温州地区儿童慢性咳嗽病因构成比研究

Analysis on causes of non-specific cough in children in Wenzhou area

目的分析温州地区慢性咳嗽患儿的常见病因分布,为临床诊治提供依据。方法选取2008年1月至2010年12月温州医学院附属育英儿童医院呼吸科门诊就诊的慢性咳嗽初诊患儿,依据年龄分为～3岁、～6岁和～14岁组,在初诊后2周、1个月和3个月门诊或电话随访,根据随访治疗效果得出最终诊断结果。分析各病因的构成比,初诊和最终诊断的符合率。结果研究期间共纳入739例慢性咳嗽患儿,年龄8个月至14岁,其中～3岁组174例(23.5%),～6岁组288例(39.0%),～14岁组277例(37.5%)。咳嗽病程4周至5年。1～4季度分别纳入103例(13.9%)、247例(33.4%)、96例(13.0%)和293例(39.7%)。①739例慢性咳嗽患儿中,单病因680例(92.0%),单病因依次为上气道咳嗽综合征237例(32.1%),咳嗽变异性哮喘219例(29.6%),感染后咳嗽109例(14.8%),变应性咳嗽76例(10.3%),心因性咳嗽25例(3.4%),胃食管反流性咳嗽9例(1.2%),其他5例(0.7%);双病因45例(6.1%);病因不明14例(1.9%)。②～3岁组最常见病因为感染后咳嗽(58例,33.3%),～6岁组为上气道咳嗽综合征(114例,39.6%),～14岁组为咳嗽变异性哮喘(103例,37.2%),上述3种主要病因的各年龄组构成比差异有统计学意义(P<0.05)。③上气道咳嗽综合征、咳嗽变异性哮喘、感染后咳嗽、变应性咳嗽、心因性咳嗽和胃食管反流性咳嗽所致慢性咳嗽共675例,其中496例初诊和最终诊断相符,初诊准确率为73.5%。结论温州地区儿童慢性咳嗽主要病因为上气道咳嗽综合征、咳嗽变异性哮喘、感染后咳嗽和变应性咳嗽;不同年龄组儿童慢性咳嗽的病因构成比有所不同。

Objectives To investigate the distribution of causes of chronic cough in children in Wenzhou area, and to explore the potentially existed considerable issues in diagnosis. Methods A prospective observational study was conducted in Yuying Children＇s Hospital from Jan. 2008 to Dec. 2010. Patients presented to pediatric respiratory clinic with cough over 4 weeks were diagnosed and treated prospectively and procedurally. Follow-up was conducted by clinical interview or by telephone 2 weeks,1 month and 3 months after the first clinic visit. The final diagnosis and treatment were adjusted according to the follow-up results. Results During the study period, totally 739 children with chronic cough were enrolled aged 8 months to 14 years old, including 174 cases （23.5%） aged 0-3 years,288 cases（39%） aged -6 years ,277 cases（37.5%） aged -14 years. The duration of chronic cough ranged from 4 weeks to 5 years. In the first-quarter of the year, there were 103 cases （13.9%）, followed with second-quarter 247 cases （33.4%）, third-quarter 96 cases （13.0%） and fourth-quarter 293 cases （39.7%）. Finally, 680 cases（92.0%） were found with single cause, 45（6.1%） with double causes, 14 （1.9%） with unidentified causes. Main causes of chronic cough were upper airway cough syndrome （n=237, 32.1%）, cough variant asthma （n=219, 29.6%）, post infection cough （n=109, 14.8%）, atopic cough （n=76, 10.3%）, psychogenic cough （n=25, 3.4%）, chronic cough due to gastroesophageal reflux （GERC）（n=9, 1.2%） and other causes （n=5, 0.7%）. The proportions of causes differed among age groups （P0.05）. The most common causes in children aged -3 years,-6 years and -14 years were post infection cough （n=58, 33.3%）, upper airways cough syndrome （n=114, 28.5%） and cough variant asthma （n=103, 37.2%）. Totally 675 cases were caused by the top 6 causes, 496 of them with the same initial and final diagnosis, the match ratio was 73.5%. Conclusions The main causes of chronic cough in children in Wenzhou were upper airway cough syndrome,cough variant asthma, post infection cough and atopic cough. The etiologic constituent ratio differed with age.