【作者】 王璐；

【导师】 崔振泽；

【作者基本信息】 大连医科大学 ， 儿科学（专业学位）， 2019， 硕士

【摘要】 目的:了解儿童慢性咳嗽常见病因分布情况,慢性咳嗽常见病因与血及气道炎症因子水平的关系,观察血清白三烯及呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)相关性;以期为儿童慢性咳嗽诊断、鉴别诊断及治疗提供依据。方法:采用回顾性研究的方法,选取2012年12月-2017年12月在大连市儿童医院慢咳门诊就诊的符合慢性咳嗽诊断的患儿,根据常见病因学诊断分组,排除有先天性呼吸道疾病、先天性心脏病、依从性较差的患儿,按照病例收集表格的内容,详细记录他们的编号、姓名、年龄、个人过敏史、家族过敏史等,记录血清白三烯、呼出气一氧化氮(FeNO)及总IgE数值,对慢性咳嗽常见病因及上述指标进行分析总结。结果:1.在符合纳入标准的有170例慢性咳嗽患儿中,常见病因有上气道咳嗽综合征(UACS)、感染后咳嗽(PIC)、咳嗽变异性哮喘(CVA)及胃食管反流性咳嗽(GERC),其中单一病因124例,占72.94%;二重病因44例,占25.89%;三重病因2例,占1.17%。2.在符合纳入标准的170例慢性咳嗽患儿中,共获得病因216例次,其中UACS有92例次,占42.59%,PIC有67例次,占31.02%,CVA有53例次,占24.54%,GERC有4例次,占1.85%,以UACS组最高。3.在符合纳入标准的216例次病因诊断中,根据年龄段分组,0～1岁组7例次,占3.24%,～3岁组38例次,占17.59%,～6岁组142例次,占65.74%,～14岁29例次,占13.43%;不同年龄段常见病因不同,在0～1岁组主要病因为GERC,占57.14%,;～3岁组主要病因为PIC,占42.11%;～6岁组及～14岁组主要病因均为UACS,分别占47.89%和55.17%。4.在符合纳入标准的212例次病因诊断中,个人过敏史阳性的81例次,阳性率为38.21%;家族过敏史阳性的有56例次,阳性率为26.42%;212例次病因诊断中,有148例次完成总IgE的检测,总IgE阳性的有97例次,异常率为66.22%。在慢性咳嗽常见病因诊断中,CVA组、PIC组、UACS组患儿个人过敏史阳性率分别为:58.49%、31.52%和31.87%,三组阳性率比较,?2=12.314,P<0.05,有统计学意义;三组患儿的的家族过敏史阳性率分别为:39.62%、22.39%和21.74%,三组阳性率比较,?2=6.350,P<0.05,有统计学意义;CVA组、PIC组、UACS组患儿总IgE的阳性率分别为:85.37%、53.19%和61.67%,三组阳性率比较,?2=10.707,P<0.05,有统计学意义。5.在符合纳入标准的212例次病因诊断中,有159例次完成血清白三烯检测,升高的有100例次,异常率为62.89%;CVA组、PIC组及UACS组血清白三烯的阳性率依次为:62.86%、70.91%和56.52%,三组阳性率比较,?2=2.764,P>0.05,差异无统计学意义;在符合纳入标准的212例次病因诊断中,有192例次完成FeNO检测,升高的有81例次,异常率为42.19%,CVA组、PIC组、UACS组FeNO阳性率依次为:65.91%、32.79%、36.78%,三组阳性率比较,?2=13.404,P<0.05,差异有统计学意义。6.在符合纳入标准的212例次病因诊断中,有123例次同时完成血清白三烯及FeNO检测,经Spearman相关性分析,P>0.05,两种监测方法不具有相关性。结论:1.慢性咳嗽常见病因以单一病因为主,最为常见的是UACS、PIC及CVA,高发年龄段为3-6岁。2.较之UACS及PIC组,CVA组患儿个人、家族过敏史及总IgE阳性率最高。3.CVA、PIC及UACS患儿血及气道的炎症因子水平均有不同程度的升高,在CVA组中,60%以上患儿血及气道炎症因子水平升高,阳性率最高。4.血清白三烯及FeNO检测在监测慢性咳嗽常见病因的炎症因子水平时均有重要作用,但评价角度不同,两种监测方法不具有相关性,不能相互替代。更多还原

