中国循证儿科杂志2025，Vol.20Issue(4)：265-271,7.DOI:10.3969/j.issn.1673-5501.2025.04.005
牛奶蛋白过敏患儿建立牛奶口服耐受影响因素分析及预测模型构建与验证
Analysis of influencing factors of milk oral tolerance in children with cow's milk protein al-lergy and construction and validation of predictive models
摘要
Abstract
Background There is a scarcity of research data on the influencing factors for establishing oral tolerance to milk in patients with cow's milk protein allergy(CMPA).Currently,there is a lack of a predictive model suitable for Chinese infants and young children with CMPA to establish oral tolerance to milk.Objective To analyze the influencing factors of establishing oral milk tolerance in infants and young children with milk protein allergy,and to construct a clinical prediction model,so as to provide references for the management of CMPA patients,the timely reintroduction of milk diet,and the provision of scientific dietary guid-ance.Design A prospective cohort study.Methods The cohort population was composed of children aged 0 to 3 years who vis-ited the Department of Pediatric Rheumatology,Immunology and Allergy of the First Hospital of Jilin University from January to De-cember 2023,were diagnosed with milk protein allergy,and were fed with hypoallergenic formula milk powder instead.The 12-month follow-up was set as the endpoint of the study.The study summarized the clinical characteristics of the patients in this group,conducted a multivariate analysis to identify the possible influencing factors for the establishment of oral milk tolerance,selected the effective influencing factors to construct a nomogram prediction model based on the effective influencing factors,and evaluated and validated the prediction model.Main outcome measures Age,gender,type of CMPA,degree of CMPA,mode of birth,feeding method,whether to delay the addition of complementary foods,duration of feeding with hypoallergenic formula milk,his-tory of food allergy in first-degree relatives.Results(1)Baseline information:A total of 226 infants and young children with CMPA were included,with more males than females.The age distribution was the largest among those aged 0 to 12 months.There were more people from cities than from rural areas.Premature infants accounted for 11.95%.The majority were born by cesarean section.Artificial feeding was the most common(41.59%),59.73%of the children postponed the addition of complementary foods,67.70%of the children had a history of food allergy in first-degree relatives,and 107 cases were combined with other aller-gic diseases.(2)Among the 226 children with CMPA,48 cases were of IgE-mediated type(28 mild cases,14 moderate cases,and 6 severe cases),and 178 cases were of non-IgE-mediated type(89 mild cases,56 moderate cases,and 33 severe cases).The incidence of digestive tract symptoms in IgE-mediated CMPA was lower than that in non-IgE-mediated CMPA,while the incidence of skin symptoms and respiratory tract symptoms was higher than that in non-IGE-mediated CMPA.The risk of multiple system in-volvement in IgE-mediated type was higher than that in non-IgE-mediated type.(3)All 226 children with CMPA completed the 12-month follow-up.During the follow-up in the 3rd month,6th month,9th month and 12th month,12 cases,51 cases,96 cases and 127 cases of children reached oral milk tolerance through clinical assessment respectively.At the follow-up in the 6th,9th and 12th months,among the children who had established oral milk tolerance,those who were fed with hypoallergenic formula replacement for more than 6 months were significantly more than those who were fed with hypoallergenic formula replacement for less than 6 months.(4)Multivariate Logistic regression analysis showed that 0 to 12 months of age,male gender,urban birth,IgE-mediated CMPA,severe CMPA,cesarean section birth,artificial feeding,delayed addition of complementary foods,hypoallergenic formula milk feeding for less than 6 months,and history of food allergy in first-degree relatives were adverse influencing factors for estab-lishing oral milk tolerance.(5)To select the effective influencing factors for establishing oral tolerance to milk and construct a no-mogram prediction model.(6)Evaluation and validation of the prediction model:The consistency index C-index of the ROC curve of the prediction model was 0.776[95%CI:0.665-0.892],indicating good predictive efficacy.The calibration curve showed good consistency between the predicted incidence curve and the actual incidence curve.Conclusion A multivariate analysis was con-ducted on the influencing factors of establishing milk oral tolerance in CMPA,and effective influencing factors were established to construct a nomogram prediction model for establishing milk oral tolerance in infants and young children with CMPA,providing a reference for clinical CMPA management and guiding scientific dietary guidance.关键词
牛奶蛋白过敏/口服耐受/影响因素/预测模型Key words
Milk protein allergy/Oral tolerance/Influencing factor/Prediction model引用本文复制引用
王赫群,宋躐夫,吕姗珊,徐萌,杨思睿,王晶华..牛奶蛋白过敏患儿建立牛奶口服耐受影响因素分析及预测模型构建与验证[J].中国循证儿科杂志,2025,20(4):265-271,7.基金项目
吉林省科技发展计划重点研发资助项目:20210203081SF （）
