide valuable clinical basis for the early diagnosis and treatment decision-making of infants with milk protein-allergic enteritis. Methods: A retrospective analysis was conducted on the clinical data of 87 infants with suspected milk protein-allergic enteritis admitted in Hangzhou Children's Hospital from January 2020 to January 2023, and 38 infants with confirmed milk protein-allergic enteritis were assigned to group A, 49 infants with non-milk protein-allergic enteritis were assigned to group B, and 73 healthy infants who underwent physical examinations in Hangzhou Children's Hospital during the same period were assigned to the group C. General data of the three groups were collected through questionnaires, and fecal specimens were collected to detect the level of fecal calprotectin. The area under receiver operating characteristic (ROC)curve (AUC)was used to analyze the diagnostic value of fecal calprotectin for allergic enteritis and milk protein-allergic enteritis. The correlation between eosinophilic granulocytes (EOS)and platelets (PLT)levels and fecal calprotectin levels was analyzed by Pearson method. Results: The levels of EOS in groups A, B and C were (0.73±0.21)×10⁹/L, (0.41±0.10)×10⁹ /L, (0.26±0.05)×10⁹ /L respectively, the levels of PLT were (381.03±46.04)×10⁹ /L, (336.98±52.57)×10⁹ /L, (300.22±23.00)×10⁹ /L respectively, and the levels of EOS, PLT in group A were higher than those in group B and group C (P < 0.05), and those in group B were higher than those in group C (P < 0.05). The levels of fecal calprotectin in groups A, B and C were (324.45±174.56) μg/g, (196.12±83.39) μg/g, (143.73±50.54) μg/g respectively, and the levels of fecal calprotectin in group A were higher than those in group B and group C (P < 0.05), and those in group B were higher than those in group C (P < 0.05). The AUC values of fecal calprotectin and milk protein in the diagnosis of allergic enteritis were 0.758 and 0.792, respectively, the sensitivities were 0.575 and 0.711 respectively, the specificities were 0.904 and 0.861 respectively, the optimal cut-off values were 202.500 and 235.000 respectively, and the 95%CI were 0.683-0.833 and 0.688-0.896 respectively. The level of EOS was positively correlated with the level of fecal calprotectin (r=0.325, P < 0.05), and the PLT level was positively correlated with the level of fecal calprotectin (r=0.280, P < 0.05). Conclusion: Fecal calprotectin may have high clinical significance in infants with milk protein-allergic enteritis, and EOS and PLT levels may be positively correlated with the levels of fecal calprotectin. The higher the fecal calprotectin level, the more serious the inflammatory response.

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作者贡献声明  贾晓怡：撰写论文；汤卫红：总体把关和审定论文；贾晓怡、张炎、汤卫红：商讨论文结构与框架，查阅文献，参与论文修改与润色。所有作者均参与论文修改，并对最终文稿进行审读和确认。