兒童慢性咳嗽常見病因診斷與中醫(yī)證素分布規(guī)律研究
發(fā)布時(shí)間：2018-08-21 19:27
【摘要】：目的:1.分析兒童慢性咳嗽病因構(gòu)成,探討病史特征、臨床特征及輔助檢查等在慢性咳嗽常見病因中分布情況。2.探討慢性咳嗽發(fā)病的危險(xiǎn)因素。3.明確兒童慢性咳嗽的中醫(yī)病位、病性證素特點(diǎn)及其組合規(guī)律,為提高臨床辨證論治水平以及制定防治方案提供依據(jù)。方法:本研究采用前瞻性臨床調(diào)查研究,設(shè)計(jì)《兒童慢性咳嗽臨床調(diào)查表》,通過詢問病史、收集臨床資料、臨床特征,結(jié)合輔助檢查、診斷性治療等,進(jìn)行病因診斷,于首、診后2周、1個(gè)月、3個(gè)月進(jìn)行電話或者門診隨訪,通過病情變化、臨床療效等評(píng)價(jià)診斷的準(zhǔn)確性,探討臨床資料、臨床特征與病因診斷的相關(guān)性。通過收集患者四診資料、《證候要素調(diào)查表》等,研究慢性咳嗽病性、病位特點(diǎn)及其分布規(guī)律。所有納入病例均建立數(shù)據(jù)庫(kù),本次研究所有數(shù)據(jù)通過Excel錄入建立數(shù)據(jù)庫(kù),采用SPSS17.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料用均數(shù)土標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料計(jì)算構(gòu)成比及率,組間比較采用卡方檢驗(yàn)或精確概率法,多因素分析采用非條件逐條Logistic回歸分析等統(tǒng)計(jì)方法。結(jié)果:1.病因構(gòu)成:本研究共收集病例295例,剔除非常見病因與診療結(jié)束后不明原因咳嗽16例(5.42%),符合研究要求常見病因病例共279例(94.58%),其中上氣道咳嗽綜合征(UJACS)79例(26.780%),咳嗽變異性哮喘(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%)。不同年齡組其病因構(gòu)成不同,嬰幼兒組(0～3歲)以PIC36例為主要病因,占42.86%,其次為CVA26例(30.95%),UACS19例(22.62),多病因3例(3.57%);學(xué)齡前期組(3～6歲)三大病因構(gòu)成比例接近;學(xué)齡期組以CVA23例(38.33%)為主,其次為UACS19例(31.67%),PIC12例(20.0%)最少。2.病史特征:慢性咳嗽發(fā)病的病史特征主要為過敏史、環(huán)境因素、氣候因素。研究顯示,家族性過敏性鼻炎病史、家族性哮喘病史、患者食物過敏史、濕疹或特異性皮炎等過敏情況在慢性咳嗽不同病因中存在的差異有統(tǒng)計(jì)學(xué)意義(P＜0.05),而藥物過敏史在慢性咳嗽不同病因中差異無(wú)統(tǒng)計(jì)學(xué)意義。居住地環(huán)境主要潮濕、灰塵、寵物、花草、新裝修、被動(dòng)吸煙等危險(xiǎn)因素,CVA與UACS患者居住地多潮濕或灰塵,而PIC患者多數(shù)居住環(huán)境良好。3.危險(xiǎn)因素:研究表明,UACS危險(xiǎn)因素包括:家族成員吸煙(煙草環(huán)境暴露)、白天咳嗽、臥位時(shí)咳嗽、鼻塞等4個(gè)因素,具有統(tǒng)計(jì)學(xué)意義(P＜0.05)而抗生素使用、夜間入睡后咳嗽、冷空氣或異味刺激等3個(gè)因素為UACS的保護(hù)因素(P＜0.05);CVA危險(xiǎn)因素包括:家族過敏性鼻炎病史、家族哮喘病史、冷空氣或異味刺激、過敏原等4個(gè)因素,具有統(tǒng)計(jì)學(xué)意義(P＜0.05),而抗生素使用、臥位時(shí)咳嗽為CVA保護(hù)因素;PIC危險(xiǎn)因素包括:氣候變化因素、抗生素使用等2個(gè)因素,具有統(tǒng)計(jì)學(xué)意義(P＜0.05)而家族過敏性鼻炎、清晨咳嗽、白天咳嗽、冷空氣或異味刺激、噴嚏、清咽等6個(gè)因素為呼吸道感染后咳嗽保護(hù)因素。