CAJ | 학술논문

目的观察儿童咳嗽变异性哮喘(CVA)患者气道高反应(AHR)的动态变化.方法纳入2012年4月至2013年3月因慢性咳嗽至苏州大学附属儿童医院呼吸科就诊且明确诊断为CVA的患儿,采用支气管激发试验(BPT)测得第一秒用力呼气量(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,并进行对应治疗,于初诊及治疗后1、6个月随访AHR的变化.结果共纳入患儿36例,其中单纯CVA者14例,CVA合并上气道咳嗽综合征(UACS) 22例.单纯CVA组PD20值低于CVA+ UACS组[(0.46±0.26)比(0.58±0.34) mg],但差异无统计学意义(t=-0.880,P=0.394).AHR初诊时:中度8例、轻度21例、极轻度5例;治疗1个月后:中度1例、轻度28例、极轻度7例;治疗6个月后:中度2例、轻度20例、极轻度7例、阴性者4例,发展为哮喘3例,失访3例.咳嗽严重程度与PD20无显著相关性(r=-0.086,P=0.514).结论 CVA患儿的AHR分级以极轻及轻度为主,治疗后初期AHR下降较快,转阴和发展为典型哮喘比例较低.
목적 관찰인동해수변이성효천(CVA)환자기도고반응(AHR)적동태변화.방법 납입2012년4월지2013년3월인만성해수지소주대학부속인동의원호흡과취진차명학진단위CVA적환인,채용지기관격발시험(BPT)측득제일초용력호기량(FEV1)하강20％시조직알루계제량(PD20),의거PD20장AHR엄중정도분위중도、중도、경도、겁경도4급,병진행대응치료,우초진급치료후1、6개월수방AHR적변화.결과 공납입환인36례,기중단순CVA자14례,CVA합병상기도해수종합정(UACS) 22례.단순CVA조PD20치저우CVA+ UACS조[(0.46±0.26)비(0.58±0.34) mg],단차이무통계학의의(t=-0.880,P=0.394).AHR초진시:중도8례、경도21례、겁경도5례;치료1개월후:중도1례、경도28례、겁경도7례;치료6개월후:중도2례、경도20례、겁경도7례、음성자4례,발전위효천3례,실방3례.해수엄중정도여PD20무현저상관성(r=-0.086,P=0.514).결론 CVA환인적AHR분급이겁경급경도위주,치료후초기AHR하강교쾌,전음화발전위전형효천비례교저.
Objective To explore the dynamic changes of airway hyperresponsiveness (AHR) in children with cough variant asthma (CVA).Methods A prospective observational study was conducted at the Children's Hospital of Soochow University from April 2012 to March 2013.A total of 36 patients were diagnosed as CVA.According to the integral dose of histamine resulting in a 20％ (PD20) fall in forced expiratory volume in 1 s (FEV1),the severity of CVA was graded.Corresponding treatment was administered and the dynamic changes of airway hyperresponsiveness were followed for 0,1 and 6 months.Results Among them,14 patients suffered from CVA only while another 22 cases had CVA plus upper airway cough syndrome (UACS).PD20 of CVA and CVA + UACS groups were (0.46 ± 0.26) and (0.58 ± 0.34) mg respectively.No statistically significance existed between two groups (t =-0.880,P ＞ 0.05).According to the value of PD20,AHR in CVA patients was classified into four degrees of severe,moderate,mild and very mild.Initially there were moderate (n =8),mild (n =21) and very mild (n =5).At 1 month follow-up,moderate (n =1),mild (n =28) and borderline (n =7) ; At 6 month,moderate (n =2),mild (n =20) and very mild (n =7).And 4 cases turned negative and another 3 cases became lost.Cough symptom score and PD20 showed no significant correlation (r =-0.086,P ＞ 0.05).Conclusions AHR in CVA patients is predominantly mild and very mild.And it decreases rapidly mostly during initial treatment phase.The proportion of conversion from CVA into negative and typical bronchial asthma is relatively low.