哮喘联盟

   摘要
   目的：确定≥4周抗生素治疗无效的慢性湿咳儿童是否更可能发生支气管扩张。
   方法：我们回顾了从2010年4月到2012年8月期间一个儿童三甲医院的所有胸部多排计算机断层扫描片结果(MDCT)，以确定呼吸科医生对儿童慢性湿咳的诊断。患者图表中记录的信息包括年龄、性别、种族、信号成像、扫描前对抗生素（≥4周）的反应情况。采用简单逻辑回归和多元逻辑回归对这些数据进行分析。
   结果：在144例（87例男童）符合标准的儿童中，106例（65例男童，30例当地儿童）年龄在10-199个月的儿童MDST扫描结果显示存在支气管扩张。109例儿童有抗生素使用数据。在至少使用4周抗生素的105例持续咳嗽儿童中，88例（83.8%）有支气管扩张。在24例使用抗生素后咳嗽缓解的儿童中，只有6例(25.0%)诊断为支气管扩张（校正OR 20.9; 95%可信区间5.36 - 81.8）。当地儿童与影像学证据显示的支气管扩张独立相关(校正OR 5.86; 95%可信区间1.20 - 28.5)。
   结论：对口服抗生素4周治疗无效的慢性湿咳儿童，应该考虑进行更多的检查（包括MDCT扫描）。但是，在减少支气管扩张潜在发生可能性时，单一抗生素长期治疗应答良好不能完全排除这一可能性。
 

（刘国梁 审校）
Arch Dis Child. 2014 Jun;99(6):522-5. doi: 10.1136/archdischild-2013-304793. Epub 2014 Feb 12.

 

Does failed chronic wet cough response to antibiotics predict bronchiectasis?
 

Goyal V1, Grimwood K2, Marchant J1, Masters IB1, Chang AB3.
 

ABSTRACT
AIM: To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis.
METHODS: All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression.
RESULTS: Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10-199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5).
CONCLUSIONS: Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.
 

Arch Dis Child. 2014 Jun;99(6):522-5. doi: 10.1136/archdischild-2013-304793. Epub 2014 Feb 12.