儿童慢性咳嗽常见病因诊断与中医证素分布规律研究
发布时间：2018-08-21 19:27
【摘要】：目的:1.分析儿童慢性咳嗽病因构成,探讨病史特征、临床特征及辅助检查等在慢性咳嗽常见病因中分布情况。2.探讨慢性咳嗽发病的危险因素。3.明确儿童慢性咳嗽的中医病位、病性证素特点及其组合规律,为提高临床辨证论治水平以及制定防治方案提供依据。方法:本研究采用前瞻性临床调查研究,设计《儿童慢性咳嗽临床调查表》,通过询问病史、收集临床资料、临床特征,结合辅助检查、诊断性治疗等,进行病因诊断,于首、诊后2周、1个月、3个月进行电话或者门诊随访,通过病情变化、临床疗效等评价诊断的准确性,探讨临床资料、临床特征与病因诊断的相关性。通过收集患者四诊资料、《证候要素调查表》等,研究慢性咳嗽病性、病位特点及其分布规律。所有纳入病例均建立数据库,本次研究所有数据通过Excel录入建立数据库,采用SPSS17.0统计软件包进行统计分析,计量资料用均数土标准差表示,计数资料计算构成比及率,组间比较采用卡方检验或精确概率法,多因素分析采用非条件逐条Logistic回归分析等统计方法。结果:1.病因构成:本研究共收集病例295例,剔除非常见病因与诊疗结束后不明原因咳嗽16例(5.42%),符合研究要求常见病因病例共279例(94.58%),其中上气道咳嗽综合征(UJACS)79例(26.780%),咳嗽变异性哮喘(CVA)91例(30.85%),呼吸道感染后咳嗽(PIC)90例(30.51%),多病因19例(6.44%)。不同年龄组其病因构成不同,婴幼儿组(0～3岁)以PIC36例为主要病因,占42.86%,其次为CVA26例(30.95%),UACS19例(22.62),多病因3例(3.57%);学龄前期组(3～6岁)三大病因构成比例接近;学龄期组以CVA23例(38.33%)为主,其次为UACS19例(31.67%),PIC12例(20.0%)最少。2.病史特征:慢性咳嗽发病的病史特征主要为过敏史、环境因素、气候因素。研究显示,家族性过敏性鼻炎病史、家族性哮喘病史、患者食物过敏史、湿疹或特异性皮炎等过敏情况在慢性咳嗽不同病因中存在的差异有统计学意义(P＜0.05),而药物过敏史在慢性咳嗽不同病因中差异无统计学意义。居住地环境主要潮湿、灰尘、宠物、花草、新装修、被动吸烟等危险因素,CVA与UACS患者居住地多潮湿或灰尘,而PIC患者多数居住环境良好。3.危险因素:研究表明,UACS危险因素包括:家族成员吸烟(烟草环境暴露)、白天咳嗽、卧位时咳嗽、鼻塞等4个因素,具有统计学意义(P＜0.05)而抗生素使用、夜间入睡后咳嗽、冷空气或异味刺激等3个因素为UACS的保护因素(P＜0.05);CVA危险因素包括:家族过敏性鼻炎病史、家族哮喘病史、冷空气或异味刺激、过敏原等4个因素,具有统计学意义(P＜0.05),而抗生素使用、卧位时咳嗽为CVA保护因素;PIC危险因素包括:气候变化因素、抗生素使用等2个因素,具有统计学意义(P＜0.05)而家族过敏性鼻炎、清晨咳嗽、白天咳嗽、冷空气或异味刺激、喷嚏、清咽等6个因素为呼吸道感染后咳嗽保护因素。4.病位证素:慢性咳嗽病位证素分布频次从高到低依次为肺261例(93.55%)、表 238 例(85.30%)、脾 96 例(34.41%)、胃 49 例(17.56%)、肾4 例(1.430%)、心 3例(1.08%)、肝1例(0.360%)。病位证素体现慢性咳嗽核心病位为肺,需重视外感表证,同时需重视五脏功能失调导致肺失宣降、肺气上逆发为咳嗽。不同病因组病位证素组合形式,二病位组合出现频率最高,UACS组与CVA组病位证素组合以三病位组合、四病位组合等相关常见,PIC组则单一病位情况相对常见。5.病性证素:慢性咳嗽病性证素分布频次从高到低依次为气虚180例(64.52%)、痰 123 例(69.42%)、阳虚 105 例(37.63%)、血虚 89 例(31.90%)、外风 82 例(29.39%)、寒 63 例(22.58%)、阴虚 61 例(21.86%)、湿 46 例(16.49%)、饮 15 例(5.38%)、气滞 14 例(5.02%)、热 11 例(3.94%)、燥 10 例(3.58%)、食积 4 例(1.43%)。不同病因组病性证素组合形式,UACS组与CVA组以四病性以上组合多见;PIC组则以单一病性为主,频率为43.33%;不同病因组均出现未明确病性情况。6.病位与病性组合形式:不同病因病位与病性组合规律中,其中UACS组病位与病性组合出现多种类型,各类型出现频次较低;CVA组中,二病位与病性组合"肺+表+气虚"出现频数与频率为76(83.52%),三病位与病性证素组合"肺+表+脾+气虚"出现频率为51(56.04%)。PIC组中,二病位"肺+表"出现频数、频率为60(66.67%),单一病性与二病位为主要组合特点,包括"气虚+肺、表"、"痰+肺、表"等组合形式。结论:1.慢性咳嗽常见病因包括:咳嗽变异性哮喘(CVA)、上气道咳嗽综合征(UACS)合呼吸道感染后咳嗽(PIC)。研究表明,不同年龄组慢性咳嗽病因构成不同;其中婴幼儿组以PIC为主,其次为CVA,学龄前期组慢性咳嗽三大病因分布较均匀,而学龄期组儿童慢性咳嗽以CVA为主,其次为UACS。2.慢性咳嗽相同病因不同年龄组间病程存在差异,其中学龄期组CVA的病程最长。3.通过多因素非条件Logistics回归分析表明,UACS危险因素包括家族成员吸烟(烟草环境暴露)、白天咳嗽、卧位时咳嗽、鼻塞等4个因素;CVA危险因素包括家族过敏性鼻炎病史、家族哮喘病史、冷空气或异味刺激、过敏原等4个因素;PIC危险因素包括:气候变化因素、抗生素使用等2个因素。4.通过收集患者四诊资料及临床证候要素,结果表明慢性咳嗽主要病位为肺、外表、脾、胃、肾等;病性证素主要为气虚、痰、阳虚、血虚、寒、阴虚、湿、热、气滞、燥、饮、食积等。
[Abstract]:Objective: 1. To analyze the etiological components of chronic cough in children and explore the distribution of history, clinical features and auxiliary examinations in the common causes of chronic cough. 2. To explore the risk factors of chronic cough. 3. To clarify the location of children's chronic cough, characteristics of disease-related syndromes and their combination rules, so as to improve the level of clinical syndrome differentiation and treatment and to improve the level of clinical treatment. Methods: A prospective clinical investigation was conducted to design a clinical questionnaire for chronic cough in children. The etiological diagnosis was made by inquiring medical history, collecting clinical data, clinical characteristics, combined with auxiliary examination and diagnostic treatment. The patients were followed up by telephone or outpatient clinic in the first two weeks, one month and three months after the diagnosis. The accuracy of diagnosis was evaluated by changes of disease condition and clinical effect, and the correlation between clinical data, clinical characteristics and etiological diagnosis was discussed. The data were analyzed by SPSS17.0 statistical software package. The measurement data were expressed by mean soil standard deviation. The composition ratio and rate of the counting data were calculated. Chi-square test or exact probability method was used for comparison among groups. Unconditional logistic regression analysis was used for multivariate analysis. A total of 295 cases were collected, excluding 16 cases (5.42%) with unexplained cough after diagnosis and treatment. 