4.病位證素:慢性咳嗽病位證素分布頻次從高到低依次為肺261例(93.55%)、表 238 例(85.30%)、脾 96 例(34.41%)、胃 49 例(17.56%)、腎4 例(1.430%)、心 3例(1.08%)、肝1例(0.360%)。病位證素體現(xiàn)慢性咳嗽核心病位為肺,需重視外感表證,同時(shí)需重視五臟功能失調(diào)導(dǎo)致肺失宣降、肺氣上逆發(fā)為咳嗽。不同病因組病位證素組合形式,二病位組合出現(xiàn)頻率最高,UACS組與CVA組病位證素組合以三病位組合、四病位組合等相關(guān)常見,PIC組則單一病位情況相對(duì)常見。5.病性證素:慢性咳嗽病性證素分布頻次從高到低依次為氣虛180例(64.52%)、痰 123 例(69.42%)、陽(yáng)虛 105 例(37.63%)、血虛 89 例(31.90%)、外風(fēng) 82 例(29.39%)、寒 63 例(22.58%)、陰虛 61 例(21.86%)、濕 46 例(16.49%)、飲 15 例(5.38%)、氣滯 14 例(5.02%)、熱 11 例(3.94%)、燥 10 例(3.58%)、食積 4 例(1.43%)。不同病因組病性證素組合形式,UACS組與CVA組以四病性以上組合多見;PIC組則以單一病性為主,頻率為43.33%;不同病因組均出現(xiàn)未明確病性情況。6.病位與病性組合形式:不同病因病位與病性組合規(guī)律中,其中UACS組病位與病性組合出現(xiàn)多種類型,各類型出現(xiàn)頻次較低;CVA組中,二病位與病性組合"肺+表+氣虛"出現(xiàn)頻數(shù)與頻率為76(83.52%),三病位與病性證素組合"肺+表+脾+氣虛"出現(xiàn)頻率為51(56.04%)。PIC組中,二病位"肺+表"出現(xiàn)頻數(shù)、頻率為60(66.67%),單一病性與二病位為主要組合特點(diǎn),包括"氣虛+肺、表"、"痰+肺、表"等組合形式。結(jié)論:1.慢性咳嗽常見病因包括:咳嗽變異性哮喘(CVA)、上氣道咳嗽綜合征(UACS)合呼吸道感染后咳嗽(PIC)。研究表明,不同年齡組慢性咳嗽病因構(gòu)成不同;其中嬰幼兒組以PIC為主,其次為CVA,學(xué)齡前期組慢性咳嗽三大病因分布較均勻,而學(xué)齡期組兒童慢性咳嗽以CVA為主,其次為UACS。2.慢性咳嗽相同病因不同年齡組間病程存在差異,其中學(xué)齡期組CVA的病程最長(zhǎng)。3.通過多因素非條件Logistics回歸分析表明,UACS危險(xiǎn)因素包括家族成員吸煙(煙草環(huán)境暴露)、白天咳嗽、臥位時(shí)咳嗽、鼻塞等4個(gè)因素;CVA危險(xiǎn)因素包括家族過敏性鼻炎病史、家族哮喘病史、冷空氣或異味刺激、過敏原等4個(gè)因素;PIC危險(xiǎn)因素包括:氣候變化因素、抗生素使用等2個(gè)因素。4.通過收集患者四診資料及臨床證候要素,結(jié)果表明慢性咳嗽主要病位為肺、外表、脾、胃、腎等;病性證素主要為氣虛、痰、陽(yáng)虛、血虛、寒、陰虛、濕、熱、氣滯、燥、飲、食積等。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R272
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