Clinical application of dense fine spot anti-nuclear antibody in children with autoimmune diseases北大核心CSCD

Objective To analyze the differences of the clinical characteristics and laboratory indexes in children with positive dense fine spot (DFS) type anti-nuclear antibody, and thereby to explore the value of positive DFS in the diagnosis of immunological diseases. Methods Among 9 613 cases who were routinely tested for antinuclear antibody (ANA) from August 2017 to February 2020, there were 197 cases with DFS positive, who were subjected to a retrospective analysis.These patients were divided into the autoimmune diseases (AID) group (39 cases) and the non-AID group (158 cases) according to clinical diagnosis.Healthy children in the same physical examination were used as healthy control group (40 cases). T test was applied to analyze the differences of humoral immunity markers between AID and non-AID groups.What′s more, DFS positive patients in different clinical departments, initial symptom and the part of body were further compared. Results Among 9 613 children tested for autoantibodies, 2 654 (27.61%) were ANA positive, with the highest detection rate of the spotted type and 197 DFS positive cases, accoun-ting for 7.42% of ANA positive children; 97 DFS positive male patients accounted for 8.20% (97/1 183 case) of ANA positive male patients, 100 DFS positive female patients accounted for 6.80% (100/1 471 cases) of ANA positive female patients, and there was no significant difference in the positive rate.The departments with high positive ANA detection included the nephrology department (27.88%) and the rheumatology department (24.83%). The departments with a higher ANA positive rate in DFS positive children included the gastroenterology department (13.25%) and the infectious department (11.76%). Among the children with DFS antibody positive, 39 cases had AID, among which 38 cases had organ-specific AID, and juvenile idiopathic arthritis (JIA) had the highest detection rate in 13 cases.The diseases with a high DFS positive rate in 158 non-AID cases included allergic purpura (46 cases). Serum immunoglobulin (IgG) level in the AID group was significantly lower than this in the non-AID group, serum IgM and C4 levels in AID children were significantly lower than those in the non-AID group and healthy control group, and the serum IgA level of DFS positive group was significantly higher than that of children in the healthy control group.All children with DFS antibody positive had no specific autoantibodies. Conclusions DFS antibody positive is important for the diagnosis of systemic AID in children.The combined detection with the DFS, other autoimmunity antibody index, humoral immune function index contributes to the early differential diagnosis of autoimmune diseases in children. © 2021 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

Mutation spectrum and clinical features of congenital long QT syndrome in 20 children: a single center study北大核心CSCD

Objective To explore the pathogenic genes, clinical characteristics and treatment follow-up of children with congenital long QT syndrome (LQTS). Methods Clinical data of 20 cases diagnosed with congenital LQTS and underwent gene testing from April 15, 2011 to April 15, 2021 in Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University were retrospectively collected and analyzed using independent sample t-test and Fisher's exact probability method. Results LQTS-related gene mutations were detected in all the 20 cases, and pathogenic or suspected pathogenic mutations were identified in 18 cases (90.0%). Five LQTS mutation genes were discovered, including KCNQ1, KCNH2, SCN5A, CACNA1C and AKAP9.Eighteen cases (90.0%) had positive symptoms, and 13 cases (65.0%) had definite inducements.The inducement of symptoms in children with LQTS type 1(LQT1) was related to exercise, the causes of syncope in LQT1 and Jervell-Lange-Nielsen syndrome type 1 (JLNS1) with complex heterozygous mutations were exercise or emotional agitation; the causes of syncope in LQTS type 2 (LQT2) were unrelated to exercise; severe exercise in LQTS type 3 (LQT3) resulted in symptoms; and seizure in LQTS type 8 (LQT8) was non-induced.The corrected QT(QTc) interval of 20 cases was (553.1±66.6) ms, with a range of 460-707 ms, among which 17 cases showed QTc≥480 ms.The electrocardiogram(ECG) manifestations of children with various types of LQTS were different.There was no significant difference in QTc between different genders, or between children with syncope and those without syncope (all P>0.05). The follow-up time was (3.4±2.3) years, ranging from 0 to 8.3 years.Seventeen children received treatment[beta blockers and implantable cardiovertor-defibrillator(ICD)] and 3 cases did not.By the end of the follow-up, 1 child died, 19 cases survived, and 2 cases of the surviving children lost consciousness. Conclusions There is a high consistency between genetic diagnosis and clinical diagnosis of congenital LQTS.The positive rate of gene detection is 90.0%.The clinical manifestations and ECG characteristics vary with genotypes.Beta blockers are protective.ICD therapy can prevent sudden cardiac death when oral medication does not respond. © 2022 Chin J Pathol, June. All rights reserved.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

