探讨儿童保健门诊蛋白质-能量营养不良(PEM)病因学分布规律。

选择2022年1月至7月于四川大学华西第二医院儿童保健门诊部(新川)·华西儿童卓越发展中心就诊的217例PEM患儿为研究对象。根据PEM严重程度，将其分别纳入轻度PEM组(n＝182)与中度PEM组(n＝33)。由于重度PEM患儿例数太少(2例)，未纳入分组。回顾性分析217例PEM患儿的PEM病因。采用χ²检验、连续性校正χ²检验或Fisher确切概率法，对轻度PEM组与中度PEM组患儿PEM病因占比进行统计学分析。轻度PEM组与中度PEM组患儿性别构成比、年龄等一般临床资料比较，差异均无统计学意义(P>0.05)。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①217例PEM患儿中，排名前5位PEM病因依次为：食物变态反应(FA)(135例，62.2%)，小于胎龄(SGA)儿(46例，21.2%)，饮食行为问题(24例，11.1%)，早产儿(15例，6.9%)与反复呼吸道感染(RRTI)(6例，2.8%)。②轻度PEM组FA占比为65.4%(119/182)，显著高于中度PEM组的45.5%(15/33)，差异有统计学意义(χ²＝4.73，P＝0.030)。轻度PEM组SGA儿占比为17.6%(32/182)，显著低于中度PEM组的42.4%(14/33)，差异亦有统计学意义(χ²＝10.25，P＝0.001)。2组患儿饮食行为问题、早产儿、RRTI等占比分别比较，差异均无统计学意义(P>0.05)。

儿童保健门诊PEM患儿中，以轻、中度PEM患儿多见。导致PEM的病因中，轻度PEM组患儿PEM病因主要为FA，中度PEM组患儿以FA、SGA儿为主要PEM病因。饮食行为问题、早产儿及RRTI是导致PEM的其他病因。

To investigate the etiological distribution law of protein-energy malnutrition (PEM) in pediatric primary care department.

A total of 217 outpatient children with PEM in West China Second University Hospital Child Healthcare for Xinchuan · West China Center for Child Development and Excellence from January 2022 to July 2022 were enrolled into study. According to the severity of PEM, they were divided into mild PEM group (n=182) and moderate PEM group (n=33). Severe PEM children were not grouped individually due to the limited number of children (2 cases). The causes of PEM were retrospectively analyzed. The proportion of different causes of PEM in mild PEM group and moderate PEM group were compared by chi-square test, continuity correction of chi-square test or Fisher′s exact probability test. There were no significant differences between mild PEM group and moderate PEM group in general clinical data, such as gender constituent ratio and age (P>0.05). The procedures of this study were consistent with the requirements of Helsinki Declaration of World Medical Association revised in 2013.

①Among the 217 children with PEM, the top five causes of PEM were food allergy (FA) (135 cases, 62.2%), small for gestational age (SGA) infant (46 cases, 21.2%), dietetic behavior problems (24 cases, 11.1%), preterm infant (15 cases, 6.9%) and recurrent respiratory tract infection (RRTI) (6 cases, 2.8%). ②The proportion of FA in mild PEM group was 65.4% (119/182), which was statistically higher than that in moderate PEM group (45.5%, 15/33), and the difference was statistically significant (χ²=4.73, P=0.030). The proportion of SGA infant in mid PEM group was 17.6% (32/182), which was statistically lower than that in moderate PEM group (42.4%, 14/33), and the difference was statistically significant (χ²=10.25, P=0.001). There was no significant difference in the proportion of other causes of PEM, such as dietetic behavior problems, preterm infants and RRTI between two groups (P>0.05).

The mainly type of PEM children in pediatric primary care department is mild and moderate PEM. Among the causes of PEM, FA is the main cause of PEM in mild PEM group, and FA and SGA infant are the main causes of PEM in moderate PEM group. Dietetic behavior problems, preterm infant and RRTI are other causes of PEM.