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.

Prospective multicenter clinical study on the causes constituents ratio of chronic cough in Chinese children

Objective To understand the causes of chronic cough in children in China and the composition ratio of the distribution and to promote the standardization and normalization of its treatment.Method According to the 2008 Guidelines of diagnosis and treatment of chronic cough in children that were formulated by The Subspecialty Group of Respiratory Diseases,The Society of Pediatrics,Chinese Medical Association and the editorial board of Chinese Journal of Pediatrics we designed the questionnaire of the causes of chronic cough in children and organized 29 hospitals in 19 provinces,municipalities and autonomous regions to enroll cases with chronic cough and completed 3-month follow-up.The data were statistically analyzed and the causes constituents ratio of chronic cough was obtained. Result Of 4582cases,4529 were eligible( the passing rate of 98.8％ ).The leading 3 causes were cough variant asthma (CVA) in 1900 cases ( 41.95％ ),upper airway cough syndrome (UACS) in 1119 cases ( 24.71％ ),respiratory infections and post-infectious cough ( PIC ) in 984 cases ( 21.73％ ). Gastroesophageal reflux cough (GERC) found in 28 cases ( accounting for 0.62％ ) ; other causes were 498 cases ( 11％ ),in which 387 cases (8.54％) had multiple etiologies.The leading cause in UACS associated with CVA,which accounted for 50.13％,followed by PIC with UACS accounting for 26.10％.The total correct diagnosis rate was 18.83％.Among different causes in different gender and age distribution were significantly different.Conclusion The main causes of chronic cough in Chinese children are CVA,UACS,PIC and other causes.We should pay attention to the causes and cases of unknown etiology.Children in different age and gender groups have different constitute ratio of cause of chronic cough.