目的:探讨以胃肠道表现为首发症状的婴儿牛奶蛋白过敏症(cow milk protein allergy,CMPA)的临床特点,以减少误诊。方法:选择2012年7月至2015年6月我院消化门诊就诊的448例诊断为婴儿牛奶蛋白过敏患儿,采用问卷调查法收集临床资料和应用COMi SS症状评分法进行症状量化评估。结果:448例患儿中男216例,女232例,以0~6个月发病年龄为主。不同胃肠道首发症状就诊中腹泻50%,便血29%,反流或呕吐9%,阵发性哭闹7%,便秘5%。治疗前COMi SS评分均值10.24±2.60分,饮食回避2~4周后评分均值为3.68±1.17分,均值差>6分。调查既往诊疗中误诊病例296例,不同胃肠道首发症状患儿的误诊率为:腹泻组71%,便血组68%,阵发性哭闹组50%,反流或呕吐组40%,便秘组66%。既往误诊病例中抗生素使用率达62%。误诊病例中发生营养不良112例,非误诊病例中营养不良4例,差异具有统计学意义(P<0.05)。结论:胃肠型婴儿牛奶蛋白过敏主要症状为腹泻及便血。因症状缺乏特异性,临床实践中误诊发生率高。COMi SS症状评分法有助于临床医师对该病首发症状的识别和疗效观察。 Objective: To investigate the clinical features of cow milk protein allergy (CMPA) with gastrointestinal manifestations as the first symptom to reduce misdiagnosis. Methods: From July 2012 to June 2015, 448 children diagnosed as infant milk protein allergy in our hospital were enrolled in this study. The clinical data were collected by questionnaire and the symptom score was evaluated by COMi SS symptom score. Results: There were 216 males and 232 females in 448 cases, with the age of onset of 0 ~ 6 months as the mainstay. The first symptom of different gastrointestinal tract treatment of diarrhea 50%, blood in the stool 29%, reflux or vomiting 9%, paroxysmal crying 7%, constipation 5%. Before treatment, the average score of COMi SS was 10.24 ± 2.60, and the average score was 3.68 ± 1.17 after 2 to 4 weeks of diet avoidance. The mean difference was> 6 points. A total of 296 cases of misdiagnosis in previous medical treatment were investigated. The misdiagnosis rate of children with different gastrointestinal symptoms was 71% in diarrhea group, 68% in hematochezia group, 50% in paroxysmal cryogenic group, 40% in reflux or vomiting group, constipation Group 66%. Antibiotic use was 62% in cases of previous misdiagnosis. Malnutrition occurred in 112 cases of misdiagnosed cases, 4 cases of malnutrition in non-misdiagnosed cases, the difference was statistically significant (P <0.05). Conclusion: The main symptoms of gastrointestinal infantile milk protein allergy are diarrhea and hematochezia. Due to the lack of specificity of symptoms, the incidence of misdiagnosis in clinical practice is high. COMi SS symptom score method helps clinicians to identify and treat the first symptom of the disease.