發(fā)布時(shí)間：2018-05-07 13:12

  本文選題：慢性咳嗽 + 咳嗽變異性哮喘��； 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：了解引起兒童非特異性慢性咳嗽病因及咳嗽變異性哮喘(cough variant asthma, CVA)出現(xiàn)喘息的危險(xiǎn)因素,并探討瞬時(shí)感受器離子通道受體1(transient receptor potential vanilloid-1, TRPV1)基因與兒童非特異性慢性咳嗽相關(guān)性。 方法：采用2008年中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)呼吸學(xué)組制定的《兒童慢性咳嗽診斷和治療指南(試行)》的診斷程序,對(duì)2008年6月至2010年10月在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院就診的451例(男255例,女196例,年齡：1～14歲,平均年齡：5.3±3.1歲)慢性咳嗽(咳嗽4周)患兒經(jīng)過(guò)詳細(xì)詢問(wèn)病史、體格檢查及輔助檢查得出初步診斷。首次就診后半個(gè)月、1個(gè)月、3個(gè)月隨訪患兒情況,及時(shí)修正診斷并制定下一步治療方案,直至隨訪結(jié)束。2008年6月至2009年10月在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院就診的105例咳嗽變異性哮喘患兒(男56例,女49例,年齡：1～14歲,平均年齡：4.59±2.17歲)進(jìn)行2年隨訪,并建議每3月復(fù)診1次,記錄期間有無(wú)出現(xiàn)喘息或呼吸困難�；純河诔踉\時(shí)進(jìn)行肺功能測(cè)試、過(guò)敏原測(cè)試和胸片檢查。采用聚合酶鏈反應(yīng)限制性酶切片段多態(tài)性(polymerase chain reaction-restriction fragment length polymorphism, PCR-RFLP)方法對(duì)195例非特異性慢性咳嗽患兒及205例正常對(duì)照兒童進(jìn)行TRPV1基因rs222747、rs222748、rs8065080位點(diǎn)的基因型和等位基因分析。 結(jié)果：1.451例非特異性慢性咳嗽患兒經(jīng)過(guò)12周隨訪后,172(38.1%)例患兒診斷為咳嗽變異性哮喘(cough variant asthma, CVA),136(30.2%)例為咳嗽變異性哮喘合并上氣道咳嗽綜合征(cough variantasthma and upper airway cough syndrome, CVA+UACS),77(17.1%)例為呼吸道感染和感染后咳嗽,57(12.6%)例為上氣道咳嗽綜合癥(upper airway cough syndrome, UACS),3(0.7%)例為心因性咳嗽,6(1.3%)例為其它診斷(病因不明)。2.105例CVA患兒經(jīng)過(guò)2年隨訪研究,24(22.9%)例患兒出現(xiàn)喘息(喘息組),喘息組和非喘息組多因素logistic回歸分析示花粉過(guò)敏是CVA患兒出現(xiàn)喘息的危險(xiǎn)因素(OR6.78,95%CI1.24-37.20,P=0.028)。3. TPPV1基因rs222747、rs222748、rs8065080位點(diǎn)均可檢出3種基因型：rs222747(CC、C、GG); rs222748(CC、 TC、TT); rs8065080(CC、TC、TT)。經(jīng)吻合度檢驗(yàn),rs222747位點(diǎn)基因多態(tài)性分布不符合Hardy-Weinberg定律,故未進(jìn)行下一步分析。非特異性慢性咳嗽組和正常對(duì)照組比較rs222748位點(diǎn)、rs8065080位點(diǎn)基因型和等位基因頻率經(jīng)Bonferroni多重檢驗(yàn)校正差異均無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：1.CVA、CVA+UACS、感染后咳嗽、UACS是引起兒童非特異性慢性咳嗽最常見(jiàn)的病因。2.CVA患者中22.9%出現(xiàn)喘息,花粉過(guò)敏可能是CVA患兒出現(xiàn)喘息的危險(xiǎn)因素。3.TRPV1基因rs222748、 rs8065080位點(diǎn)基因型可能與非特異性慢性咳嗽的發(fā)生無(wú)關(guān)。
[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 鹵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 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R725.6

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