Objective The scientific basis and the clinical effectiveness of allergen specific immunotherapy (SIT) administered by subcutaneous injection are well established. This study aimed to observe the changes in amount of inhaled corticosteroids, total IgE, specific IgE, peak expiratory flow rate (PEF), etc. during a standardized SIT against house dust mite in allergic asthmatic children. Method Children (5-13 years old) with mild to moderate allergic asthma seen from February 2005 to June 2008 were enrolled into this study. A non- randomized retrospective study was performed. All children were diagnosed sensitive to dust mites, the treatment group accepted standardized dust mite allergen specific immunotherapy. Each fourth injections were defined as observation points, the study took 3.4 years. The investigators recorded the treatment, the cumulative allergen extract, changes of daffy doses of inhaled corticosteroid, peak expiratory flow (PEF), total IgE (TIgE), specific IgE (SIgE). The control group only received inhaled corticosteroids. The daily doses of inhaled corticosteroid and the number of asthma attacks,and the control rate were compared between the 2 groups. Result Totally 85 children were treated with SIT [(7.6 ± 1.4) years], 45 males and 40 females; 50 children received only drug treatment [(7.7 ± 1.5)years], 28 males and 22 females. The cumulative dose of allergen was up to (69.7 ± 4.8) μg after the 20 times injection, the dose of inhaled corticosteroids was significantly less than that in the control group ( t =2. 359, P ＜ 0.05). PEF was significantly higher than that of pre-treatment level ( F = 7.874, P ＜ 0.05 ).TIgE and SIgE had no significant change (t = 0.313, P ＞ 0.05, tDerp = 0.517, tDerf = 0.717,P ＞ 0.05 ). After the treatment, the control rate of the SIT group was 85.5%, that of the control group was 62.0% (X2 =10.150, P ＜0.01). Conclusion The standardized SIT against house dust mite could reduce steroid use in mild to moderate allergic asthmatic children. After ( 38.7± 2.3 ) weeks, the cumulative dose of allergen was up to (69.7 + 4.8) μg, inhaled corticosteroid was significantly reduced. At the end of SIT, 85% of patients obtained complete control of asthma. Total IgE and mite-specific IgE had no significant changes.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

Objective The scientific basis and the clinical effectiveness of allergen specific immunotherapy (SIT) administered by subcutaneous injection are well established. This study aimed to observe the changes in amount of inhaled corticosteroids, total IgE, specific IgE, peak expiratory flow rate (PEF), etc. during a standardized SIT against house dust mite in allergic asthmatic children. Method Children (5-13 years old) with mild to moderate allergic asthma seen from February 2005 to June 2008 were enrolled into this study. A non- randomized retrospective study was performed. All children were diagnosed sensitive to dust mites, the treatment group accepted standardized dust mite allergen specific immunotherapy. Each fourth injections were defined as observation points, the study took 3.4 years. The investigators recorded the treatment, the cumulative allergen extract, changes of daffy doses of inhaled corticosteroid, peak expiratory flow (PEF), total IgE (TIgE), specific IgE (SIgE). The control group only received inhaled corticosteroids. The daily doses of inhaled corticosteroid and the number of asthma attacks,and the control rate were compared between the 2 groups. Result Totally 85 children were treated with SIT [(7.6 ± 1.4) years], 45 males and 40 females; 50 children received only drug treatment [(7.7 ± 1.5)years], 28 males and 22 females. The cumulative dose of allergen was up to (69.7 ± 4.8) μg after the 20 times injection, the dose of inhaled corticosteroids was significantly less than that in the control group ( t =2. 359, P ＜ 0.05). PEF was significantly higher than that of pre-treatment level ( F = 7.874, P ＜ 0.05 ).TIgE and SIgE had no significant change (t = 0.313, P ＞ 0.05, tDerp = 0.517, tDerf = 0.717,P ＞ 0.05 ). After the treatment, the control rate of the SIT group was 85.5%, that of the control group was 62.0% (X2 =10.150, P ＜0.01). Conclusion The standardized SIT against house dust mite could reduce steroid use in mild to moderate allergic asthmatic children. After ( 38.7± 2.3 ) weeks, the cumulative dose of allergen was up to (69.7 + 4.8) μg, inhaled corticosteroid was significantly reduced. At the end of SIT, 85% of patients obtained complete control of asthma. Total IgE and mite-specific IgE had no significant changes.     

