Iyngkaran N, Yadav M, Boey C G, Kamath K R, Lam K L
Department of Paediatrics, University of Malaya, Kuala Lumpur.
J Gastroenterol Hepatol. 1989 Mar-Apr;4(2):127-36. doi: 10.1111/j.1440-1746.1989.tb00816.x.
Some infants intolerant to cow's milk protein (CMP) are often also intolerant to other food proteins including soy protein (SP). The effect of CMP and SP in infants recovering from diarrhoeal disease was studied in 22 infants who were maintained on an hypo-allergenic formula for 4-6 weeks. The infants were then challenged successively, initially with SP, followed 24 h later with CMP and then rechallenged with SP 24 h after CMP provocation. Three groups were recognized on the basis of clinical symptoms and mucosal changes following SP challenge. Group 1 comprised four infants who developed clinical and histological reactions on SP challenge. The subsequent CMP challenge, 24 h after the initial SP challenge, resulted in clinical symptoms in three of the four infants, and they developed increased mucosal injury. Rechallenge with SP in the three infants caused development of severe clinical symptoms. Group 2 comprised 12 infants who developed histological reaction but had no clinical symptoms to initial SP challenge. The subsequent CMP challenge caused further progression in mucosal pathology in 11 of the 12 infants and six also had associated clinical symptoms. Rechallenge with SP in the latter six infants resulted in development of clinical symptoms in three and tolerance to SP in three infants. Group 3 comprised six infants who tolerated SP and CMP but one of these infants developed mild histological changes to CMP. The progression of mucosal injury following SP and CMP challenge was associated with a significant decrease in mucosal disaccharidases, alkaline phosphatase levels and presence of reducing sugar in the stools. The 1 h blood xylose level continued to decrease significantly following the pre-SP, post-SP, and post-CMP challenge. It appears that the small bowel mucosa of young infants recovering from diarrhoeal disease remains sensitive not only to CMP but also to SP. The feeding of these proteins in rapid successive sequence to infants with mucosal damage might result in further progression of the mucosal injury. Thus, the exclusion for a variable period of time of antigenic food proteins like CMP and SP from the diet of young infants recovering from diarrhoea might reduce the risk of inducing mucosal sensitivity to these proteins in susceptible infants.
一些对牛奶蛋白（CMP）不耐受的婴儿通常也对包括大豆蛋白（SP）在内的其他食物蛋白不耐受。在22名婴儿中研究了CMP和SP对腹泻病恢复期婴儿的影响，这些婴儿采用低敏配方奶粉喂养4 - 6周。然后依次对婴儿进行激发试验，最初用SP激发，24小时后用CMP激发，然后在CMP激发后24小时再次用SP激发。根据SP激发后的临床症状和黏膜变化将婴儿分为三组。第1组包括4名婴儿，他们在SP激发时出现临床和组织学反应。在最初的SP激发24小时后的后续CMP激发中，这4名婴儿中有3名出现临床症状，并且黏膜损伤加重。对这3名婴儿再次用SP激发导致出现严重临床症状。第2组包括12名婴儿，他们在最初的SP激发时出现组织学反应但无临床症状。后续的CMP激发导致12名婴儿中的11名黏膜病理学进一步进展，其中6名婴儿还伴有临床症状。对后6名婴儿再次用SP激发，3名婴儿出现临床症状，3名婴儿对SP耐受。第3组包括6名对SP和CMP耐受的婴儿，但其中1名婴儿对CMP出现轻度组织学变化。SP和CMP激发后黏膜损伤的进展与黏膜双糖酶、碱性磷酸酶水平显著降低以及粪便中还原糖的存在有关。在SP激发前、SP激发后和CMP激发后，1小时血木糖水平持续显著下降。似乎腹泻病恢复期的幼儿小肠黏膜不仅对CMP敏感，而且对SP也敏感。将这些蛋白质快速连续地喂给有黏膜损伤的婴儿可能会导致黏膜损伤进一步进展。因此，在腹泻恢复期的幼儿饮食中在一段可变时间内排除抗原性食物蛋白如CMP和SP，可能会降低易感婴儿诱导对这些蛋白黏膜敏感性的风险。
