早期水解蛋白配方喂养影响CMPA婴儿体格生长与代谢的研究

With the people's understanding to cow's milk protein allergy (CMPA) and the significance of elimination diet, children with CMPA who are protein-hydrolysate formulas (PHFs) fed have become an increasing special group. As compared to the intact protein, the absorption and metabolism of hydrolysed protein have their own characteristics. Considering the long-term effect of nutrition in early life on body health, understanding the impacts of early PHFs feeding on the growth of children with CMPA has important practical significance. Relative to the common growth parameters like height and weight, body composition (fat mass and non-fat mass of body) is an important indicator reflecting the internal change of physical growth. In this study, we will recruit eighty children with CMPA who are under six months of age from our food allergy clinic, and according to the principle of 1:1 matching, choose eighty healthy children with same sex and months who are exclusive breastfeeding or cow-milk formula feeding from our health care clinic as two control groups, to conduct a follow-up study by twenty-four months of age. All the children recruited will come to our hospital for a visit according to children's routine physical examination sequence of Shanghai (one、two、three、four、six、nine、twelve、eighteen and twenty four months old). We will measure the common growth parameters (height, weight and head circumference), detect body composition by using PEA POD Infant Body Composition System, detemine the level of metabolic indices (leptin、ghrelin、insulin and IGF-1) in blood and urine by radioimmunoassay and chemiluminescence, and also assess the dietary intake three days before the visit. We hope to understand the effects of early PHFs feeding on the physical growth (growth parameters and body composition) and metabolic indices of children with CMPA, and through multiple regression analysis, to explore the correlation between body composition and metabolic indices above in blood. Finally enrich our knowledge about the role of PHFs feeding on children's health, and provide theoretical and practical evidence on the more scientific and reasonable usage of hydrolysed protein diet in clinical practice.

随着人们对牛奶蛋白过敏（CMPA）以及饮食回避治疗的重要性的认识，目前食用水解蛋白配方（PHFs）的CMPA儿童已成为日益增长的一个特殊群体。相对于完整蛋白，水解蛋白的吸收与代谢方式具有其自身的特点。鉴于生命早期营养对人体健康的长远作用，了解早期的PHFs喂养对CMPA婴儿生长发育的影响具有重要的现实意义。本项目通过纳入我院食物过敏门诊新确诊的小于6个月的CMPA儿童共80名，并按照1:1匹配的原则，选择我院儿童保健门诊同性别、同月龄的纯母乳或普通配方喂养的健康儿童各80名为两组对照，开展一项截至24月龄的随访性研究，了解早期的PHFs喂养对CMPA儿童体格生长（生长参数和体成分）及代谢指标（瘦素、胃饥饿素、胰岛素和胰岛素样生长因子-1）的影响，以及体成分与血清中上述代谢指标的相关性。进一步丰富PHFs对儿童健康的作用的认识，为在临床实践中更加科学合理的实施水解蛋白饮食提供理论与实践依据。

随着人们对牛奶蛋白过敏（CMA）以及饮食回避治疗的重要性的认识，目前食用低敏配方（HF）的CMA儿童已成为日益增长的一个特殊群体。不论是疾病本身还是其所食用限制饮食，都使得CMA儿童更容易发生营养不足及生长落后，因此对CMA婴儿生长发育的监测具有重要的现实意义。本项目通过纳入我院免疫科、消化科门诊新确诊的小于4个月、无母乳喂养的的CMA儿童共60名，并按照1:1年龄匹配的原则，选择我院儿童保健门诊的健康儿童60名作为对照，开展一项截至24月龄的观察性的随访研究，试图了解HF喂养的CMA儿童在体格生长（生长参数和体成分）及代谢类激素（瘦素、胃饥饿素、胰岛素和胰岛素样生长因子-1）方面与正常健康儿童的差异，以及体成分与血清中上述激素水平的相关性。本次研究的入组平均年龄为2.9 ± 1.0月，CMA 儿童平均在HF喂养1个月后症状得到全部缓解；同年龄匹配的健康对照组相比， CMA 儿童在6月龄时的每日平均配方奶摄入量、平均每日总热卡摄入量、奶来源的热卡摄入量、总碳水化合物摄入量均低下；6-18月龄时的年龄别体重Z评分、9-12月龄时的身高别体重Z评分均明显落后，但至24月龄时身高、体重与对照组相比已无统计学差异性；6月龄时的脂肪组织百分比明显落后（26.2% versus 30.3%，P=0.015)，脂肪组织指数（FMI）在 4（3.65 kg/m2versus 3.89 kg/m2）和 6（4.75 kg/m2 versus 4.99 kg/m2）月龄时的数值均低于对照组,但是差异无统计学显著性，至24月龄两组之间的脂肪组织百分比无统计学差异；6和24月龄时，CMA 儿童的血清瘦素浓度明显低于健康对照组，且瘦素水平与脂肪组织重量呈正性相关。因此，HF喂养的CMA儿童的生长落后主要表现在生后头一年，以体重增长迟滞和体脂肪组织堆积受损为特征，并在生后2年内逐步追赶至正常，但血清瘦素水平仍持续低下。进一步我们需要开展更为长期的纵向随访以及该早期变化对健康的长期影响的研究。