【Abstract】 Objective: To understand the common etiology of chronic cough in children,the relationship between common causes of chronic cough and the levels of blood and airway inflammatory factors,and to observe the correlation between blood leukotrienes and fractional exhaled nitric oxide(FeNO);Provide a basis for cough diagnosis,differential diagnosis and treatment.Methods:A retrospective study was conducted to select children diagnosed with chronic cough in the Dalian children’s Hospital from December 2012 to December 2017.According to the common etiology diagnosis group,children with congenital respiratory diseases,sexual heart disease and poor compliance were excluded.According to the contents of the case collection form,their number,name,age,personal allergy history,family history of allergies,etc.were registered,the levels of FeNO,serum leukotrienesand serum total IgE were recorded,the common causes of chronic cough and the above indicators were analyzed and summarized.Result:1.Among the 170 children with chronic cough who met the inclusion criteria,UACS,PIC,CVA and GERC were common causes,124 cases with single cause,accounting for 72.94%;44 cases with double cause,accounting for 25.89%;2 cases with triple cause,accounted for 1.17%.2.Among the 170 children with chronic cough who met the inclusion criteria,216 cases were obtained,of which 92 cases were UACS,accounting for 42.59%,67 cases were PIC,accounting for 31.02%,and 53 cases were CVA,accounting for 24.54%.GERC had 4 cases,accounting for 1.85%,the highest cases were in the UACS group.3.Among the 216 cases of etiological diagnosis that met the inclusion criteria,according to the age group,7 cases were in the 0～1 year old group,accounting for3.24%,38 cases in the ～3 year old group,accounting for 17.59%,and 142 cases in the～6 year old group,accoutin for 65.74%,～14 years old 29 cases,accounting for 13.43%;The common causes of different age groups are different.In the 0～1 year old group,the main causeswere GERC,accounting for 57.14%,the main causes of the ～3 year old group were PIC,accounting for 42.11% and in the ～6 year old group and the ～14 year old group were UACS,accounting for 47.89% and 55.17% respectively.4.Among the 212 etiology diagnoses that met the inclusion criteria,81 cases were positive for personal allergy history,the positive rate was 38.21%;56 cases were positive for family allergy history,the positive rate was 26.42%;212 cases of etiological diagnosis,there were 148 cases of total IgE,and 97 cases of total IgE were positive,with an abnormal rate of 66.22%.In the common etiology of chronic cough,the positive rates of personal allergy history in children in CVA group,PIC group and UACS group were: 58.49%,31.52% and 31.87%,?2=12.314,P<0.05,the difference was statistically significant;The positive rates of family allergy history in the group were 39.62%,22.39%,and 21.74%,?2=6.350,P<0.05,which was statistically significant.Total IgE in children in CVA,PIC,and UACS groups the positive rates were 85.37%,53.19%,and61.67%,and ?2=10.707,P<0.05,which was statistically significant.5.Among the 212 etiology diagnoses that met the inclusion criteria,159 cases completed serum leukotriene test,100 cases increased,the abnormal rate was 62.89%;serum leukotrienes in CVA group,PIC group and UACS group The positive rates were:62.86%,70.91% and 56.52%.Compared with the positive rates of the three groups,? 2=2.764,P>0.05,the difference was not statistically significant.Among the 212 etiology diagnoses that met the inclusion criteria,192 cases completed the FeNO test,81 cases were increased,and the abnormal rate was 42.19%.The positive rates of FeNO in CVA group,PIC group and UACS group were 65.91%,32.79% and 36.78%,compared the positive rates of the three groups,?2=13.404,P<0.05,the difference wasstatistically significant.6.Among the 212 etiology diagnoses that met the inclusion criteria,123 were completed simultaneously with serum leukotrienes and FeNO.After Spearman correlation analysis,P>0.05,the two monitoring methods were not relevant.Conclusion:1.The common cause of chronic cough is single disease,the most common are UACS,PIC and CVA,and the high age group is 3-6 years old.2.Compared with the UACS and PIC groups,the CVA group had the highest personal,family allergic history and total IgE positive rate.3.The levels of inflammatory factors in blood and airways of children with CVA,PIC and UACS increased to varying degrees.In the CVA group,more than 60% of children had elevated levels of blood and airway inflammatory factors,with the highest positive rate.4.Serum leukotrienes and FeNO play an important role in monitoring the levels of inflammatory factors in the common causes of chronic cough,but the evaluation angles are different.The two monitoring methods are not relevant and cannot be replaced.更多还原