儿童咳嗽变异性哮喘患儿气道高反应的动态观察

Dynamic observation of airway high response in children with cough variant asthma

目的观察咳嗽变异性哮喘(CVA)患儿气道高反应(AHR)的动态变化。方法选取2013年1月到2014年12月内在我院呼吸科接受治疗的儿童慢性咳嗽患儿51例,所有患儿进行常规肺功能检查、支气管激发试验和呼出气一氧化氮(Fe NO)检查。对比不同病症患儿临床特征、AHR分级以及随访前后诱导痰和Fe NO及其相关性。结果 CVA患儿第6个月中度分布[6例(11.76%)]比例明显低于初诊时[15例(29.41%)],第6个月极轻度[16例(31.37%)]及阴性分布[7例(13.73%)]比例明显高于初诊时[7例(13.73%)、0例(0.00%),P<0.05);CVA+上气道咳嗽综合征(UACS)组患儿胺累计剂量(PD20)水平显著低于支气管激发试验(BPT)阴性组,中度患儿比例[11例(45.83%)]明显高于BPT阴性组[0例(0.00%)],极轻度患儿比例明显低于BPT阴性组[1例(4.17%)vs 6例(75.00%),P<0.05];CVA+UACS组患儿痰嗜酸性粒细胞(EOS)百分比及Fe NO水平[(0.9±0.1)%、(18±9)]均显著低于CVA组[(6.4±0.8)%、(34±16)],诱导痰EOS和Fe NO存在明显的正相关(r=0.672,P=0.000)。结论 CVA患儿治疗过程中对AHR进行动态观察,可以对CVA的转归进行一定的预测。

Objective To study the dynamic changes of airway high response(AHR) in children with cough variant asthma(CVA). Methods Fifty-one children with chronic cough in our hospital from January 2013 to December2014 were selected, which all received routine pulmonary function test, bronchial provocation test(BPT), and fractional exhaled nitric oxide(Fe NO) examination. The clinical characteristics, AHR grading, and the correlation between Fe NO and the patients with different symptoms of the disease were analyzed. Results Sixth months after treatment, the moderate distribution ratio of CVA children was significantly lower than that at the first visit [6 children(11.76%) vs 15 children(29.41%)], and very mild and negative distribution ratio was significantly higher than that at the first visit [16 children(31.37%) vs 7 children(13.73%), 7 children(13.73%) vs 0 children(0.00%), P<0.05)]. PD20 level in CVA+upper airway cough syndrome(UACS) group was significantly lower than that of BPT negative group, and the proportion of children with moderate BPT was significantly higher than that in BPT negative group [11 children(45.83%) vs 0 children(0.00%)], with the proportion of children with very mild BPT significantly lower than that in BPT negative group [1 children(4.17%) vs 6 children(75.00%), P<0.05]. EOS and Fe NO levels in CVA + UACS group were significantly lower than that in CVA group [(0.9±0.1)% vs(6.4±0.8)%,(18±9) vs(34±16)], and EOS and Fe NO showed a positive correlation(r=0.672,P=0.000). Conclusion Dynamic observation of AHR in the treatment of children with CVA can predict the prognosis of CVA, which is helpful to the development of diagnosis and treatment.