慢性咳嗽儿童的相关因素分析
2009/09/17
初级保健医生常常遇到慢性咳嗽的儿童，但是目前尚缺乏有关其病因学方面的相关数据。
方法：对40名5～12岁至初级保健医生就诊，伴无明显诱因的慢性咳嗽（>8周）患儿进行评价。所有患者均进行系统检查，包括肺部、GI、过敏症、免疫性疾病以及耳鼻喉科相关疾病检查。采用视觉模拟量表对治疗前和治疗8周后的反应进行定量。
结果：阳性诊断试验显示胃食管反流病占27.5％，过敏症占22.5％，哮喘占12.5％，感染占5％，误吸占2.5％，20％的患者存在多种病因。针对上述原因的合理治疗能显著改善咳嗽症状。
结论：反流、过敏及哮喘占儿童慢性咳嗽病因的近80％，且对适当的治疗有反应
（刘国梁 审校）
Khoshoo V, Edell D, Mohnot S, et al.
Chest. 2009 Jun 30. [Epub ahead of print]
Associated Factors in Children With Chronic Cough.
Khoshoo V, Edell D, Mohnot S, Haydel R Jr, Saturno E, Kobernick A.
West Jefferson Medical Center (Drs. Khoshoo, Edell, and Haydel), New Orleans, LA; Tulane University (Ms. Mohnot), New Orleans, LA; and Tulane University Medical Center (Dr. Kobernick), New Orleans, LA.
Children presenting with chronic cough are common to the primary care physicians but data on the etiology are scant.
Methods: We evaluated forty children (5-12 years) with chronic cough (> 8 weeks duration) with no obvious cause and referred by the primary care physicians. All patients underwent an extensive multispecialty workup that included pulmonary, GI, allergy, immunology and otorhinolaryngology. Response to treatment was quantified pretreatment and 8 weeks after treatment using a visual analog scale.
Results: Positive diagnostic tests were noted for gastroesophageal reflux disease (27.5%); allergy (22.5%); asthma (12.5%); infection (5%); aspiration (2.5%) and multiple etiologies (20%). Appropriate treatment for these factors resulted in a significant improvement in cough.
Conclusions: Reflux, allergy and asthma accounted for > 80% of the likely etiological factors of chronic cough in children and responded to appropriate treatment.
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神经生长因子通过TrkA 和 TRPV1受体依赖机制增强咳嗽和气道阻塞
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同时刺激喉及气管支气管受体或刺激中枢呼吸神经元能增加咳嗽反射强度
