本文選題：兒童 + 痙攣性咳嗽�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：{背景}中國(guó)百日咳流行病學(xué)調(diào)查項(xiàng)目為中國(guó)疾病預(yù)防與控制中心在全國(guó)流行病學(xué)調(diào)查項(xiàng)目,在山東省及新疆維吾爾自治區(qū)兩個(gè)點(diǎn)進(jìn)行調(diào)查,其中山東省選擇滕州市中心人民醫(yī)院及萊蕪中心醫(yī)院進(jìn)行,滕州市中心人民醫(yī)院兒科負(fù)責(zé)臨床資料收集工作。該項(xiàng)目由山東省疾病預(yù)防與控制中心直接負(fù)責(zé),由山東省疾病預(yù)防與控制中心提供新鮮羊血制作百日咳培養(yǎng)基,專(zhuān)門(mén)人員已經(jīng)由山東省疾病預(yù)防與控制中心培訓(xùn)3個(gè)月,已經(jīng)工作近1年時(shí)間,PCR方法查百日咳DNA,由我院收集鼻咽拭子,由山東省疾病預(yù)防與控制中心直接檢測(cè),百日咳抗體檢測(cè)由我院進(jìn)行,山東省疾病預(yù)防與控制中心進(jìn)行督導(dǎo)檢查,流行病學(xué)調(diào)查由滕州市疾病預(yù)防與控制中心預(yù)防保健科進(jìn)行。 {目的}探討兒童痙攣性咳嗽的病原學(xué),以利于臨床針對(duì)性治療,尤其是百日咳的流行病學(xué)調(diào)查,為國(guó)家制定預(yù)防接種政策提供科學(xué)的依據(jù)。 {方法}針對(duì)152例痙攣性咳嗽患兒采用痰培養(yǎng)檢測(cè)細(xì)菌,鼻咽拭子查百日咳培養(yǎng)及PCR法測(cè)百日咳DNA(山東省疾病預(yù)防控制中心協(xié)助完成),抽血查百日咳抗體IgM、IgG,抽血查呼吸道病毒9項(xiàng)(包括肺炎支原體、立克次體、腺病毒、嗜肺軍團(tuán)菌、呼吸道合胞病毒、流感病毒、肺炎衣原體、副流感病毒)IgM,同時(shí)部分患兒檢查血常規(guī)、超敏C反應(yīng)蛋白、胸部正位片、胸部CT、兒童肺功能檢查、過(guò)敏原檢測(cè)等�？紤]有氣道高反應(yīng)性的患兒進(jìn)行支氣管舒張?jiān)囼?yàn)、呼出氣一氧化氮測(cè)定(NO)。對(duì)照組為非痙攣性咳嗽患兒85例,同時(shí)進(jìn)行百日咳、痰培養(yǎng)、呼吸道病毒九項(xiàng)檢測(cè)。 {結(jié)果}43例咽拭子PCR法查百日咳DNA11例陽(yáng)性,43例咽拭子百日咳培養(yǎng)均為陰性,114例抽血查百日咳抗體IgM陽(yáng)性32例(其中5例與PCR法測(cè)百日咳DNA共同陽(yáng)性),百日咳確診38例,占總病例25%。痰培養(yǎng)陽(yáng)性7例(包括鮑曼不動(dòng)桿菌1例、金黃色葡萄球菌1例、肺炎克雷伯菌2例、銅綠假單胞菌1例、白假絲酵母菌2例),肺炎支原體陽(yáng)性7例,肺炎衣原體陽(yáng)性3例,腺病毒陽(yáng)性1例,其中百日咳以五個(gè)月以內(nèi)14例,占百日咳總數(shù)的36.8%,5歲以上11例,占百日咳總數(shù)的28.9%。病原體檢測(cè)陽(yáng)性共為56例,占總病例36.8%。血白細(xì)胞2萬(wàn)以上44例占29%,淋巴細(xì)胞比例70%以上53例占35%,胸部正位片有支氣管炎征象54例,占35.5%,有肺炎征象21例,占13.8%,肺功能檢查：FEV1(一秒鐘用力呼氣容積)、PEF(呼氣峰值流速)降低大于20%14例,占9.2%,過(guò)敏原檢測(cè)陽(yáng)性21例,占13.8%,呼出氣一氧化氮(NO)測(cè)定：陽(yáng)性為24例,占15.8%。 {結(jié)論}目前兒童痙攣性咳嗽仍以百日咳感染為主,其中以五個(gè)月以內(nèi)及五歲以上為主,與疫苗未接種及接種五年后抗體滴度降低有關(guān),96例患兒(占63.2%)未檢測(cè)到病原菌,可能與檢測(cè)設(shè)備及技術(shù)、以及患兒為其他原因引起的咳嗽有關(guān)。患兒其他原因的咳嗽包括咳嗽變異性哮喘、感染后咳嗽、上氣道咳嗽綜合征等各種疾病。
[Abstract]:{background} the China pertussis Epidemiology Survey Project is the National Epidemiological investigation Project of the China Center for Disease Prevention and Control. It has been investigated at two points in Shandong Province and Xinjiang Uygur Autonomous region. Shandong Province selected Tengzhou central people's hospital and Laiwu central hospital to carry out the pediatrics of Tengzhou central people's hospital was responsible for clinical data collection. The project is under the direct responsibility of the Shandong Center for Disease Prevention and Control, which provides fresh sheep blood for making pertussis media. The specialized personnel have been trained by the Shandong Center for Disease Prevention and Control for three months. It has been working for nearly one year to check the pertussis DNA by PCR method. Nasopharynx swabs were collected by our hospital, directly detected by the Shandong Disease Prevention and Control Center, the pertussis antibody test was carried out by our hospital, and the Shandong Disease Prevention and Control Center conducted supervision and inspection. The epidemiological investigation was carried out by the Department