气道神经源性炎症介质在儿童感染后咳嗽的变化及临床意义

目的 观察感染后咳嗽（post infection cough,PIC）患儿气道分泌物神经肽变化,探讨其在该症发病机制中的作用及临床意义.方法 选择PIC患儿52例作为PIC组,另选择30例支气管肺炎患儿作为肺炎组,观察两组痰细胞分类及P物质（SP）、神经激肽A（NKA）、神经激肽B（NKB）和降钙素基因相关肽（CGRP）浓度在治疗前后的变化.结果 两组痰细胞分类比较：肺炎组抗感染治疗前中性粒细胞、巨噬细胞、淋巴细胞较PIC组明显升高（P＜0.05）；抗感染治疗后肺炎组中性粒细胞、巨噬细胞、淋巴细胞明显下降（P ＜0.01）；PIC组治疗前后痰细胞分类无明显变化（P＞0.05）；治疗后两组痰细胞分类比较差异无统计学意义（P＞0.05）；两组嗜酸性粒细胞治疗过程中无明显变化（P＞0.05）.两组神经源性炎症介质比较：PIC组抗感染治疗前SP和CGRP分别为（538.4 ＆#177;432.2）ng/L、（123.6 ＆#177;70.2）ng/L,肺炎组分别为（613.2 ＆#177;345） ng/L、（156.2＆#177;82.6）ng/L,差异无统计学意义（P＞0.05）；抗感染治疗后PIC组SP和CGRP分别为（552.8 ＆#177;421.7） ng/L、（133.5 ＆#177;81.3） ng/L,与治疗前对比无明显变化（P＞0.05）；抗感染治疗后肺炎组SP和CGRP明显下降,分别为（156.2＆#177;131.2） ng/L、（741.2＆#177;35.4） ng/L（P＜0.01）；治疗后两组SP和CGRP浓度存在显著差异（P ＜0.01）；NKA和NKB在治疗前后无明显变化.结论 SP和CGRP介导的气道神经源性炎症参与气道的急性和慢性感染过程,PIC患儿伴随SP和CGRP的持续升高,提示其与PIC的发病密切相关,SP和CGRP可作为早期检测感染后慢性咳嗽的参考指标.

The change and diagnostic value of airway neurogenic inflammatory mediators in post infection cough

Objective To observe the change of neuropeptide of the infant patients with post infection cough （PIC） and explore the possible pathogenesis and diagnostic value.Methods Fifty-two cases with PIC in our hospital were selected as PIC group,while thirty infant patients with bronchopneumonia as pneumonia group.Phlegm cells classification and substance P（S P）,neurokinin（NKA）,neurokinin （NKB）,calcitonin gene-related peptide （CGRP） concentration of the patients in both groups were compared.Results Phlegm cells classification of the two groups showed that,compared with the PIC group,the neutrophils,macrophages,and lymphocytes of the infant patients in the pneumonia group were obviously higher （P 〈 0.05）.After anti-infection treatment,the neutrophils,macrophages and lymphocytes of the infant patients in the pneumonia group were obviously lower（P 〈 0.01）.The phlegm cells classification of the PIC group had not changed significantly before and after treatment （P 〉 0.05）.After treatment,the phlegm cells classification of both groups had no significant difference （P 〉 0.05）.During the progress of treatment,there was no evident change for the eosinophils （P 〉 0.05）.Neuropeptide of the two groups showed that,before treatment,the SP and CGRP of the patients in the PIC group were （538.4 ＆#177;432.2） ng/L,（123.6 ＆#177;70.2） ng/L,and that in the pneumonia group were （613.2 ＆#177; 345） ng/L,（156.2 ＆#177; 82.6） ng/L.There was no significant difference （P 〉 0.05）.After treatment,the SP and CGRP of the PIC group were （552.8 ＆#177; 421.7） ng/L,（133.5 ＆#177; 81.3） ng/L,and there was no significant difference （P 〉0.05）.While the SP and CGRP of the patients in the pneumonia group were （156.2 ＆#177; 131.2） ng/L,（741.2 ＆#177; 35.4） ng/L,they were obviously lower （P 〈 0.01）.There was statistical difference compared with the PIC group after treatment （P 〈 0.01）.The NKA and NKB had not changed significantly before and after treatment.Conclusion Airway neurogenic inflammation mediated SP and CGRP plays a key role in the acute and chronic infections.The increase of SP and CGRP is closely related to the morbidity of PIC.So SP and CGRP is a reference index for early detection of PIC.