血及气道炎症水平在上气道咳嗽综合征诊治中的应用研究

发布时间：2018-03-09 03:27

本文选题：上气道咳嗽综合征　切入点：呼出气一氧化氮　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解上气道咳嗽综合征的临床特点,探究上气道咳嗽综合征体内血清炎症介质水平与气道炎症水平的关系,以期探究替代辐射性及创伤性检查的可能,为上气道咳嗽综合征的临床诊断及治疗提供临床依据。方法:采用回顾性分析的研究方法,选择2014年9月—2017年2月大连市儿童医院慢性咳嗽门诊就诊,除外近期呼吸道感染者、其他病因引起的慢性咳嗽者、先天呼吸道畸形、及免疫功能障碍者,对符合儿童上气道咳嗽综合症诊断标准的患儿进行临床症状、鼻窦CT结果、气道呼出气一氧化氮水平、血清白三烯水平分析总结,并对其气道呼出气一氧化氮与白三烯水平相关性进行分析。所得数据应用SPSS23.0软件进行统计学分析。结果:1.在符合纳入标准的108例患儿中,学龄组共39例,占总例数的36%,学龄前共69例,占总例数的64%。UACS患儿中学龄前组患儿多于学龄组患儿。2.在符合纳入标准108例UACS患儿中,UACS患儿中单一病因多于二重以上(包括二重病因),占57.4%。其中接受鼻窦CT检查者共59例,其中确诊鼻窦炎的患儿45例,占76.3%,鼻窦未见明显异常者14例,占23.7%。鼻窦CT异常者明显多于鼻窦CT正常者,占76.3%。3.符合纳入标准的108例UACS患儿中完成血清白三烯检测的共62例,UACS患儿中血清白三烯异常者多于血清白三烯正常者,占81.2%。符合纳入标准的108例UACS患儿中完成FeNO检测的共89例,UACS患儿中FeNO异常者多于FeNO正常者,占61.2%。符合纳入标准的108例UACS患儿中完成NNO检测的共86例,其中鼻塞组共32例,占37.2%,非鼻塞组共54例,占62.8%。两组的nNO结果经独立样本t检验,鼻塞组患儿nNO浓度小于非鼻塞组患儿nNO浓度,P0.05,差异性具有统计学意义。4.在符合纳入标准的108例UACS患儿中,其中均能够有效完成nNO检测与血清白三烯的患儿有31例,两者经Spearman相关检验,两者具有正相关性,P0.05,具有统计学意义;在符合纳入标准的108例UACS患儿中,均能够有效完成血清白三烯与FeNO检测的患儿有50例,两者经Spearman相关检验,两者具有正相关性,P0.05,具有统计学意义;在符合纳入标准的108例UACS患儿中,其中均能够有效完成nNO与FeNO检测的患儿有44例,两者进行Spearman相关检验,两者具有正相关性,P0.05,具有统计学意义。结论:1.在UACS患儿中,2/3的患儿为学龄前期,多以单一因素为主。2.UACS患儿nNO、FeNO、血清白三烯水平均有不同程度的升高;nNO水平无鼻塞者明显高于有鼻塞者,鼻塞可以影响患儿鼻部炎症水平的评估,需经过对症治疗,鼻塞症状缓解后再次进行鼻部气道炎症水平的监测。3.UACS患儿血清白三烯水平与气道炎症水平呈正相关,UACS患儿nNO水平、FeNO水平呈正相关。
[Abstract]:Objective: to investigate the clinical characteristics of upper airway cough syndrome and the relationship between the level of serum inflammatory mediators and the level of airway inflammation in order to explore the possibility of radiation substitution and traumatic examination. Methods: retrospective analysis was used to select the outpatient clinic of chronic cough in Dalian Children's Hospital from September 2014 to February 2017, with the exception of recent respiratory infections, and to provide clinical basis for the diagnosis and treatment of upper airway cough syndrome. Patients with chronic cough caused by other causes, congenital respiratory malformation, and immune dysfunction were treated with clinical symptoms, nasal sinus CT findings, level of nitric oxide (no) exhaled in the airway, which met the diagnostic criteria of upper airway cough syndrome in children. The serum leukotriene level was analyzed and summarized, and the correlation between nitric oxide and leukotriene level in airway exhalation was analyzed. The data were statistically analyzed by SPSS23.0 software. Results: 1. Among 108 children who met the inclusion criteria, There were 39 cases in the school-age group, accounting for 36% of the total cases, 69 cases in the preschool group, 64% of the total number of patients with UACS was more than that of the school-age group. 2. Among the 108 children who met the inclusion criteria, the single cause of UACS was more than double (including double etiology, 57.4%). 59 of them underwent CT examination of paranasal sinuses. Among them, 45 cases (76.3%) were diagnosed as sinusitis, 14 cases (23.7m) had no obvious abnormality in paranasal sinusitis, the number of abnormal CT in paranasal sinus was significantly higher than that of normal CT in paranasal sinusitis. There were 62 children with UACS whose serum leukotrienes were abnormal than those with normal serum leukotriene. 81.2.Among the 108 patients with UACS who met the inclusion criteria, 89 patients with FeNO were more abnormal than those with normal FeNO, accounting for 61.2%. 86 of the 108 UACS children who met the inclusion criteria completed NNO detection, including 32 in the nasal congestion group. There were 54 cases in the non-nasal congestion group, accounting for 62.8%. The nNO concentration in the nasal congestion group was lower than that in the non-nasal congestion group (P 0.05), and the difference was statistically significant (P < 0.05). Among the 108 UACS children who met the inclusion criteria, the nNO concentration in the nasal congestion group was lower than that in the non-nasal congestion group (P 0.05). There were 31 children who were able to complete nNO detection and serum leukotriene effectively, both of them had positive correlation (P 0.05) by Spearman correlation test, and there were significant differences among 108 children with UACS who met the inclusion criteria. There were 50 children with serum leukotriene and FeNO, both of whom had positive correlation (P 0.05) by Spearman correlation test, and there were significant differences among 108 children with UACS who met the inclusion criteria. There were 44 children who were able to test nNO and FeNO effectively. They were tested by Spearman correlation test, which had a positive correlation (P 0.05). Conclusion: 1. 2 / 3 of children with UACS were pre-school children, and there was no significant difference between the two groups (P < 0. 05, P 0. 05, P 0. 05, P 0. 05, P < 0. 05). The level of serum leukotriene in children with UACS was significantly higher than that in patients without nasal congestion, and nasal congestion could affect the assessment of inflammation in children's nose, and needed to be treated with symptomatic treatment. The level of nasal airway inflammation was monitored again. 3. The level of leukotriene in serum was positively correlated with the level of airway inflammation. There was a positive correlation between the levels of nNO and FeNO in UACS children.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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