重庆地区儿童非特异性慢性咳嗽病因研究及与TRPV1基因多态性关系研究

发布时间：2018-05-07 13:12

本文选题：慢性咳嗽 + 咳嗽变异性哮喘　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：了解引起儿童非特异性慢性咳嗽病因及咳嗽变异性哮喘(cough variant asthma, CVA)出现喘息的危险因素,并探讨瞬时感受器离子通道受体1(transient receptor potential vanilloid-1, TRPV1)基因与儿童非特异性慢性咳嗽相关性。方法：采用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(试行)》的诊断程序,对2008年6月至2010年10月在重庆医科大学附属儿童医院就诊的451例(男255例,女196例,年龄：1～14岁,平均年龄：5.3±3.1岁)慢性咳嗽(咳嗽4周)患儿经过详细询问病史、体格检查及辅助检查得出初步诊断。首次就诊后半个月、1个月、3个月随访患儿情况,及时修正诊断并制定下一步治疗方案,直至随访结束。2008年6月至2009年10月在重庆医科大学附属儿童医院就诊的105例咳嗽变异性哮喘患儿(男56例,女49例,年龄：1～14岁,平均年龄：4.59±2.17岁)进行2年随访,并建议每3月复诊1次,记录期间有无出现喘息或呼吸困难。患儿于初诊时进行肺功能测试、过敏原测试和胸片检查。采用聚合酶链反应限制性酶切片段多态性(polymerase chain reaction-restriction fragment length polymorphism, PCR-RFLP)方法对195例非特异性慢性咳嗽患儿及205例正常对照儿童进行TRPV1基因rs222747、rs222748、rs8065080位点的基因型和等位基因分析。结果：1.451例非特异性慢性咳嗽患儿经过12周随访后,172(38.1%)例患儿诊断为咳嗽变异性哮喘(cough variant asthma, CVA),136(30.2%)例为咳嗽变异性哮喘合并上气道咳嗽综合征(cough variantasthma and upper airway cough syndrome, CVA+UACS),77(17.1%)例为呼吸道感染和感染后咳嗽,57(12.6%)例为上气道咳嗽综合症(upper airway cough syndrome, UACS),3(0.7%)例为心因性咳嗽,6(1.3%)例为其它诊断(病因不明)。2.105例CVA患儿经过2年随访研究,24(22.9%)例患儿出现喘息(喘息组),喘息组和非喘息组多因素logistic回归分析示花粉过敏是CVA患儿出现喘息的危险因素(OR6.78,95%CI1.24-37.20,P=0.028)。3. TPPV1基因rs222747、rs222748、rs8065080位点均可检出3种基因型：rs222747(CC、C、GG); rs222748(CC、 TC、TT); rs8065080(CC、TC、TT)。经吻合度检验,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。非特异性慢性咳嗽组和正常对照组比较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：1.CVA、CVA+UACS、感染后咳嗽、UACS是引起儿童非特异性慢性咳嗽最常见的病因。2.CVA患者中22.9%出现喘息,花粉过敏可能是CVA患儿出现喘息的危险因素。3.TRPV1基因rs222748、 rs8065080位点基因型可能与非特异性慢性咳嗽的发生无关。
[Abstract]:Objective: to investigate the etiology of nonspecific chronic cough in children and the risk factors of wheezing in cough variant asthma (cough variant asthma, CVA), and to investigate the correlation between the gene of transient receptor 1(transient receptor potential vanilloid-1 (TRPV1) and the non-specific chronic cough in children. Methods: the diagnostic procedure of the guidelines for the diagnosis and treatment of chronic cough in Children (trial), which was formulated by the Respiratory Section of the Chinese Academy of Pediatrics in 2008, was used. From June 2008 to October 2010, 451 children (255 males and 196 females, aged from 1 to 14 years, with an average age of 5. 3 卤3. 1 years) who were admitted to the Children's Hospital affiliated to Chongqing Medical University were asked about their history of chronic cough (cough for 4 weeks). Medical examination and auxiliary examination to obtain the initial diagnosis. The children were followed up for half a month, one month and three months after the first visit, and the diagnosis was corrected and the next treatment plan was formulated. From June 2008 to October 2009, 105 children with cough variant asthma (56 males, 49 females, aged 1 to 14 years with an average age of 1: 4.59 卤2.17 years) who were admitted to the affiliated Children's Hospital of Chongqing Medical University were followed up for 2 years. It is recommended to return every 3 months to record any wheezing or dyspnea during the recording period. Lung function test, allergen test and chest radiography were performed at the first visit. The genotypes and alleles of TRPV1 gene rs222747 rs2247 and rs8065080 in 195 children with nonspecific chronic cough and 205 normal controls were analyzed by polymerase chain reaction restriction fragment polymorphism polymerase chain reaction-restriction fragment length polymorphism, PCR-RFLPmethod. Results 1. 451 children with nonspecific chronic cough were followed up for 12 weeks. One patient was diagnosed as cough variant asthma with cough variant asthma (CVA 13630.2) and cough variant asthma complicated with upper airway cough syndrome (cough variantasthma and upper airway cough syndrome, CVA UACSN 7717.1). Upper airway cough syndrome (upper airway cough syndrome), upper airway cough syndrome (upper airway cough syndrome), upper airway cough syndrome (upper airway cough), upper airway cough syndrome (upper airway cough syndrome), upper airway cough syndrome, upper airway cough syndrome Multivariate logistic regression analysis showed that pollen hypersensitivity was the risk factor of wheezing in children with CVA. Three genotypes of rs222747, rs222748, rs8065080, were detected, and three genotypes, rs222747, rs222748, tcttit, rs8065080, were detected. The polymorphism distribution of rs222747 locus was not in accordance with Hardy-Weinberg 's law, so no further analysis was made. There was no significant difference in genotype and allele frequency of rs222748 locus rs8065080 between non-specific chronic cough group and normal control group by Bonferroni multiple test. Conclusion: 1. CVA CVA UACS.After infection, UACS is the most common cause of chronic cough in children. 2. 22.9% of CVA patients have wheezing. Pollen allergy may be the risk factor of wheezing in children with CVA. 3. TRPV1 gene rs222748, rs8065080 locus genotype may not be associated with the occurrence of non-specific chronic cough.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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