Risk factors for death in children with severe adenovirus pneumonia in southwest Chongqing北大核心CSCD

Objective To investigate the risk factors for death in children with severe adenovirus pneumonia (SAP) in pediatric intensive care unit (PICU), and to provide reference basis for clinical reasonable treatment and reducing the adverse outcome. Methods The clinical data of 68 children with SAP hospitalized in PICU, Children′s Hospital of Chongqing Medical University from August 2018 to September 2019 were retrospectively analyzed.They were divided into the death group and the survival group according to their condition.The age, basic diseases, complications and laboratory examination results of children were collected for univariate analysis, and multivariate Logistic regression analysis was performed for those with significant univariate analysis. Results Among the 68 children with SAP, 50 were males and 18 were females, and 46 cases (67.6%) aged between 6 months and 2 years.Fifty-five cases(80.9%) of SAP occurred in spring and summer.There were 61 cases (89.7%) with the spike over 39 ? and 21 cases (30.9%) had fever for over 2 weeks; 42 cases (61.8%) were infected with mixed other pathogens.Intrapulmonary and extrapulmonary complications at varying severity were observed.There were 23 cases (33.8%) deaths.Univariable Logistic regression analysis showed that the rates of congenital heart disease(13 cases vs. 9 cases), alanine transaminase >100 U/L(12 cases vs. 8 cases), acute respiratory distress syndrome (ARDS)(13 cases vs. 9 cases) and severe extrapulmonary complications (19 cases vs. 14 cases) were significantly higher in the death group than those in the survival group (all P<0.05). Multivariate Logistic regression analysis showed that congenital heart disease, ARDS and severe extrapulmonary complications were independent risk factors for death in children with SAP (all P<0.05). Conclusions Children with SAP in PICU are mostly 6 months to 2 years old.SAP mainly occurs in spring and summer, which is featured by the high spike of fever, long duration of fever, easy to be infected with other pathogens, high incidences of systemic complications, and high mortality.The combination of congenital heart disease, ARDS and severe extrapulmonary complications increases the risk of death in children with SAP in PICU. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Selective coronary angiography in follow - up and technical study of Kawasaki disease - induced giant coronary artery aneurysm北大核心CSCD

Objective To investigate the characteristics of long - term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children. Methods A retrospective analysis was made in 52 patients with KD and GCAA in acute phase, including 38 males and 14 females with an average age of (4. 1 ±2.5) years old ranging from 1 to 14 years old,from January 2008 to December 2018 at the Department of Cardiology, Guangzhou Women and Children's Medical Center. The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6 ±3.6) years (1-19 years). The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children. Results Among 52 patients investigated by SCAG, the location of coronary artery lesion was found the left - anterior descending branch in 21 cases(40.4%),20 cases(38. 5%) in the right coronary artery,8 cases (15.4%) in the left main trunk and 3 cases(5.7%) in circumflex. The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded,and collateral vessel formation was found in 12 cases. There were 21 cases of right coronary artery stenosis, including 7 cases of the right coronary artery occlusion and bridge - like neovascularization, and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). There were 27 cases of the left coronary artery stenosis with different degrees, including 5 cases of the left coronary artery occlusion and bridge - like neovascularization, and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). All of 52 patients with GCAA were followed up for 1 to 19 years. GCAA still existed in 40 cases. Regression to small coronary artery aneurysm was found in 8 cases,and mild - dilation regression was observed only in 4 patients. The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases,and normal in the remaining 46 patients. The children had no subjective symptoms and their activities were not restricted.compared with SCAG,echocardiography detected 52 cases with proximal morphological changes in the coronary artery, but distal changes were found only in 3 cases. And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography. Conclusions GCAA induced by KD can persist for a long time, and has characteristics of coronary occlusion, stenosis, and collateral vessel formation. The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae. The SCAG is of great value in tracking this disease. For using SCAG in children,as long as the appropriate equipment and projection angle are selected, and the operation skills are mastered, satisfactory images and high success rate can be obtained. © 2019 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Chest CT features of children infected by B.1.617.2 (Delta) variant of COVID‑19

