山东省儿童百日咳感染与哮喘的相关性  

Correlation between asthma and pertussis infection in children of Shandong Province,China

作　　者：闫金燕 杨春[2] 李雷 吴福玲[4] 焦永莉 张晓蔚 李晶 张瑞珍 王磊[9] 马香[2,10] YAN Jinyan;YANG Chun;LI Lei;WU Fuling;JIAO Yongli;ZHANG Xiaowei;LI Jing;ZHANG Ruizhen;WANG Lei;MA Xiang(Department of Infectious Diseases,Childrens Hospital Affiliated to Shandong University,Jinan 250022,Shandong,China;Jinan Key Laboratory of Pediatric Respiratory Diseases,Childrens Hospital Affiliated to Shandong University,Jinan 250022,Shandong,China;Department of Pediatrics,Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University,Jinan 250001,Shandong,China;Department of Pediatrics,Binzhou Medical University Hospital,Binzhou 256600,Shandong,China;Department of Pediatric,Shizhong District Maternal and Child Health Care Hospital,Zaozhuang 277100,Shandong,China;Department of Pediatrics,Peoples Hospital of Zhangqiu District,Jinan 250200,Shandong,China;Department of Pediatric,Jining Rencheng District Maternal and Child Care Hospital,Jining 272005,Shandong,China;Department of Pediatric,Qihe Maternity and Childrens Health Care Hospital,Dezhou 251100,Shandong,China;Department of Pediatrics,Taian Maternity and Child Health Care Hospital,Taian 271000,Shandong,China;Shandong Provincial Clinical Research Center for Childrens Health and Disease,Jinan Childrens Hospital,Jinan 250022,Shandong,China)

机构地区：[1]山东大学附属儿童医院感染性疾病科,山东济南250022 [2]济南市儿童呼吸病重点实验室,山东大学附属儿童医院,山东济南250022 [3]山东第一医科大学附属济南妇幼保健院儿科,山东济南250001 [4]滨州医学院附属医院儿科,山东滨州256600 [5]枣庄市市中区妇幼保健院儿科,山东枣庄277100 [6]济南市章丘区人民医院儿科,山东济南250200 [7]济宁市任城区妇幼保健院儿科,山东济宁272005 [8]德州市齐河县妇幼保健院儿科,山东德州251100 [9]泰安市妇幼保健院儿科,山东泰安271000 [10]山东省儿童疾病及健康研究中心,济南市儿童医院,山东济南250022

出　　处：《山东大学学报（医学版）》2024年第7期33-41,共9页Journal of Shandong University:Health Sciences

基　　金：济南市卫生健康委科技计划项目(2022-2-163);山东省医药卫生科技项目(202306011027);山东省儿童健康与疾病临床医学研究中心立项项目(SDPRC009);济南市卫生健康委大数据科技计划项目(2022-YBD-1-06,2022-BD-13);济南市临床科技创新项目(202225022)。

摘　　要：目的通过多中心、前瞻性调查,评估不同分期、不同类型哮喘儿童百日咳的感染情况,并分析哮喘与百日咳的相关性。方法通过调查问卷收集因咳嗽持续时间≥1周而就诊的哮喘儿童相关信息,并进行百日咳毒素(pertussis toxin,PT)IgG抗体浓度和/或百日咳核酸检测,对结果进行判读。根据年龄、哮喘分期、是否合并百日咳感染等进行分组,分析不同分组间百日咳抗体分布、感染情况及临床特点等。结果1049例哮喘患儿中,PT-IgG总阳性率为26.22%,其中≥6岁组显著高于3个月~<3岁组和3岁~<6岁组(P均<0.001);百日咳感染率为25.17%,其感染率随年龄段增长而升高(P均<0.001)。咳嗽变异性哮喘合并百日咳感染者显著高于经典哮喘(28.00%vs.22.59%,P=0.040)。对656例患儿临床特点进行分析发现,哮喘急性发作期患儿合并百日咳感染率高于慢性持续期及临床缓解期(26.15%vs.10.46%,P<0.001;26.15%vs.8.00%,P=0.042);是否合并百日咳在哮喘初诊与复诊患儿之间差异无统计学意义(P=0.189)。哮喘合并百日咳者更易出现痉挛性咳嗽、面红、鸡鸣样回声、呕吐症状(P均<0.05)。哮喘未合并百日咳者以晨起咳嗽多见(9.36%vs.4.20%,P=0.047),而在夜间、晨起及夜间、日间、运动后等的咳嗽时相性特点在两组中差异无统计学意义(P均>0.05)。两组间白细胞计数、中性粒细胞计数、淋巴细胞计数、嗜酸性粒细胞计数及IgE水平差异均无统计学意义(P均>0.05)。结论哮喘儿童百日咳检出率高,尤其是哮喘急性发作与百日咳密切相关,临床症状对两者有一定的鉴别意义,实验室检查结果对两种疾病无鉴别意义。建议对咳嗽持续时间>2~4周的哮喘患儿常规筛查百日咳,以更好地鉴别或判断,指导治疗。Objective To assess the prevalence of pertussis infection in children with asthma across different stages and subtypes and to analyze the correlation between the two diseases via a multicenter prospective investigation.Methods Information was collected from children with asthma who had a cough≥1 week through questionnaires,and pertussis toxin(PT)IgG antibodies levels and/or pertussis nucleic acid tests were performed to interpret the results.The distribution of pertussis antibody,infection and clinical characteristics of different groups were analyzed according to different age,asthma stage and pertussis infection.Results Among the 1,049 asthmatic children,the positive rate of PT-IgG was 26.22%,and the rate was significantly higher in≥6 years old group compared with 3 months-<3 years old group and 3 years-<6 years old group(both P<0.001).The overall rate of pertussis infection in asthmatic children was 25.17%,with an increasing trend in infection rates corresponding to advancing age(P<0.001).The incidence rate of cough variant asthma combined with pertussis infection was significantly higher than classical asthma(28.00%vs.22.59%,P=0.040).According to the clinical characteristics of 656 children,the incidence rate of pertussis infection was higher in patients with acute asthma attack than in chronic duration and clinical remission(26.15%vs.10.46%,P<0.001;26.15%vs.8.00%,P=0.042).There was no significant difference between newly diagnosed and recurrent cases of asthma(P=0.189).Asthmatic children with pertussis were more likely to have spasmodic cough,facial redness,chickenlike echo and vomiting symptoms than those without pertussis(all P<0.05).Morning cough was more common in asthmatic children without pertussis(9.36%vs.4.20%,P=0.047).There was no significant difference in other cough phase characteristics at night,morning or night,day and after exercise between the two groups(all P>0.05).There were no significant differences in leukocyte count,neutrophil count,lymphocyte count,eosinophilic count,and IgE levels

关 键 词：儿童 百日咳 感染 哮喘 相关性 

分 类 号：R725.6[医药卫生—儿科]