摘要
目的 研究不同病因儿童慢性咳嗽的气道高反应性（AHR）特征.方法 纳入2012年4月至2013年12月于苏州大学附属儿童医院呼吸科就诊并明确为单病因的慢性咳嗽患儿,采用支气管激发试验测得FEV1下降20％时组织胺累计剂量（PD20）,依据PD20将AHR严重程度分为重度、中度、轻度、极轻度4级,同时测定诱导痰嗜酸粒细胞（EOS）计数和呼出气一氧化氮（FeNO）浓度,按儿童慢性咳嗽指南推荐方案进行治疗,4周后随访,复查上述指标.结果 共纳入患儿66例,其中咳嗽变异性哮喘（CVA）17例,上气道咳嗽综合征（UACS） 37例,感染后咳嗽（PIC） 12例.CVA、UACS及PIC组AHR阳性初诊例数分别为17、13和9例,4周复诊时分别为17、5和2例.AHR严重程度分级,初诊时CVA、UACS和PIC组中～重度分别为5、0和0例,轻度～极轻度分别为12、13和9例,阴性分别为0、24和3例;4周后复诊CVA、UACS和PIC组中～重度度分别为1、0和0例,轻度～极轻度分别为16、5和2例,阴性分别为0、32和10例.CVA组PD20值为（0.47±0.28） mg,低于UACS组和PIC组[分别为（1.80±0.64）和（1.20±0.80） mg],差异均有统计学意义（均P＜0.01）.CVA组的诱导痰EOS比例均＞3％,UACS和PIC组均＜3％.FeNO与痰EOS比例呈正相关（r=0.687,P=0.000）.结论 不同病因儿童慢性咳嗽气道高反应的严重程度和持续时间不同,气道激发试验结合诱导痰对慢性咳嗽病因诊断有重要价值.
Objective To study the characteristics of airway hyperresponsiveness in children with different causes of chronic cough.Methods A prospective study was conducted in children suffering from chronic cough caused by a single reason at the department of respirology of Children＇ s Hospital of Soochow University from April 2012 to December 2013.Bronchial provocation test,induced sputum eosinophil count,and exhale nitric oxide were detected at beginning and 4 weeks later.The severity of the CVA was classified according to the integral dose of histamine which resulted in a 20％ （PD20） fall in forced expiratory volume in 1 s （FEV1）.All patients received treatment according to the recommended guidelines for chronic cough in children of China.According to the responses to the treatment and the results of physical examinations and laboratory findings,a final diagnosis was confirmed.Results A total of 66 children were enrolled in this study,including cough variant asthma （CVA） in 17,upper airway cough syndrome （UACS） in 37,and post infection cough （PIC） in 12 cases.Positive AHR in CVA,UACS,and PIC groups was found in 17,13,and 9 cases respectively at the first visit,and after 4 weeks,it was found in 17,5,and 2 cases respectively.The severity of AHR in CVA,UACS and PIC at beginning and after 4 weeks were moderate to severe in 5,0,0 cases and 1,0,0 case; Mild to very mild in 12,13,9 cases and 16,5,2 cases.Negative response was found in 0,24,3 cases and 0,32,10 cases,respectively.The values of PD20 in CVA group（0.47 ± 0.28） mg were statistically lower those in UACS group （1.8 ± 0.64） mg and PIC group （1.2 ± 0.80） mg （P ＜ 0.01）.The sputum eosinophil count was ＞ 3％ in all cases of CVA but all ＜3％ in UACS and PIC.FeNO and sputum eosinophil counts were positively correlated （r =0.687,P =0.000）.Conclusion The characteristics of airway responsiveness of chronic cough caused by different causes were varied in different AHR severity and course.Bronchial provocation test combined with induced sputum showed certain values for confirming the cause of chronic cough in children.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2015年第1期55-58,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
咳嗽
支气管高反应性
病因
儿童
Cough
Bronchial hyperresponsiveness
Causes
Child