Background This study aimed to explore the imaging characteristics,diversity and changing trend in CT scans of pediatric patients infected with Delta-variant strain by studying imaging features of children infected with Delta and comparing the results to those of children with original COVID-19.Methods A retrospective,comparative analysis of initial chest CT manifestations between 63 pediatric patients infected with Delta variant in 2021 and 23 pediatric patients with COVID-19 in 2020 was conducted.Corresponding imaging features were analyzed.In addition,the changing trend in imaging features of COVID-19 Delta-variant cases were explored by evaluating the initial and follow-up CT scans.Results Among 63 children with Delta-variant COVID-19 in 2021,34(53.9%)showed positive chest CT presentation;and their CT score(1.10±1.41)was signifcantly lower than that in 2020(2.56±3.5)(P=0.0073).Lesion distribution:lung lesions of Delta cases appear mainly in the lower lungs on both sides.Most children had single lobe involvement(18 cases,52.9%),14(41.2%)in the right lung alone,and 14(41.2%)in both lungs.A majority of Delta cases displayed initially ground glass(23 cases,67.6%)and nodular shadows(13 cases,38.2%)in the frst CT scan,with few extrapulmonary manifestations.The 34 children with abnormal chest CT for the frst time have a total of 92 chest CT examinations.These children showed a statistically signifcant diference between the 0-3 day group and the 4-7 day group(P=0.0392)and a signifcant diference between the 4-7 day group and the more than 8 days group(P=0.0003).Conclusions The early manifestations of COVID-19 in children with abnormal imaging are mostly small subpleural nodular ground glass opacity.The changes on the Delta-variant COVID-19 chest CT were milder than the original strain.The lesions reached a peak on CT in 4-7 days and quickly improved and absorbed after a week.Dynamic CT re-examination can achieve a good prognosis.     

Clinical features of children with colorectal polyps and the efficacy of endoscopic treatment: an analysis of 1 351 cases北大核心CSCD

Objective To study the clinical features of children with colorectal polyps and the efficacy of endoscopic treatment. Methods A retrospective analysis was performed on the medical data of 1 351 children with colorectal polyps who were admitted and received colonoscopy and treatment in the past 8 years, including clinical features and the pattern and outcomes of endoscopic treatment. Results Among the 1 351 children, 893 (66.10%) were boys and 981 (72.61%) had an age of 2-<7 years, and hematochezia (1 307, 96.74%) was the most common clinical manifestation. Of all the children, 89.27% (1 206/1 351) had solitary polyps, and 95.77% (1 290/1 347) had juvenile polyps. The polyps were removed by electric cauterization with hot biopsy forceps (6 cases) or high-frequency electrotomy and electrocoagulation after snare ligation (1 345 cases). A total of 1 758 polyps were resected, among which 1 593 (90.61%) were pedunculated and 1 349 (76.73%) had a diameter of <2 cm. Postoperative complications included bleeding in 51 children (3.77%), vomiting in 87 children (6.44%), abdominal pain in 14 children (1.04%), and fever in 39 children (2.89%), while no perforation was observed. The children aged <3 years had the highest incidence rates of postoperative bleeding and fever (P<0.0125), and the children with a polyp diameter of ≥2 cm had significantly higher incidence rates of postoperative bleeding, vomiting, and fever (P<0.05). Conclusions Solitary polyps, pedunculated polyps, and juvenile polyps are common types of pediatric colorectal polyps. Electric cauterization with hot biopsy forceps or high-frequency electrotomy and electrocoagulation after snare ligation can effectively remove colorectal polyps in children, with good efficacy and few complications. Younger age and larger polyp diameter are associated with a higher risk of postoperative bleeding. © 2022 Xiangya Hospital of CSU. All rights reserved.     

