青少年或成人咳嗽患者中是否存在百日咳？
2010/11/04
摘要
前言：百日咳作为咳嗽的原因常常被忽视，特别是在青少年和成人患者中。一些症状被认为是百日咳的表现，但各个症状的诊断价值尚不清楚。
目的：对三个百日咳常见症状的有关证据进行系统性回顾：阵发性咳嗽、咳嗽后呕吐、吸入性哮声。
数据来源、试验选择以及数据提取：对MEDLINE（1966年1月～2010年4月）、EMBASE（1969年1月～2010年4月）及相关文献的参考书目进行搜索，研究相关英文文献。选取包括年龄>5岁的儿童、青少年或成人患者的研究，基于前期标准，对这些百日咳伴咳嗽的患者进行确诊。两名作者独立地对满足选择标准的文献进行数据提取分析，通过协商达成一致意见。
数据合成：5个前瞻性研究满足入选标准：其中3个用于分析。咳嗽后呕吐（似然比LR：1.8；95% CI：1.4-2.2）或吸入性哮吼声（LR, 1.9; 95% CI, 1.4-2.6）能增加诊断为百日咳的可能性。缺少阵发性咳嗽（LR, 0.52; 95% CI, 0.27-1.0）或咳嗽后呕吐（LR, 0.58; 95% CI, 0.44-0.77）则会减少诊断为百日咳的可能性。缺少吸入性哮吼声的相关性较小（LR, 0.78; 95% CI, 0.66-0.93）。没有研究对上述结果进行综合评价。
结论：在咳嗽非爆发性环境中，有关百日咳相关症状诊断价值的数据有限，其质量也欠佳。出现或缺少咳嗽后呕吐或吸入性哮吼声对百日咳可能性存在某种影响。因此，临床医生需根据总体临床表现，决定是否采用进一步检测或进行经验性治疗。
（林江涛 审校）
JAMA. 2010 Aug 25;304(8):890-896.
Does this coughing adolescent or adult patient have pertussis?
Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R.
Primary and Specialty Medical Care Service, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, USA.
Abstract
CONTEXT: Pertussis is often overlooked as a cause of chronic cough, especially in adolescents and adults. Several symptoms are classically thought to be suggestive of pertussis, but the diagnostic value of each of them is uncertain.
OBJECTIVE: To systematically review the evidence regarding the diagnostic value of 3 classically described symptoms of pertussis: paroxysmal cough, posttussive emesis, and inspiratory whoop. DATA SOURCES, STUDY SELECTION, AND
DATA EXTRACTION: We searched MEDLINE (January 1966-April 2010), EMBASE (January 1969 to April 2010), and the bibliographies of pertinent articles to identify relevant English-language studies. Articles were selected that included children older than 5 years, adolescents, or adults and confirmed the diagnosis of pertussis among patients with cough illness (of any duration) with an a priori-defined accepted reference standard. Two authors independently extracted data from articles that met selection criteria and resolved any discrepancies by consensus.
DATA SYNTHESIS: Five prospective studies met inclusion criteria; 3 were used in the analysis. Presence of posttussive emesis (summary likelihood ratio [LR], 1.8; 95% confidence interval [CI], 1.4-2.2) or inspiratory whoop (summary LR, 1.9; 95% CI, 1.4-2.6) increases the likelihood of pertussis. Absence of paroxysmal cough (summary LR, 0.52; 95% CI, 0.27-1.0) or posttussive emesis (summary LR, 0.58; 95% CI, 0.44-0.77) reduced the likelihood. Absence of inspiratory whoop was less useful (summary LR, 0.78; 95% CI, 0.66-0.93). No studies evaluated combinations of findings.
CONCLUSIONS: In a nonoutbreak setting, data to determine the diagnostic usefulness of symptoms classically associated with pertussis are limited and of relatively weak quality. The presence or absence of posttussive emesis or inspiratory whoop modestly change the likelihood of pertussis; therefore, clinicians must use their overall clinical impression to decide about additional testing or empirical treatment
JAMA. 2010 Aug 25;304(8):890-6.