279 cases (94.58%) with common causes met the research requirements, including 79 cases (26.780%) with upper airway cough syndrome (UJACS), 91 cases (30.85%) with cough variant asthma (CVA), 90 cases (30.51%) with postinfectious cough (PIC) and 19 cases (6.4%) with multiple causes. There were 36 cases of PIC (42.86%) in the infant group (0-3 years old), followed by 36 cases of CVA2 (30.95%), 19 cases of UACS (22.62%), 3 cases of multiple causes (3.57%); the proportion of three major causes in the preschool group (3-6 years old) was close; the proportion of CVA2 3 cases (38.33%) in the school age group was the main cause, followed by 19 cases of UACS (31.67%) and 12 cases of PIC1 (20.0%). History characteristics: The history of chronic cough is mainly allergic history, environmental factors, climate factors. Research shows that familial allergic rhinitis history, familial asthma history, patients with food allergy history, eczema or specific dermatitis and other allergic conditions in different causes of chronic cough were significantly different (P < 0.0). 5) The history of drug allergy had no significant difference among the different causes of chronic cough. The main risk factors for UACS were humidity, dust, pets, flowers and plants, new decoration, passive smoking and so on. Four factors were statistically significant (P Air or odor stimulation, allergen and other four factors were statistically significant (P Six factors including taste stimulation, sneezing and pharynx clearance were the protective factors of cough after respiratory tract infection. 4. Syndrome elements: the distribution frequency of chronic cough syndrome elements was from high to low in order: lung 261 cases (93.55%), surface 238 cases (85.30%), spleen 96 cases (34.41%), stomach 49 cases (17.56%), kidney 4 cases (1.430%), heart 3 cases (1.08%) liver 1 case (0.360%). The core of cough is lung, which needs to pay attention to the external symptoms, and the dysfunction of the five viscera leading to lung arrhythmia, and the reversal of lung qi is cough. Pathogenic syndrome elements: chronic cough syndrome elements from high to low frequency distribution of 180 cases (64.52%), sputum 123 cases (69.42%), Yang deficiency 105 cases (37.63%), blood deficiency 89 cases (31.90%), wind 82 cases (29.39%), cold 63 cases (22.58%), Yin deficiency 61 cases (21.86%), wet 46 cases (16.49%), drinking 15 cases (5.38%) and qi stagnation 14 cases (5.38%). There were 11 cases of fever (3.94%), 10 cases of dryness (3.58%) and 4 cases of food accumulation (1.43%). In combination rule, there were many types of disease location and disease combination in UACS group, and the frequency of each type was lower; in CVA group, the frequency and frequency of lung + surface + Qi deficiency in two disease location and disease combination were 76 (83.52%) and 51 (56.04%) respectively. The frequency was 60 (66.67%). The main combination of single disease and secondary disease was Qi deficiency + lung, surface, sputum + lung, surface. Conclusion: 1. The common causes of chronic cough include cough variant asthma (CVA), upper airway