Establishment of the normal reference range of neurotransmitters in Han - nationality children aged 3-12 in Hubei province北大核心CSCD

Objective To establish the normal reference range of neurotransmitters in Han - nationality children aged 3-12 in Hubei province. Methods A prospective study was conducted on healthy Han - nationality children aged 3-12 who took physical examination in Wuhan Children's Hospital, Hubei province from January to August 2021. The children were asked for their medical histories, and those with neurological diseases, psychiatric diseases, infection, trauma, and a drug history in the past 2 weeks were excluded. The plasma of 324 children (262 males, 62 females;217 cases in the 3-7 years old, 107 cases in the 8-12 years old) and urine of 391 children (302 males, 89 females;266 cases in the 3-7 years old, 125 cases in the 8-12 years old) were collected. They ultra performance liquid chromatography - mass spectrometry multiple techniques (UPLC - MS/MS) were used to detect 10 kinds of neurotransmitters (e. g., dopamine, epinephrine, glutamic acid, etc.) in plasma and 8 kinds of neurotransmitters (e. g., dopamine, epinephrine, 5 - hydroxyindoleacetic acid, etc.) in random urine. The normal reference range of neurotransmitters in Han - nationality children aged 3-12 in Hubei province was established. The Kruskal - Wallis H test was made for statistical analysis of the differences in neurotransmitter levels among different age groups and gender groups. The neurotransmitter levels between different groups were compared by the Nemenyi test. Results There were no significant differences in the levels of various neurotransmitters in children of different genders(all P > 0. 05). There were significant differences in the levels of dopamine, methoxy - norepinephrine, tryptophan and γ - aminobutyric acid in the plasma of children aged 3-7 years and 8-12 years. There were significant differences in the levels of dopamine, epinephrine, norepinephrine, methoxy - norepinephrine, high vanillic acid and 5 - hydroxyindoleacetic acid in the random urine between the 3-7 years old group and the 8-12 years old group. Conclusions The normal reference range of neurotransmitters in Han - nationality children aged 3-12 in Hubei province is established. This study provides reference for clinical practice and lays a foundation for the study of neurotransmitter - related diseases in children. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

Clinical feature analysis of subdural effusion/hematoma after shunt use of adjustable valves in children with hydrocephalus北大核心CSCD

Objective To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow - up. Methods A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children's Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively. There were 16 cases with SEHS, 11 of whom were male and 5 were female. The age ranged from 3 months to 13 years (median;2. 5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods (pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed. The pressure adjustment treatment was to increase the by 10-20 mmH2O (1 mmH2O =0.0098 kPa) each time and the patients were followed up 2-4 weeks after the adjustment. If SEHS didn't improve according to the follow - up results, pressure regulation combined with drilling and drainage was recommended. Results Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below. Eleven cases were treated by pressure regulation only, and 5 cases who were all aged 3 years received pressure regulation combined with drilling and drainage. Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case. Fourteen cases were asymptomatic. The time from shunt operation to the occurrence of SEHS was 1 month in 5 cases, who were all cured by pressure regulation only. SEHS occurred in 5 cases > 1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with drilling and drainage. Three cases had SEHS > 3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4. 5 months, 7. 5 months, and 25. 0 months, respectively. The time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2. 0 months, 3. 0 months, 7. 0 months and 8. 0 months, respectively. Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured. Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median;39. 0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median; 158. 2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side. Conclusions SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms. SEHS mostly occurs within 6 months after operation, especially within 3 months. SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only. Therefore, SEHS can be cured by pressure regulation only by shortening follow - up and identifying SEHS early after shunt operation. This will also reduce the probability that patients require the drilling and drainage operation. © 2022 ＣｈｉｎＪＡｐｐｌＣｌｉｎＰｅｄｉａｔ. All rights reserved.     

