目的：研究儿童慢性咳嗽的病因。方法：对2010年8月至2011年9月132例慢性咳嗽患儿的临床资料进行回顾性分析，调查慢性咳嗽的病因构成。结果：咳嗽变异性哮喘是慢性咳嗽最常见的病因（56例次），其次为上气道咳嗽综合征（44例次）、感染/感染后咳嗽（22例次）、变应性咳嗽（8例次）、胃食管反流性咳嗽（5例次），3例次为其他病因。感染/感染后咳嗽在婴儿组（<1岁）、幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）间的病因分布差异有统计学意义（χ2=11.638，P=0.001），其中<1岁的婴儿组感染/感染后咳嗽的比例高于其他3个年龄组（P<0.05）。感染/感染后咳嗽是婴儿组（<1岁）慢性咳嗽的主要病因，咳嗽变异性哮喘和上气道咳嗽综合征是幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）慢性咳嗽的主要病因。变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征患儿有较高比例的个人过敏史、不良外界环境接触史以及家族过敏/哮喘史。结论：咳嗽变异性哮喘、上气道咳嗽综合征、感染/感染后咳嗽是儿童慢性咳嗽的主要病因。不同年龄组患儿慢性咳嗽的主要病因不同。具有个人过敏史、不良外界环境接触史以及家族过敏/哮喘史的慢性咳嗽患儿更易患变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征。
Abstract
OBJECTIVE: To study the causes of chronic cough in children. METHODS: Retrospective analysis was carried out on the clinical data of 132 children with chronic cough from August 2010 to September 2011. RESULTS: Several conditions were found to contribute to chronic cough in children, including cough variant asthma (CVA, n=56), upper airway cough syndrome (UACS, n=44), infections/postinfectious cough (IC/PIC, n=22), allergic cough (AC, n=8), gastroesophageal reflux cough (GERC, n=5), and others (n=3). There was significant difference in the distribution of IC/IPC among an infant group (1 year), a group of preschool aged children (>3 years) and a group of school-age children (6-14 years) (χ2=11.638, P=0.001), and the infant group showed a significantly higher prevalence of IC/PIC than the other three age groups (P<0.05). IC/PIC was the main cause of chronic cough in the infant group, while CVA and UACS were the main causes in each of the other groups. A relatively large proportion of AC, CVA and UACS cases had a personal history of allergy, a family history of allergy/asthma and a history of exposure to harmful environments. CONCLUSIONS: CVA, UACS, and IC/PIC are main causes of chronic cough in children, varying among different age groups. Children with a personal history of allergy, family history of allergy/asthma and a history of exposure to harmful environment are more vulnerable to AC, CVA and UACS.
关键词
慢性咳嗽 /
病因 /
儿童
Key words
Chronic cough /
Etiology /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
［1］任慈芳, 张灵恩. 小儿慢性咳嗽的诊断思路［J］. 中国实用儿科杂志, 2004, 19(12): 717-719.
［2］Chang AB, Berkowitz RG. Cough in the pediatric population［J］. Otolaryngol Clin North Am, 2010, 43(1): 181-198.
［3］Leonardi GS, Houthuijs D, Nikiforov B, Volf J, Rudnai P, Zejda J, et al. Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe［J］. Eur Respir J, 2002, 20(4): 890-898.
［4］中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会. 儿童慢性咳嗽诊断与治疗指南(试行)［J］. 中华儿科杂志, 2008, 46(2): 104-107.
［5］Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough［J］. Lancet, 2008, 371(9621): 1364-1374.
［6］Nakajima T, Nishimura Y, Nishiuma T, Kotani Y, Nakata H, Yokoyama M. Cough sensitivity in pure cough variant asthma elicited using continuous capsaicin inhalation［J］. Allergol Int, 2006, 55(2): 149-155.
［7］中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南［J］．中华儿科杂志, 2008, 46(10): 745-753.
［8］Chang AB, Asher MI. A review of cough in children［J］. J Asthma, 2001, 38(4): 299-309.
［9］严永东, 黄莉, 季伟.鼻后滴漏综合征引起儿童慢性咳嗽的临床分析［J］. 中国当代儿科杂志, 2008, 10(1): 790-780.
［10］张海邻. 儿童慢性咳嗽诊治进展［J］. 中华儿科杂志, 2008, 46(1)：41-44.
［11］Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough［J］. Chest, 2006, 129(5): 1132-1141.
［12］陈志敏.小儿慢性咳嗽诊治中的若干问题［J］. 中华儿科杂志, 2008, 46(12): 939-941.
［13］Niimi A, Matsumoto H, Mishima M. Eosinophilic airway disorders associated with chronic cough［J］. Pulm Pharmacol Ther, 2009, 22(2): 114-120.
［14］McGarvey L, Morice AH. Atopic cough: little evidence to support a new clinical entily［J］. Thorax, 2003, 58(8): 736-737.
［15］Fujimura M, Ogawa H, Nishizawa Y, Nishi K. Comparison of atopic cough with cough variant asthma: is atopic cough a precursor of asthma?［J］. Thorax, 2003, 58(1): 14-18.
［16］Thomson F, Masters IB, Chang AB. Persistent cough in children and the overuse of medications［J］. J Paediatr Child Health, 2002, 38(6): 578-581.
［17］刘峰, 江米足, 周雪莲, 余金丹. 小儿慢性咳嗽与胃食管返流的关系［J］. 临床儿科杂志, 2007, 25(6): 442-444.
［18］Gilger MA. Pediatric otolaryngologic manifestations of gastroesophageal reflux disease［J］. Curr Gastroenterol Rep, 2003, 5(3): 247-252.
PDF(893 KB)
