儿童腺样体肥大和腺样体炎所致上气道咳嗽综合征的临床特点探讨  

Analysis of upper airway cough syndrome caused by adenoidal hypertrophy and adenoiditis in children

作　　者：谷庆隆[1] 高帆[1] 陈育智[2] 庞冲[1] 刘晨[1] 陆颖霞[1] 黄春雷[1] 赵晶[1] 

机构地区：[1]首都儿科研究所附属儿童医院耳鼻咽喉科,北京100020 [2]首都儿科研究所哮喘防治与教育中心

出　　处：《中国中西医结合耳鼻咽喉科杂志》2011年第5期343-346,348,共5页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的了解儿童腺样体肥大和腺样体炎所致上气道咳嗽综合征（UACS）的临床特点和诊断要点。方法从哮喘中心转到耳鼻咽喉科会诊的慢性咳嗽患儿中，对确诊为UACS的患儿进行研究，分析UACS患儿中腺样体肥大和腺样体炎的临床特点。结果238例患儿中，诊断为UACS患儿有149例，其中88例（59．1％）患儿伴有腺样体肥大或炎症，包括腺样体肥大67例和慢性腺样体炎21例。对伴腺样体肥大和伴腺样体炎的UACS各种临床表现进行比较，鼻炎相关症状和口咽腔可见脓性分泌物在伴腺样体肥大的UACS患儿中发生率较高（X2值分别为32．71和17．08，P值均小于0．01）。体位变化咳嗽对诊断伴腺样体肥大的UACS以及伴腺样体炎的UACS敏感度（分别为80．6％和76．2％）、特异度（分别为63．2％＊1153．5％）以及阴性预测值（分别为89．3％＊1195．9％）都较高，但阳性预测值较低（分别为46．2％和13．7％）。睡眠打鼾、鼻炎相关症状以及口咽腔见脓性分泌物倒流对诊断伴腺样体肥大UACS的敏感度（分别为67．2％、82．1％和61．2％）和阴性预测值（分别为87．8％、86．2％和83．2％）均较高，并且睡眠打鼾的特异度亦较高（92．4％）。结论UACS患儿中以腺样体肥大和腺样体炎为病因的比例较高，并且易于漏诊，体位变化性咳嗽对诊断有较高的敏感性和特异性。Objective To understand the clinical characteristics and diagnostic points of upper airway cough syndrome （UACS） caused by adenoidal hypertrophy and adenoiditis in children. Method We analyzed the clinical characteristics of the patients with adenoidal hyertrotrophy and adenoiditis in the children with UACS, who were transferred from the asthma center to consult. Results Among 238 cases, 149 patients were diagnosed as UACS, in which 88 cases （59.1%） were associated with adenoidal hypertrophy or adenoiditis. Among the 88 cases, there were 67 cases with adenoid hypertrophy and 21 cases with adenoiditis. To compare the clinical characteristics, the risk of rhinitis-related symptoms and purulent discharge in pharyngo-oral cavity in UACS children with adenoidal hypertrophy was higher than that in UACS children with adenoiditis （L,2=32.71 and 17.08, P〈0.01, respectively）. For diagnosing UACS with adenoid hypertrophy or adenoiditis, cough with postural variations had high sensitivity （80.6% and 76.2%, respectively）, specificity （63.2% and 53.5%, respectively） and negative predictive value （89.3% and 95.9%, respectively）, but the positive predictive value （46.2% and 13.7%, respectively） was lower. Snoring, rhinitis-related symptoms and purulent discharge in pharyngo-oral cavity had high sensitivity （67.2%, 82.1% and 61.2%, respectively） and negative predictive value （87.8%, 86.2% and 83.2%, respectively） in diagnosing UACS with adenoid hypertrophy, in addition snoring also had high specificity （92.4%）. Conclusion The adenoid disorders accounted for the high risk of UACS and most likely to be easily missed. Cough associated with postural variations had high sensitivity and specificity in diagnosing UACS with adenoid hypertrophy and adenoiditis.

关 键 词：腺样体肥大 腺样体炎 咳嗽 上气道咳嗽综合征 

分 类 号：R765[医药卫生—耳鼻咽喉科]