在慢性不明原因咳嗽儿童中用联合阻抗pH值测压记录研究胃食管反流和咳嗽的关系
2010/12/17
摘要
前言：在儿童中评价反流与咳嗽的关系是一个难题。食管（阻抗）pH值记录是发现反流的一个敏感方法。然而，将咳嗽记录为一个事件标志物，可能准确性欠佳。本试验旨在慢性咳嗽儿童中研究反流与咳嗽的准确时间关系。
方法：26名患有不明原因咳嗽的儿童（12名男孩；1～10.5岁）入选本项研究，对其进行非卧床阻抗pH测压记录。测压用于准确识别咳嗽。反流通过阻抗pH监测来进行评价，并分为酸性（pH<4）、弱酸性（WA）（pH4～7）、弱碱性（WALK） (pH ≥7)或单纯酸性(pH <4持续时间≥4秒而无阻抗)几类。若反流后≤2分钟内出现咳嗽，则将其定义为反流诱发性咳嗽。计算症状的关联概率(SAP)，如SAP>95%时则认为是阳性。若反流前30秒出现咳嗽，则定义为咳嗽诱发性反流。
结果：采用阻抗pH监测，每名患者共检测到平均30次（21～52次）反流（55.2%为酸, 41.5%为WA及 3.3%为WALK）。此外，还发现有59次单纯酸性出现（每名患者平均1次[0～21次]）。测压显示，每名患者平均出现47次（5～203次）咳嗽。26名患者中有22名患者检测到反流-咳嗽。10名患者反流-咳嗽的SAP为阳性（1名为酸性，6明为弱酸性，3名为酸性+弱酸性胃食管反流[GER])，其中，有9名患者为正常酸性暴露。10名患者中有6名患者测压显示SAP为阳性，采用事件标志物时仍然为SAP阳性。在19名患者中均检测到咳嗽-反流（每名患者3次[0～7次]）。仅小部分食管酸性暴露[9.6 (0.4～31.8%)]继发于咳嗽。
结论：对于无明显原因的咳嗽儿童，酸性和弱酸性GER可出现于咳嗽前，但咳嗽并不会诱发GER。客观的咳嗽记录有助于改善症状关联分析。
（陈欣 审校）
Pediatr Pulmonol. 2010 Oct 22. [Epub ahead of print]
The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings.
Blondeau K, Mertens V, Dupont L, Pauwels A, Farré R, Malfroot A, De Wachter E, De Schutter I, Hauser B, Vandenplas Y, Sifrim D.
Center for Gastroenterological Research, K.U.Leuven, Leuven, Belgium.
Abstract
INTRODUCTION: Assessment of the reflux-cough association in children is challenging. Esophageal (impedance) pH recording is sensitive to recognize reflux. However, cough recorded by an event marker, possibly lacks accuracy. We aimed to study the exact time relationship between reflux and cough in children with chronic cough.
METHODS: Twenty-six children (12 boys; 1-10.5 years) with chronic unexplained cough underwent ambulatory impedance-pH-manometry recordings. Manometry was used for precise cough recognition. Reflux was assessed with impedance-pH monitoring and defined as acid (pH <4), weakly acidic (WA) (pH 4-7), weakly alkaline (WALK) (pH ≥7), or acid only (pH <4 for ≥4 sec without impedance pattern). Cough was considered "induced by" reflux, if it started ≤2 min after reflux. The Symptom Association Probability (SAP) was calculated and considered positive if >95%. Cough-induced reflux if it occurred 30 sec before the reflux event.
RESULTS: Impedance-pH detected 30 (21-52) reflux episodes/patient (55.2% acid, 41.5% WA, and 3.3% WALK). Additionally 59 acid only events were identified [1 (0-21)/patient]. Manometry detected 47 (5-203) cough bursts/patient. Reflux-cough was found in 22/26 patients. Ten patients had a +SAP for reflux-cough (one acid, six WA, and three acid + WA gastroesophageal reflux [GER]), of which nine had a normal acid exposure. Six out of 10 patients with +SAP using manometry had a +SAP using the event marker. Cough-reflux was detected in 19 patients [3 (0-7)/patient]. Only a small fraction of the esophageal acid exposure [9.6 (0.4-31.8%)] was secondary to cough.
CONCLUSION: Both acid and WA GER may precede cough in children with unexplained cough, but cough does not induce GER. Objective cough recording improves symptom association analysis.
