原发性纤毛不动综合征法则评分在儿童慢性湿性咳嗽的临床应用

目的　分析原发性纤毛不动综合征法则（PICADAR）评分在儿童慢性湿性咳嗽中的临床应用。方法　回顾分析重庆医科大学附属儿童医院2015年1月至2018年12月收治的42例慢性湿性咳嗽患儿临床资料，其咳嗽病程达3个月，且均行纤毛透射电镜（TEM）检查。总结患儿的PICADAR评分、临床特征及诊疗情况。结果　PICADAR评分高分组（＞5分） 6例（14.3%），低分组（≤5分） 36例（85.7%）。高分组确诊原发性纤毛不动综合征（PCD） 1例，而该例患儿纤毛超微结构正常；低分组无确诊PCD患儿。低分组降钙素原较高分组显著升高（P＝0.044），高分组患儿住院天数较低分组明显延长（P＝0.008）。纤毛超微结构异常患儿27例，其中10例（37.0%）均为继发性纤毛损害（SCD）。结论　当慢性湿性咳嗽患儿病程达3个月且治疗效果欠佳时，PICADAR评分比TEM纤毛超微结构检查更有助于预测PCD以及评估基因检查的必要性。

Clinical application of PICADAR score in children with chronic wet cough

Objective　To analyze the clinical application of PICADAR score in children’s chronic wet cough. Methods　Retrospective analysis was performed on 42 cases of inpatients with chronic wet cough treated in our hospital from January 2015 to December 2018；they had a course up to 3 monthsand received parallel ciliary ultrastructure examination by transmission electron microscope（TEM），and the PICADAR score，the clinical characteristics，diagnosis and treatment of the cases were summarized. Results　6（14.3%） patients in high PICADAR score group（> 5） and 36（85.7%） patients in the low score group（≤5）. One patient was diagnosed with primary ciliary dyskinesia（PCD） in the high score group，who had normal cilia ultrastructure，but none in the low score group. The level of procalcitonin in the high score group was significantly lower than that in the low score group（P＝0.044），and the length of hospital stay in the high score group was significantly prolonged（P＝0.008）. Among 27 children with abnormal cilia ultrastructure，10（37.0%） had secondary cilia damage（SCD）. Conclusion　When the course of children with chronic wet cough reaches 3 months and the treatment effect is not good，the PICADAR score can help to predict PCD and evaluate the necessity of further genetic testing，which is more efficient than TEM cilia ultrastructure examination.