福建省福州地区儿童慢性咳嗽病因分析

Etiological analysis of the children with non-specific chronic cough in Fuzhou area of Fujian provinc

目的 探讨福建省福州地区儿童慢性咳嗽的病因.方法 根据中华医学会儿科学分会呼吸学组与〈中华儿科杂志〉编辑委员会2008年制定的〈儿童慢性咳嗽诊断与治疗指南〉的标准,对福建省福州儿童医院哮喘专科门诊诊断的364例慢性咳嗽患儿,按照指南的诊断流程询问病史,进行体检、辅助检查,初步确定病因后,并针对病因进行特异性治疗,分别在初诊后半个月、1个月、3个月对患儿进行随访,根据辅助检查及疗效判定病因诊断,进而分析病因构成比.结果 364例慢性咳嗽患儿病因依次为：咳嗽变异性哮喘171例（47.0%）,上气道咳嗽综合征104例（28.6%）,呼吸道感染和感染后咳嗽58例（15.9%）,胃食管反流17例（4.7%）,支气管异物3例（0.8%）;引起慢性咳嗽只有单一病因的299例（82.1%）,同时有2种病因的56例（15.4%）,同时有3种病因的9例（2.5%）.结论 福建省福州地区儿童慢性咳嗽的病因依次为咳嗽变异性哮喘、上气道咳嗽综合征、呼吸道感染和感染后咳嗽、胃食管反流、支气管异物;不同年龄组儿童慢性咳嗽病因构成比不同;部分患儿合并有2或3种病因,表明儿童慢性咳嗽病因呈多因素.

Objective Chronic cough in children is a common pediatric symptom with complex causes and its diagnosis is difficult; chronic cough affects the life of children in both physical and mental health and also learning. Therefore this study aimed to investigate the causes of chronic cough in children in Fuzhou area of Fujian province. Method Data were collected from 364 children with chronic cough who visited the asthma specialist clinic of Children＇s Hospital of Fuzhou, Fujian Province from March 2009 to April 2010. The diagnosis was made according to Guideline for Diagnosis and Treatment of Chronic Cough in Pediatrics published in 2008. Among the patients, 241 were boys and 123 girls. The patients were divided into 3 age groups： group 1, 1 to 3 years old （ infants and young children group, n =75）; group 2, 4 to 6years old （pre-school group, n =215 ）; and group 3, over 7 years （school-age group, n = 74）, the mean age was （4.8 ± 1.1） years （3 months to 14 years）, course of the illness was （4.5 ± 1.8） months （4 weeks to 38 months ）. Mycoplasma pneumoniae was detected by Enzyme-linked immunosorbent assay （ELISA）. Result The causes of chronic cough were as follows： 171 cases （46. 98% ） had cough variant asthma; 104 cases （ 28.57% ） had upper airway cough syndrome; 58 cases （ 15.93% ） had respiratory infections; 17 cases （4.67% ） had gastroesophageal reflux; 3 cases （0.82% ） had foreign bodies. Totally 9 cases （2.47% ） had chronic cough associated with 3 causes; 56 cases （ 15.38% ） had 2 causes and 299cases （ 82.14% ） had single cause. The main causes of cough in the group of pre-school children were cough variant asthma and upper airway cough syndrome. The proportion of the upper airway cough syndrome in school-age children group was the highest among the 3 age groups, which is flowed by cough variant asthma.Conclusion The causes of chronic cough in children were cough variant asthma, upper airway cough syndrome, respiratory infections, cough after infection, gastroesophageal reflux and foreign bodies in Fuzhou area of Fujian province. Children with chronic cough in different age groups had different etiology, in about 18% of the children the etiology of chronic cough was associated with 3 or 2 causes, indicating that the causes of chronic cough in children are multifactorial