Pediatr Pulmonol. 2010 Oct 22. [Epub ahead of print]
前言：在儿童中评价反流与咳嗽的关系是一个难题。食管（阻抗）pH值记录是发现反流的一个敏感方法。然而，将咳嗽记录为一个事件标志物，可能准确性欠佳。本试验旨在慢性咳嗽儿童中研究反流与咳嗽的准确时间关系。
方法：26名患有不明原因咳嗽的儿童（12名男孩；1～10.5岁）入选本项研究，对其进行非卧床阻抗pH测压记录。测压用于准确识别咳嗽。反流通过阻抗pH监测来进行评价，并分为酸性（pH<4）、弱酸性（WA）（pH4～7）、弱碱性（WALK） (pH ≥7)或单纯酸性(pH <4持续时间≥4秒而无阻抗)几类。若反流后≤2分钟内出现咳嗽，则将其定义为反流诱发性咳嗽。计算症状的关联概率(SAP)，如SAP>95%时则认为是阳性。若反流前30秒出现咳嗽，则定义为咳嗽诱发性反流。
结果：采用阻抗pH监测，每名患者共检测到平均30次（21～52次）反流（55.2%为酸, 41.5%为WA及 3.3%为WALK）。此外，还发现有59次单纯酸性出现（每名患者平均1次[0～21次]）。测压显示，每名患者平均出现47次（5～203次）咳嗽。26名患者中有22名患者检测到反流-咳嗽。10名患者反流-咳嗽的SAP为阳性（1名为酸性，6明为弱酸性，3名为酸性+弱酸性胃食管反流[GER])，其中，有9名患者为正常酸性暴露。10名患者中有6名患者测压显示SAP为阳性，采用事件标志物时仍然为SAP阳性。在19名患者中均检测到咳嗽-反流（每名患者3次[0～7次]）。仅小部分食管酸性暴露[9.6 (0.4～31.8%)]继发于咳嗽。
结论：对于无明显原因的咳嗽儿童，酸性和弱酸性GER可出现于咳嗽前，但咳嗽并不会诱发GER。客观的咳嗽记录有助于改善症状关联分析。
（陈欣 审校）
Pediatr Pulmonol. 2010 Oct 22. [Epub ahead of print]
The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings.
Blondeau K, Mertens V, Dupont L, Pauwels A, Farré R, Malfroot A, De Wachter E, De Schutter I, Hauser B, Vandenplas Y, Sifrim D.
Center for Gastroenterological Research, K.U.Leuven, Leuven, Belgium.
Abstract
INTRODUCTION: Assessment of the reflux-cough association in children is challenging. Esophageal (impedance) pH recording is sensitive to recognize reflux. However, cough recorded by an event marker, possibly lacks accuracy. We aimed to study the exact time relationship between reflux and cough in children with chronic cough.
METHODS: Twenty-six children (12 boys; 1-10.5 years) with chronic unexplained cough underwent ambulatory impedance-pH-manometry recordings. Manometry was used for precise cough recognition. Reflux was assessed with impedance-pH monitoring and defined as acid (pH <4), weakly acidic (WA) (pH 4-7), weakly alkaline (WALK) (pH ≥7), or acid only (pH <4 for ≥4 sec without impedance pattern). Cough was considered "induced by" reflux, if it started ≤2 min after reflux. The Symptom Association Probability (SAP) was calculated and considered positive if >95%. Cough-induced reflux if it occurred 30 sec before the reflux event.
RESULTS: Impedance-pH detected 30 (21-52) reflux episodes/patient (55.2% acid, 41.5% WA, and 3.3% WALK). Additionally 59 acid only events were identified [1 (0-21)/patient]. Manometry detected 47 (5-203) cough bursts/patient. Reflux-cough was found in 22/26 patients. Ten patients had a +SAP for reflux-cough (one acid, six WA, and three acid + WA gastroesophageal reflux [GER]), of which nine had a normal acid exposure. Six out of 10 patients with +SAP using manometry had a +SAP using the event marker. Cough-reflux was detected in 19 patients [3 (0-7)/patient]. Only a small fraction of the esophageal acid exposure [9.6 (0.4-31.8%)] was secondary to cough.
CONCLUSION: Both acid and WA GER may precede cough in children with unexplained cough, but cough does not induce GER. Objective cough recording improves symptom association analysis.
Pediatr Pulmonol. 2010 Oct 22. [Epub ahead of print]