温州地区儿童慢性咳嗽病因构成比研究

目的：分析温州地区慢性咳嗽患儿的常见病因分布,为临床诊治提供依据。方法：选取2008年1月至2010年12月温州医学院附属育英儿童医院呼吸科门诊就诊的慢性咳嗽初诊患儿,依据年龄分为～3岁、～6岁和～14岁组,在初诊后2周、1个月和3个月门诊或电话随访,根据随访治疗效果得出最终诊断结果。分析各病因的构成比,初诊和最终诊断的符合率。结果：研究期间共纳入739例慢性咳嗽患儿,年龄8个月至14岁,其中～3岁组174例（23.5%）,～6岁组288例（39.0%）,～14岁组277例（37.5%）。咳嗽病程4周至5年。1～4季度分别纳入103例（13.9%）、247例（33.4%）、96例（13.0%）和293例（39.7%）。①739例慢性咳嗽患儿中,单病因680例（92.0%）,单病因依次为上气道咳嗽综合征 237例（32.1%）,咳嗽变异性哮喘219例（29.6%）,感染后咳嗽109例（14.8%）,变应性咳嗽76例（10.3%）,心因性咳嗽25例（3.4%）,胃食管反流性咳嗽 9例（1.2%）,其他5例（0.7%）;双病因45例（6.1%）;病因不明 14例（1.9%）。②～3岁组最常见病因为感染后咳嗽（58例,33.3%）,～6岁组为上气道咳嗽综合征（114例,39.6%）,～14岁组为咳嗽变异性哮喘（103例,37.2%）,上述3种主要病因的各年龄组构成比差异有统计学意义（P＜0.05）。③上气道咳嗽综合征、咳嗽变异性哮喘、感染后咳嗽、变应性咳嗽、心因性咳嗽和胃食管反流性咳嗽所致慢性咳嗽共675例,其中496例初诊和最终诊断相符,初诊准确率为73.5%。结论：温州地区儿童慢性咳嗽主要病因为上气道咳嗽综合征、咳嗽变异性哮喘、感染后咳嗽和变应性咳嗽;不同年龄组儿童慢性咳嗽的病因构成比有所不同。     

儿童慢性咳嗽111例病因分析

目的：探讨儿童慢性咳嗽的病因,为其诊断和治疗提供依据。方法：选择2008年12月至2010年1月广西医科大学第一附属医院儿科的慢性咳嗽患儿111例,对该组患儿进行前瞻性临床研究以获得其病因。结果：儿童慢性咳嗽的病因为：咳嗽变异性哮喘45例（40.5%）,上气道咳嗽综合征34例（30.6%）,感染后咳嗽19例（17.1%）,过敏性咳嗽5例（4.5%）,多发性抽动4例（3.6%）,心因性咳嗽1例（0.9%）,支气管内膜结核1例（0.9%）,原因不明2例（1.8%）。60例（54.1%）慢性咳嗽为单个病因所致,47例（42.3%）有2种病因,2例（1.8%）有3种病因。结论：本组儿童慢性咳嗽的前3位病因依次为咳嗽变异性哮喘、上气道咳嗽综合征、感染后咳嗽。     

重庆地区202例儿童慢性咳嗽的病因研究

目的 探讨儿童慢性咳嗽的病因构成。方法 对2015年5月至2017年11月于重庆医科大学附属儿童医院住院治疗的202例慢性咳嗽患儿的临床资料进行回顾性分析。结果 202例患儿的病因分布为：感染后咳嗽81例（40.1%）,咳嗽变异性哮喘71例（35.1%）,上气道咳嗽综合征43例（21.3%）,异物吸入3例（1.5%）,胃食管反流性咳嗽1例（0.5%）,多发性抽动症2例（1.0%）,先天性呼吸道疾病1例（0.5%）。119例（58.9%）慢性咳嗽是单病因所致,83例（41.1%）有多种病因。不同年龄组（< 1岁、1岁~、3岁~、6~14岁）和不同咳嗽性质组（湿咳、干咳）慢性咳嗽病因构成差异均有统计学意义（P < 0.01）。结论 儿童慢性咳嗽的前三位主要病因为：感染后咳嗽、咳嗽变异性哮喘和上气道咳嗽综合征;不同年龄阶段及不同咳嗽性质的患儿其慢性咳嗽的主要病因存在差异。     

小儿慢性咳嗽的病因分析

目的：研究儿童慢性咳嗽的病因。方法：对2010年8月至2011年9月132例慢性咳嗽患儿的临床资料进行回顾性分析,调查慢性咳嗽的病因构成。结果：咳嗽变异性哮喘是慢性咳嗽最常见的病因（56例次）,其次为上气道咳嗽综合征（44例次）、感染/感染后咳嗽（22例次）、变应性咳嗽（8例次）、胃食管反流性咳嗽（5例次）,3例次为其他病因。感染/感染后咳嗽在婴儿组（<1岁）、幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）间的病因分布差异有统计学意义（χ2=11.638,P=0.001）,其中<1岁的婴儿组感染/感染后咳嗽的比例高于其他3个年龄组（P<0.05）。感染/感染后咳嗽是婴儿组（<1岁）慢性咳嗽的主要病因,咳嗽变异性哮喘和上气道咳嗽综合征是幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）慢性咳嗽的主要病因。变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征患儿有较高比例的个人过敏史、不良外界环境接触史以及家族过敏/哮喘史。结论：咳嗽变异性哮喘、上气道咳嗽综合征、感染/感染后咳嗽是儿童慢性咳嗽的主要病因。不同年龄组患儿慢性咳嗽的主要病因不同。具有个人过敏史、不良外界环境接触史以及家族过敏/哮喘史的慢性咳嗽患儿更易患变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征。     