cough syndrome (UACS) and postinfectious cough (PIC). Among them, PIC was the main cause of chronic cough, followed by CVA in infant group, and CVA was the main cause of chronic cough in preschool group, while CVA was the main cause of chronic cough in school-age group, followed by UACS.2. The same cause of chronic cough was different among different age groups, and the course of CVA in school-age group was the longest.3. Statistical regression analysis showed that the risk factors of UACS included family members'smoking (tobacco exposure), daytime cough, cough in decubitus position and nasal congestion; CVA risk factors included family history of allergic rhinitis, family history of asthma, cold air or odor stimulation, allergens; and PIC risk factors included climate change, antibiotics. 4. By collecting the four diagnostic data and clinical syndromes, the results showed that the main sites of chronic cough were lung, appearance, spleen, stomach, kidney, etc. The main syndromes were Qi deficiency, phlegm, Yang deficiency, blood deficiency, cold, Yin deficiency, dampness, heat, Qi stagnation, dryness, drinking, food accumulation and so on.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R272
[Abstract]:Objective: 1. To analyze the etiological components of chronic cough in children and explore the distribution of history, clinical features and auxiliary examinations in the common causes of chronic cough. 2. To explore the risk factors of chronic cough. 3. To clarify the location of children's chronic cough, characteristics of disease-related syndromes and their combination rules, so as to improve the level of clinical syndrome differentiation and treatment and to improve the level of clinical treatment. Methods: A prospective clinical investigation was conducted to design a clinical questionnaire for chronic cough in children. The etiological diagnosis was made by inquiring medical history, collecting clinical data, clinical characteristics, combined with auxiliary examination and diagnostic treatment. The patients were followed up by telephone or outpatient clinic in the first two weeks, one month and three months after the diagnosis. The accuracy of diagnosis was evaluated by changes of disease condition and clinical effect, and the correlation between clinical data, clinical characteristics and etiological diagnosis was discussed. The data were analyzed by SPSS17.0 statistical software package. The measurement data were expressed by mean soil standard deviation. The composition ratio and rate of the counting data were calculated. Chi-square test or exact probability method was used for comparison among groups. Unconditional logistic regression analysis was used for multivariate analysis. A total of 295 cases were collected, excluding 16 cases (5.42%) with unexplained cough after diagnosis and treatment. 279 cases (94.58%) with common causes met the research requirements, including 79 cases (26.780%) with upper airway cough syndrome (UJACS), 91 cases (30.85%) with cough variant asthma (CVA), 90 cases (30.51%) with postinfectious cough (PIC) and 19 cases (6.4%) with multiple causes. There were 36 cases of PIC (42.86%) in the infant group (0-3 years old), followed by 36 cases of CVA2 (30.95%), 19 cases of UACS (22.62%), 3 cases of multiple causes (3.57%); the proportion of three major causes in the preschool group (3-6 years old) was close; the proportion of CVA2 3 cases (38.33%) in the school age group was the main cause, followed by 19 cases of UACS (31.67%) and 12 cases of PIC1 (20.0%). History characteristics: The history of chronic cough is mainly allergic history, environmental factors, climate factors. Research shows that familial allergic rhinitis history, familial asthma history, patients with food allergy history, eczema or specific dermatitis and other allergic conditions in different causes of chronic cough were significantly different (P < 0.0). 