Kuitunen P, Visakorpi J K, Savilahti E, Pelkonen P
Arch Dis Child. 1975 May;50(5):351-6. doi: 10.1136/adc.50.5.351.
Fifty-four infants with the malabsorption syndrome and cow's milk intolerence seen during 1962-1971 were investigated. All had diarrhoea and failed to thrive. Most had vomiting and about 20% had atopic eczema and recurrent respiratory infections. Laboratory investigations revealed malabsorption, raised serum IgA, and precipitins to cow's milk. Biopsies showed that the jejunal mucosa was damaged, and in about half the cases was flat. The patient did well on human milk but reacted clinically to cow's milk challenge, either in a few hours or gradually during 3-4 weeks. Some patients showed first a quick, but later a slow, reaction. Clinical symptoms of cow's milk intolerance disappeared at the age of about one year. At that time 81% had normal faecal fat, but only 29% had a normal proximal jejunal mucosa. Many of the patients developed intolerances to other food proteins, such as soya and wheat, if these were given during the sensitive period. Forty-two patients have been followed up for 2 years on a normal gluten-containing diet. Of these, 37 have a normal or nearly normal jejunal mucosa and 5 (12%) have subtotal villous atrophy indicative of coeliac disease. It is concluded that the malabsorption syndrome with cow's milk intolerance is a clear-cut clinical entity. However, the symptomatology, results of laboratory tests, and jejunal biopsy findings closely resemble those of other entities where damage to the intestinal mucosa causes a malabsorption snydrome. Follow-up studies showed that the disease is transient, but about 10% of the patients have coeliac disease, regarded in such cases as the primary disorder.
对1962年至1971年间诊治的54例患有吸收不良综合征和牛奶不耐受的婴儿进行了调查。所有患儿均有腹泻且发育不良。多数患儿有呕吐症状，约20%有特应性湿疹和反复呼吸道感染。实验室检查显示有吸收不良、血清IgA升高以及对牛奶的沉淀素。活检表明空肠黏膜受损，约半数病例为空肠黏膜扁平。患儿食用人乳时情况良好，但对牛奶激发试验有临床反应，反应时间可在数小时内出现，也可在3 - 4周内逐渐出现。有些患儿起初反应迅速，但后来反应缓慢。牛奶不耐受的临床症状在约1岁时消失。此时81%的患儿粪便脂肪正常，但只有29%的患儿近端空肠黏膜正常。如果在敏感时期给予其他食物蛋白，如大豆和小麦，许多患儿会出现对这些食物蛋白的不耐受。42例患儿在正常含麸质饮食下随访了2年。其中37例空肠黏膜正常或接近正常，5例（12%）有小肠绒毛萎缩，提示患有乳糜泻。结论是，伴有牛奶不耐受的吸收不良综合征是一种明确的临床实体。然而，其症状学、实验室检查结果和空肠活检发现与其他因肠黏膜损伤导致吸收不良综合征的实体极为相似。随访研究表明，该病是短暂性的，但约10%的患儿患有乳糜泻，在这些病例中乳糜泻被视为原发性疾病。
