儿童咳嗽变异性哮喘患者气道高反应的动态观察  

Study on dynamic changes of airway hyperresponsiveness in children with cough variant asthma

作　　者：于兴梅[1] 朱海艳[1] 杨晓蕴[1] 陆燕红[1] 孙惠泉[1] 范丽萍[1] 陶慧[1] 周菁[1] 罗炜[2] 赖克方[2] 郝创利[1] 

机构地区：[1]苏州大学附属儿童医院呼吸科,215003 [2]广州呼吸疾病研究所

出　　处：《中华医学杂志》2014年第16期1215-1218,共4页National Medical Journal of China

摘　　要：目的 观察儿童咳嗽变异性哮喘（CVA）患者气道高反应（AHR）的动态变化.方法 纳入2012年4月至2013年3月因慢性咳嗽至苏州大学附属儿童医院呼吸科就诊且明确诊断为CVA的患儿,采用支气管激发试验（BPT）测得第一秒用力呼气量（FEV1）下降20％时组织胺累计剂量（PD20）,依据PD20将AHR严重程度分为重度、中度、轻度、极轻度4级,并进行对应治疗,于初诊及治疗后1、6个月随访AHR的变化.结果 共纳入患儿36例,其中单纯CVA者14例,CVA合并上气道咳嗽综合征（UACS） 22例.单纯CVA组PD20值低于CVA＋ UACS组[（0.46±0.26）比（0.58±0.34） mg],但差异无统计学意义（t=-0.880,P=0.394）.AHR初诊时：中度8例、轻度21例、极轻度5例;治疗1个月后：中度1例、轻度28例、极轻度7例;治疗6个月后：中度2例、轻度20例、极轻度7例、阴性者4例,发展为哮喘3例,失访3例.咳嗽严重程度与PD20无显著相关性（r=-0.086,P=0.514）.结论 CVA患儿的AHR分级以极轻及轻度为主,治疗后初期AHR下降较快,转阴和发展为典型哮喘比例较低.Objective To explore the dynamic changes of airway hyperresponsiveness （AHR） in children with cough variant asthma （CVA）.Methods A prospective observational study was conducted at the Children＇s Hospital of Soochow University from April 2012 to March 2013.A total of 36 patients were diagnosed as CVA.According to the integral dose of histamine resulting in a 20％ （PD20） fall in forced expiratory volume in 1 s （FEV1）,the severity of CVA was graded.Corresponding treatment was administered and the dynamic changes of airway hyperresponsiveness were followed for 0,1 and 6 months.Results Among them,14 patients suffered from CVA only while another 22 cases had CVA plus upper airway cough syndrome （UACS）.PD20 of CVA and CVA ＋ UACS groups were （0.46 ± 0.26） and （0.58 ± 0.34） mg respectively.No statistically significance existed between two groups （t =-0.880,P ＞ 0.05）.According to the value of PD20,AHR in CVA patients was classified into four degrees of severe,moderate,mild and very mild.Initially there were moderate （n =8）,mild （n =21） and very mild （n =5）.At 1 month follow-up,moderate （n =1）,mild （n =28） and borderline （n =7） ; At 6 month,moderate （n =2）,mild （n =20） and very mild （n =7）.And 4 cases turned negative and another 3 cases became lost.Cough symptom score and PD20 showed no significant correlation （r =-0.086,P ＞ 0.05）.Conclusions AHR in CVA patients is predominantly mild and very mild.And it decreases rapidly mostly during initial treatment phase.The proportion of conversion from CVA into negative and typical bronchial asthma is relatively low.

关 键 词：哮喘 咳嗽 支气管高反应性 支气管激发试验 儿童 

分 类 号：R725.6[医药卫生—儿科]