临床特征对儿童慢性咳嗽常见病因诊断的价值

目的 对慢性咳嗽常见病因的临床特征进行研究,分析其对各病因诊断的价值.方法 选取2008年1月 - 2009年12月门诊就诊的慢性咳嗽初诊患儿496例,按慢性咳嗽诊断程序作出慢性咳嗽初步诊断并按时随访,根据随访患儿治疗效果得出最终诊断.结果 496例患儿中感染后咳嗽(PIC)69例,咳嗽变异性哮喘(CVA)和变应性咳嗽(AC)219例,上气道咳嗽综合征(UACS)139例.CVA的临床特征主要为夜间咳嗽、干性咳嗽、特应性体质;UACS的临床特征主要为湿痰咳嗽、晨起咳嗽.结论 儿童慢性咳嗽主要病因为CVA、UACS、AC和PIC.各种病因的慢性咳嗽具有其主要的临床特征,其病因构成及临床特征可为经验性诊治慢性咳嗽提供参考.     

纤维支气管镜检查在儿童慢性咳嗽中的诊断价值

目的：探讨和分析纤维支气管镜检查在诊断小儿慢性咳嗽中的应用价值。方法：2006年1月至2007年3月,对原因不明或常规治疗效果不佳的反复或持续性咳嗽时间超过1个月的慢性咳嗽患儿118例,男73例,女45例,年龄3个月至13岁,应用纤维支气管镜,在局部麻醉下进行病因检查和局部治疗。结果：118例患儿中有115例获病因诊断,最多见的原因依次为反复感染（39例）、支气管异物（19例,其中18例成功取出）、上呼吸道咳嗽综合征（17例）、支气管哮喘或咳嗽变异性哮喘(17例),其他较少见的有喉-气管-支气管软化、先天畸形、纤毛不动综合征等。结论：儿科开展纤维支气管镜术对儿童慢性咳嗽的病因诊断具有重要价值,是一种安全有效的检查方法。     

儿童非特异性慢性咳嗽病因及与TRPV1基因多态性的关系

目的：研究儿童非特异性慢性咳嗽病因及与瞬时感受器离子通道受体1 (TRPV1) 基因多态性的关系。方法：对195例非特异性慢性咳嗽患儿首次就诊后半个月、1个月、3个月进行随访,以明确病因。采用聚合酶链反应限制性酶切片段多态性 (PCR-RFLP)方法对其进行TRPV1基因rs222747、rs222748、rs8065080位点的基因型和等位基因分析。205例健康或无慢性咳嗽的外科患儿作为对照。结果：195例非特异性慢性咳嗽患儿病因分布如下：咳嗽变异性哮喘（CVA）96例（49.2%）、CAV合并上气道咳嗽综合征（CVA+UACS）48例（24.6%）、感染后咳嗽34例（17.4%）、上气道咳嗽综合征（UACS）17例（8.7%）。 TPPV1基因rs222747、rs222748、rs8065080位点均可检出3种基因型：rs222747（CC、GC、GG）;rs222748（CC、TC、TT）;rs8065080（CC、TC、TT）。rs222747位点基因多态性分布不符合Hardy-Weinberg定律,故未进行下一步分析。慢性咳嗽组和对照组比较rs222748位点、rs8065080位点基因型和等位基因频率经Bonferroni多重检验校正差异均无统计学意义。结论：非特异性慢性咳嗽患儿中CVA、UACS、感染后咳嗽是引起儿童慢性咳嗽的主要病因。TRPV1基因rs222748和rs8065080位点基因多态性可能与非特异性慢性咳嗽的发生无关。     

