CAJ | 학술논문

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.
목적 연구불동병인인동만성해수적기도고반응성(AHR)특정.방법 납입2012년4월지2013년12월우소주대학부속인동의원호흡과취진병명학위단병인적만성해수환인,채용지기관격발시험측득FEV1하강20％시조직알루계제량(PD20),의거PD20장AHR엄중정도분위중도、중도、경도、겁경도4급,동시측정유도담기산립세포(EOS)계수화호출기일양화담(FeNO)농도,안인동만성해수지남추천방안진행치료,4주후수방,복사상술지표.결과 공납입환인66례,기중해수변이성효천(CVA)17례,상기도해수종합정(UACS) 37례,감염후해수(PIC) 12례.CVA、UACS급PIC조AHR양성초진례수분별위17、13화9례,4주복진시분별위17、5화2례.AHR엄중정도분급,초진시CVA、UACS화PIC조중～중도분별위5、0화0례,경도～겁경도분별위12、13화9례,음성분별위0、24화3례;4주후복진CVA、UACS화PIC조중～중도도분별위1、0화0례,경도～겁경도분별위16、5화2례,음성분별위0、32화10례.CVA조PD20치위(0.47±0.28) mg,저우UACS조화PIC조[분별위(1.80±0.64)화(1.20±0.80) mg],차이균유통계학의의(균P＜0.01).CVA조적유도담EOS비례균＞3％,UACS화PIC조균＜3％.FeNO여담EOS비례정정상관(r=0.687,P=0.000).결론 불동병인인동만성해수기도고반응적엄중정도화지속시간불동,기도격발시험결합유도담대만성해수병인진단유중요개치.
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.