5) The history of drug allergy had no significant difference among the different causes of chronic cough. The main risk factors for UACS were humidity, dust, pets, flowers and plants, new decoration, passive smoking and so on. Four factors were statistically significant (P Air or odor stimulation, allergen and other four factors were statistically significant (P Six factors including taste stimulation, sneezing and pharynx clearance were the protective factors of cough after respiratory tract infection. 4. Syndrome elements: the distribution frequency of chronic cough syndrome elements was from high to low in order: lung 261 cases (93.55%), surface 238 cases (85.30%), spleen 96 cases (34.41%), stomach 49 cases (17.56%), kidney 4 cases (1.430%), heart 3 cases (1.08%) liver 1 case (0.360%). The core of cough is lung, which needs to pay attention to the external symptoms, and the dysfunction of the five viscera leading to lung arrhythmia, and the reversal of lung qi is cough. Pathogenic syndrome elements: chronic cough syndrome elements from high to low frequency distribution of 180 cases (64.52%), sputum 123 cases (69.42%), Yang deficiency 105 cases (37.63%), blood deficiency 89 cases (31.90%), wind 82 cases (29.39%), cold 63 cases (22.58%), Yin deficiency 61 cases (21.86%), wet 46 cases (16.49%), drinking 15 cases (5.38%) and qi stagnation 14 cases (5.38%). There were 11 cases of fever (3.94%), 10 cases of dryness (3.58%) and 4 cases of food accumulation (1.43%). In combination rule, there were many types of disease location and disease combination in UACS group, and the frequency of each type was lower; in CVA group, the frequency and frequency of lung + surface + Qi deficiency in two disease location and disease combination were 76 (83.52%) and 51 (56.04%) respectively. The frequency was 60 (66.67%). The main combination of single disease and secondary disease was Qi deficiency + lung, surface, sputum + lung, surface. Conclusion: 1. The common causes of chronic cough include cough variant asthma (CVA), upper airway cough syndrome (UACS) and postinfectious cough (PIC). Among them, PIC was the main cause of chronic cough, followed by CVA in infant group, and CVA was the main cause of chronic cough in preschool group, while CVA was the main cause of chronic cough in school-age group, followed by UACS.2. The same cause of chronic cough was different among different age groups, and the course of CVA in school-age group was the longest.3. Statistical regression analysis showed that the risk factors of UACS included family members'smoking (tobacco exposure), daytime cough, cough in decubitus position and nasal congestion; CVA risk factors included family history of allergic rhinitis, family history of asthma, cold air or odor stimulation, allergens; and PIC risk factors included climate change, antibiotics. 4. By collecting the four diagnostic data and clinical syndromes, the results showed that the main sites of chronic cough were lung, appearance, spleen, stomach, kidney, etc. The main syndromes were Qi deficiency, phlegm, Yang deficiency, blood deficiency, cold, Yin deficiency, dampness, heat, Qi stagnation, dryness, drinking, food accumulation and so on.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R272
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