前言：百日咳作为咳嗽的原因常常被忽视，特别是在青少年和成人患者中。一些症状被认为是百日咳的表现，但各个症状的诊断价值尚不清楚。
目的：对三个百日咳常见症状的有关证据进行系统性回顾：阵发性咳嗽、咳嗽后呕吐、吸入性哮声。
数据来源、试验选择以及数据提取：对MEDLINE（1966年1月～2010年4月）、EMBASE（1969年1月～2010年4月）及相关文献的参考书目进行搜索，研究相关英文文献。选取包括年龄>5岁的儿童、青少年或成人患者的研究，基于前期标准，对这些百日咳伴咳嗽的患者进行确诊。两名作者独立地对满足选择标准的文献进行数据提取分析，通过协商达成一致意见。
数据合成：5个前瞻性研究满足入选标准：其中3个用于分析。咳嗽后呕吐（似然比LR：1.8；95% CI：1.4-2.2）或吸入性哮吼声（LR, 1.9; 95% CI, 1.4-2.6）能增加诊断为百日咳的可能性。缺少阵发性咳嗽（LR, 0.52; 95% CI, 0.27-1.0）或咳嗽后呕吐（LR, 0.58; 95% CI, 0.44-0.77）则会减少诊断为百日咳的可能性。缺少吸入性哮吼声的相关性较小（LR, 0.78; 95% CI, 0.66-0.93）。没有研究对上述结果进行综合评价。
结论：在咳嗽非爆发性环境中，有关百日咳相关症状诊断价值的数据有限，其质量也欠佳。出现或缺少咳嗽后呕吐或吸入性哮吼声对百日咳可能性存在某种影响。因此，临床医生需根据总体临床表现，决定是否采用进一步检测或进行经验性治疗。
（林江涛 审校）
JAMA. 2010 Aug 25;304(8):890-896.
Does this coughing adolescent or adult patient have pertussis?
Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R.
Primary and Specialty Medical Care Service, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, USA.
Abstract
CONTEXT: Pertussis is often overlooked as a cause of chronic cough, especially in adolescents and adults. Several symptoms are classically thought to be suggestive of pertussis, but the diagnostic value of each of them is uncertain.
OBJECTIVE: To systematically review the evidence regarding the diagnostic value of 3 classically described symptoms of pertussis: paroxysmal cough, posttussive emesis, and inspiratory whoop. DATA SOURCES, STUDY SELECTION, AND
DATA EXTRACTION: We searched MEDLINE (January 1966-April 2010), EMBASE (January 1969 to April 2010), and the bibliographies of pertinent articles to identify relevant English-language studies. Articles were selected that included children older than 5 years, adolescents, or adults and confirmed the diagnosis of pertussis among patients with cough illness (of any duration) with an a priori-defined accepted reference standard. Two authors independently extracted data from articles that met selection criteria and resolved any discrepancies by consensus.
DATA SYNTHESIS: Five prospective studies met inclusion criteria; 3 were used in the analysis. Presence of posttussive emesis (summary likelihood ratio [LR], 1.8; 95% confidence interval [CI], 1.4-2.2) or inspiratory whoop (summary LR, 1.9; 95% CI, 1.4-2.6) increases the likelihood of pertussis. Absence of paroxysmal cough (summary LR, 0.52; 95% CI, 0.27-1.0) or posttussive emesis (summary LR, 0.58; 95% CI, 0.44-0.77) reduced the likelihood. Absence of inspiratory whoop was less useful (summary LR, 0.78; 95% CI, 0.66-0.93). No studies evaluated combinations of findings.
CONCLUSIONS: In a nonoutbreak setting, data to determine the diagnostic usefulness of symptoms classically associated with pertussis are limited and of relatively weak quality. The presence or absence of posttussive emesis or inspiratory whoop modestly change the likelihood of pertussis; therefore, clinicians must use their overall clinical impression to decide about additional testing or empirical treatment
JAMA. 2010 Aug 25;304(8):890-6.
