浙江台州地区儿童慢性咳嗽的病因构成和临床特征分析

The spectrum and clinical feature of the children with chronic cough in Taizhou area of Zhejiang province

目的对浙江台州地区儿童慢性咳嗽常见病因构成和临床特征进行研究,为经验性诊治该地区儿童慢性咳嗽提供依据。方法收集2009年2月～2011年8月就诊并有完整资料的慢性咳嗽患儿258例,遵循国内儿童慢性咳嗽诊断与治疗指南作出慢性咳嗽初步诊断并按时随访,作出最终诊断。结果 258例患儿中最终确定病因患儿239例(92.6%),其中单一病因咳嗽患儿204例,占85.4%;二重病因35例,占14.6%。儿童慢性咳嗽的病因构成前四位分别是咳嗽变异性哮喘(CVA)107例(41.5%),呼吸道感染和感染后咳嗽59例(22.9%),CVA合并上气道咳嗽综合征(UACS)35例(13.6%),UACS 31例(12.0%)。幼儿组和学龄前期组患儿均以变异哮喘咳嗽为主,而学龄期儿童组以呼吸道感染和感染后咳嗽为主。CVA的临床特征主要为夜间咳嗽,UACS的临床特征主要为湿痰咳嗽。初诊就能确定病因诊断的比例为57.4%(148/258)。结论浙江台州地区儿童慢性咳嗽的病因依次为咳嗽变异性哮喘、呼吸道感染和感染后咳嗽、CVA+UACS、上气道咳嗽综合征,而且不同年龄组儿童慢性咳嗽的病因构成不同。各种病因的咳嗽具有一定的临床特征,可为经验性诊治儿童慢性咳嗽提供依据。

Objective To explore the spectrum and clinical feature of chronic coughs in children in Taizhou area of Zhe- jiang province. Methods A total of 258 children with chronic coughs were recruited in our study between Feb 2009 to Aug 2011. The diagnosis was made according to Guideline for diagnosis and treatment of chronic cough in Pediatrics published in 2008. After etiological treatment, the patients were followed up and etiological diagnosis was confirmed if cough was re- solved after specific therapy. Results The cause of chronic cough was defined in 239 children （92.6%）, of which 204 （85.4%） patients with single cause and 35 （14.6%） patients with 2 causes. The fist four causes of chronic cough were as follows： 107 cases （41.5%） had cough variant asthma （CVA）; 59 cases （22.9%） had respiratory infections, 35 cases （13.6%） had CVA and upper airway cough syndrome （UACS）, 31 cases （12.0%） had UACS. The main causes of cough in the group of infant and pre-school children were cough variant asthma. The proportion of the respiratory infections in school-age children group was the highest among the 3 age groups. The clinical feature of CVA was nighttime cough, and the clinical feature of UACS was wet phlegm cough. The rate of newly diagnosis will be able to determine the proportion of the etiolog- ical diagnosis was 57.4% （148/258）. Conclusion It is concluded that CVA, post-infection cough, CVA and UACS, and simple UACS were identified as the four top reasons for children with chronic cough in Taizhou area of Zhejiang province. In different age groups, the proportion of incidence of etiological agents is distinct. Various chronic cough have certain clin- ical features, which provide the basis for empirical diagnosis and treatment of children with chronic cough.