中国儿童慢性咳嗽病因构成比多中心研究

目的 了解中国儿童慢性咳嗽的病因分布及构成比,推动其诊治的标准化和规范化.方法 根据2008年中华医学会儿科学分会呼吸学组制定的《儿童慢性咳嗽诊断和治疗指南》,设计儿童慢性咳嗽病因调查表,组织全国19个省、直辖市、自治区共29所医院前瞻性入组慢性咳嗽病例并完成3个月随访;对汇总的各项数据统计分析、得出全国儿童慢性咳嗽病因构成比等.结果 实际入组病例数共4582例,合格病例4529例,合格率98.80％.列病因构成比前3位的分别是咳嗽变异性哮喘1900例(41.95％)、上气道咳嗽综合征1119例(24.71％)、呼吸道感染和感染后咳嗽984例(21.73％).胃食管反流28例(占0.62％);其他病因者498例(11.00％),其中多病因者占387例(8.54％),首位是上气道咳嗽综合征合并有咳嗽变异性哮喘(占50.13％),其次是呼吸道感染和感染后咳嗽合并上气道咳嗽综合征占(26.10％).总诊断修正率18.83％.不同病因在不同性别间和不同年龄间的分布是有显著差异的,不同病因致慢性咳嗽的好发时相各有特点.结论 中国儿童慢性咳嗽的主要病因构成比依次为咳嗽变异性哮喘、上气道咳嗽综合征、呼吸道感染和感染后咳嗽和其他各种病因,要注意多病因和病因未明的病例.不同年龄和不同性别组儿童慢性咳嗽病因构成比是不同的.要重视观察、等待和随访的原则.     

纤维支气管镜术在小儿慢性咳嗽诊断及治疗中的价值

目的 探讨纤维支气管镜(纤支镜)术在小儿慢性咳嗽诊断及治疗中的价值.方法 对2006年8月-2011年3月在本院应用纤支镜进行检查和(或)治疗的61例慢性咳嗽患儿的临床资料进行回顾性分析.病例均采用局部麻醉的方法,而且患儿均经临床程序排除咳嗽变异性哮喘和胃食管反流.通过镜下直视、支气管刷检及肺泡灌洗液,明确病因诊断;应用支气管肺泡灌洗、局部注药和钳取异物进行治疗,并对疗效做出评价.结果 61例患儿中男36例,女25例;年龄8个月～13岁.61例患儿镜下炎性改变21例(34.5％),先天性心肺发育畸形12例(19.7％),支气管异物10例(16.4％),上呼吸道咳嗽综合征8例(13.1％),支气管内膜结核7例(11.5％),未见异常3例(4.9％).气管黏膜刷检涂片找到革兰阳性细菌和(或)革兰阴性细菌12例(12/31例,38.7％),肺泡灌洗液细菌培养阳性5例(5/40例,12.5％),未找到抗酸杆菌和癌细胞.对镜下炎性改变重、有痰栓阻塞者经纤支镜行支气管灌洗治疗,取得较好疗效.10例支气管异物经纤支镜成功取出8例.结论 小儿慢性咳嗽经纤支镜检查发现以炎症及支呼吸管异物多见,婴幼儿期慢性咳嗽应警惕心肺发育异常及呼吸道异物.纤支镜检查对儿童慢性咳嗽的病因诊断与治疗具有重要价值,尤其对先天性心肺发育畸形及支气管细小异物的诊断有独特价值.     

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目的探讨慢性孤立性咳嗽的病因诊断及其程序。方法从首都医科大学附属北京儿童医院2003年10月至2004年8月在门诊就诊的58例慢性咳嗽患儿中,首先筛选慢性孤立性咳嗽病例,进一步根据咳嗽特征、辅助检查、治疗反应等确定慢性孤立性咳嗽的病因。结果在58例慢性咳嗽的患儿中,筛选出慢性孤立性咳嗽50例,其中鼻后滴流综合征20例(8例慢性副鼻窦炎,6例慢性过敏性鼻炎,6例感染后鼻炎)、咳嗽变异性哮喘17例、感染后咳嗽5例、心理性咳嗽4例、原发性胃食道反流1例、嗜酸粒细胞性支气管炎2例、未明原因1例。结论儿童慢性孤立性咳嗽的病因有鼻后滴流综合征、咳嗽变异性哮喘、感染后咳嗽、心理性咳嗽等。根据咳嗽特征、辅助检查、治疗反应等能确定绝大多数慢性孤立性咳嗽的病因。