不同年龄段儿童慢性咳嗽的病因构成及影响因素

Etiology and influencing factors of chronic cough in children of different ages

目的调查不同年龄段儿童慢性咳嗽的病因构成及影响因素。方法选取2016年6月至2018年12月本院儿科收治的慢性咳嗽患儿364例为研究组,有咳嗽症状但非慢性咳嗽的患儿224例为对照组,调查分析两组患儿过敏史、烟草暴露、房屋异味等慢性咳嗽的可能影响因素。将慢性咳嗽患儿分为婴儿组(<1岁)36例,幼儿组(≥1~<3岁)124例,学龄前组(≥3~<6岁)116例,学龄组(≥6岁)88例,分析各年龄段的病因构成和感染病原学特征。结果研究组患儿过敏史、烟草暴露、房屋异味、空气污染、接触动物皮毛、呼吸道疾病住院史的发生率明显高于对照组,差异均有统计学意义(均P<0.05)。不同年龄段慢性咳嗽患儿的病因构成之间差异均有统计学意义(均P<0.05)。不同年龄段慢性咳嗽患儿病原菌均以肺炎链球菌、肺炎克雷伯菌、流感嗜血杆菌为主,但不同年龄段慢性咳嗽患儿感染病原菌构成之间比较差异有统计学意义(P<0.05),随着年龄增长细菌感染率明显下降。不同年龄段慢性咳嗽患儿肺炎支原体和衣原体感染阳性率之间差异有统计学意义(P<0.05),随着年龄增长患儿肺炎支原体和衣原体感染率明显增加。咳嗽变异性哮喘患儿82例,初诊确诊40例,诊断性治疗确诊42例,随访发现:痊愈56例、有效20例、无效6例。呼吸道感染及感染后咳嗽106例,初诊确诊64例,诊断性治疗确诊42例,随访发现:痊愈84例、有效14例、无效8例。上气道咳嗽综合征患儿72例,初诊确诊38例,诊断性治疗确诊34例,随访发现:痊愈52例、有效16例、无效4例。结论过敏史、烟草暴露、房屋异味、空气污染、接触动物皮毛、呼吸道疾病住院史是儿童慢性咳嗽的危险因素;不同年龄段儿童慢性咳嗽病因构成,以及细菌、肺炎支原体和衣原体感染间有明显差异,应给予针对性防治措施。

Objective To explore the causes and influencing factors of chronic cough in children of different ages.Methods 364 children with chronic cough admitted to pediatrics department of our hospital from June 2016 to 2018 were selected as the study group, 224 children with cough symptoms but not chronic cough as the control group. The possible influencing factors of chronic cough such as allergic history, tobacco exposure and house odor were investigated and analyzed. The children with chronic cough were further divided into infant group (< 1 year old) 36 cases, infant group (> 1-3 years old) 124 cases, preschool group (>3-6 years old) 1 16 cases and school age group (>6 years old) 88 cases. The etiological composition and infectious etiology characteristics of each age group were analyzed.Results The incidence of allergic history, tobacco exposure, house odor, air pollution , exposure to animal fur and respiratory diseases in the study group was significantly higher than that in the control group ( P<0.05). There were significant differences in the etiology of chronic cough arnong children of different age groups ( P<0.05);respiratory tract infection accounted for 50.00% in infant group, 35.48% in infant group, 39.66% in preschool group and 38.64% in upper airway cough syndrome in school age group. There was significant difference in pathogenic bacteria composition among children with chronic cough in different age groups ( P< 0.05), and the infection rate decreased significantly with the increase of age. The positive rates of mycoplasma pneumoniae and chlamydia pneumoniae infection in children with chronic cough in different age groups were significantly different ( P< 0.05 ), and the infection rate increased with age.There were 82 cases of cough variant asthma, 40 cases of newly diagnosed cough variant asthma and 42 cases of diagnostic treatment ,56 cases were cured, 20 cases were effective and 6 cases were ineffective. 106 cases of respiratory tract infection and cough after infection ,64 cases of newly diagrosed diagnosis. 42 cases of diagnostic treatment, follow up found, that 84 casese were cured, 14 case were effective and 8 cases were in eflective. Of the 72 children with upper air way cough syndrome, 72 cases were dignosed in the first diagnosis, 38 cases were diagnosed by the diagnosis and the follow-up was found, 52 case recovered, 16 cases were effective and 4 cases were invalid. Conclusion Allergy history, tobacco exposure, house odor, air pollution, exposure to animal fur and hospitalization history of respiratory diseases are risk factors for chronic cough in children. There are significant differences in etiological components of chronic cough among children of different ages, as well as bacterial, Mycoplasma pneumoniae and Chlamydia infections. Targeted prevention and control measures should be taken.