百日咳与非百日咳迁延性慢性咳嗽儿童及青少年临床特征分析

Clinical characteristics of pertussis and no-pertussis in children and adolescents with chronic cough

目的分析迁延性慢性咳嗽儿童及青少年中百日咳与非百日咳患者临床特征。方法将上海、重庆、昆明及银川地区持续咳嗽2周以上、年龄≥6岁的患者分为百日咳组及非百日咳组,比较两组患者咳嗽特征及并发症。百日咳实验室检测采用培养、多重PCR及百日咳鲍特菌特异毒素IgG(PTIgG)检测(ELISA)。结果有1001例患者入组,113例百日咳检查阳性,888例排除百日咳,患病率达11.3%。40.7%百日咳患者表现间歇性阵发性咳嗽,无咳嗽后吼声、呕吐、紫绀及呼吸暂停病例,18.6%合并肺炎。非百日咳患者间歇性阵发性咳嗽比例(29.7%)明显低于百日咳患者(P<0.01)。结论阵发性咳嗽仍是大龄儿童及青少年百日咳患者主要临床表现,咳嗽后出现的典型并发症已少见,仅凭临床表现诊断百日咳可能导致漏诊及延误治疗。

Objective To compare the clinical manifestations and complications of pertussis and no-pertussis in children and adolescents with chronic cough.Methods Subjects aged above 6 years old with chronic cough for more than 2 weeks had been recruited in Shanghai,Chongqing,Kunming,and Yinchuan.Subjects were divided into pertussis and no-pertussis groups according to laboratory test.The laboratory test for identification of B.pertussis included culture,multiplex PCR,and specific toxin antibody of B.pertussis（PTIgG） assay by ELISA.Results A total number of 1 001 subjects were enrolled.Among them,113 subjects were pertussis positive,and 888 subjects were pertussis negative.The positive rate was 11.3%.In pertussis positive group,40.7% subjects had intermittent paroxysmal cough,but no subjects had roaring,vomiting,cyanosis,and apnea.18.6% pertussis positive subjects were complicated with pneumonia.Compared with the pertussis positive group,no-pertussis subjects had a significantly lower rate of intermittent paroxysmal cough（29.7%）（P〈0.01）.Conclusions Paroxysmal cough is the predominant clinical manifestation in older children and adolescents with pertussis,but the typical complications of pertussis are rare.Diagnosis of pertussis by clinical manifestations may lead to a missed diagnosis and delay proper treatment.