误诊为慢性咽炎的小儿咳嗽变异型哮喘临床分析  

Clinical Analysis of Children with Cough Variant Asthma Misdiagnosed as Chronic Pharyngitis

作　　者：周杏 骆京津 ZHOU Xing;LUO Jing-jin(Department of Pediatrics,Jiangbei Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing 210044,China)

机构地区：[1]东南大学附属中大医院江北院区儿科,南京210044

出　　处：《临床误诊误治》2023年第2期27-29,40,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨小儿咳嗽变异型哮喘(CVA)的临床特点、误诊为慢性咽炎的原因及防范误诊的措施。方法回顾性分析2019年3月-2022年3月收治5例被误诊为慢性咽炎的CVA患儿病例资料。结果本组3例因慢性咳嗽持续3个月~2.5年,复发1周入院治疗;2例以0.5~3.0年慢性咳嗽入院治疗。5例根据症状、体征及实验室检查均误诊为慢性咽炎,误诊时间1~15(7.43±1.62)个月。接受针对慢性咽炎的综合治疗后,效果不佳,进一步完善相关检查(支气管激发及舒张试验、皮肤变应原试验、肺功能检查),追问患儿的既往史(过敏史、哮喘家族史),并结合诱发病因、咳嗽的特点及相关检查结果,最终确诊为CVA。给予对症支持治疗(沙丁胺醇、氯雷他定、布地奈德、特布他林)后,患儿病情转归良好。结论CVA缺乏特异性的临床症状及影像学特征,容易被误诊为慢性咽炎。应该提高临床医师对CVA的鉴别诊断能力,详细询问病史,完善相关检查,扩散临床思维,减少CVA误诊或漏诊发生。Objective To investigate the clinical characteristics of cough variant asthma(CVA)in children,the causes of misdiagnosis as chronic pharyngitis and the measures to prevent misdiagnosis.Methods Retrospective analysis was performed on the case data of 5 children with CVA who were misdiagnosed as chronic pharyngitis from March 2019 to March 2022.Results In this group,3 patients were hospitalized due to chronic cough lasting from 3 months to 2.5 years and relapsed for 1 week.Two patients were hospitalized with chronic cough for 0.5 to 3.0 years.Five cases were misdiagnosed as chronic pharyngitis according to symptoms,signs and laboratory examination,and the duration of misdiagnosis was 1-15(7.43±1.62)months.After receiving comprehensive treatment for chronic pharyngitis,the effect was far from satisfactory.Relevant examinations(bronchial excitation and diastole test,skin allergen test,lung function test)were further improved,and the previous history(allergy history,family history of asthma)of the child was inquired,and combined with the inducing cause,cough characteristics and relevant examination results,CVA was finally diagnosed.Symptomatic supportive therapy(Salbutamol,Loratadine,Budesonide,Terbutaline)was given,and the patient made a good recovery.Conclusion CVA is more likely to be misdiagnosed as chronic pharyngitis due to its lack of specific clinical symptoms and imaging features.Clinicians should improve their ability to differentiate and diagnose CVA,inquire about the medical history in detail,perform relevant examinations,and expand clinical thinking,to reduce the occurrence of misdiagnosis or missed diagnosis of CVA.

关 键 词：咳嗽变异型哮喘 儿童 误诊 慢性咽炎 

分 类 号：R725.6[医药卫生—儿科]