of Prevention and Health of the Center for Disease Prevention and Control in Tengzhou City. Objective: to explore the etiology of spastic cough in children in order to provide scientific basis for clinical targeted treatment, especially epidemiological investigation of pertussis. {methods} sputum culture was used to detect bacteria in 152 children with spastic cough. Rhinopharynx swab test pertussis culture and PCR method to measure pertussis DNA (Shandong Centers for Disease Control and Prevention assisted in completing pertussis, blood samples for pertussis antibody IgMN IgG, blood samples for 9 items of respiratory viruses (including Mycoplasma pneumoniae, Rickettsiae, adenovirus, Legionella pneumophila), Respiratory syncytial virus, influenza virus, chlamydia pneumoniae, parainfluenza virus IgM. At the same time, blood routine examination, hypersensitive C-reactive protein, chest radiograph, chest CTS, pulmonary function test, allergen test, etc. Bronchodiastolic test was performed in children with airway hyperresponsiveness and nitric oxide in exhaled air was measured. In the control group, 85 children with non-spastic cough were examined for pertussis, sputum culture and respiratory virus. {results} there were 43 cases of pertussis DNA11 positive by throat swab PCR method and 43 cases of throat swab pertussis culture were all negative in 114 cases of pertussis antibody IgM positive (5 cases were positive with PCR method to detect pertussis DNA, 38 cases of pertussis were diagnosed. Accounting for 25% of the total cases. Sputum culture was positive in 7 cases, including Acinetobacter baumannii 1 case, Staphylococcus aureus 1 case, Klebsiella pneumoniae 2 cases, Pseudomonas aeruginosa 1 case, Candida albicans 2 cases, Mycoplasma pneumoniae 7 cases, Chlamydia pneumoniae 3 cases. One case was positive for adenovirus, of which 14 cases were pertussis within five months, accounting for 36.8% of the total pertussis, 11 cases were over 5 years old, accounting for 28.990% of the total pertussis. 56 cases were positive for pathogens, accounting for 36.8% of the total cases. The proportion of lymphocytes was over 70% in 53 cases (35 cases), bronchitis signs in 54 cases (35%), pneumonia signs in 21 cases (54 cases) in positive chest radiographs, the proportion of white blood cells was above 20 000 in 44 cases, and the proportion of lymphocytes was over 70% in 53 cases (35%). Lung function examination: FEV1 (forced expiratory volume in one second) decreased more than 20 cases (9.2%), allergen was positive in 21 cases (13.8%) and exhaled nitric oxide (no) was detected in 24 cases (15.8%). {conclusion} at present, pertussis infection is still the main cause of spastic cough in children, especially within 5 months and over five years of age. No pathogenic bacteria were detected in 96 children (63.2%) who were not vaccinated and the antibody titer decreased five years after inoculation. May be related to testing equipment and technology, as well as cough caused by other causes in the child. Other causes of cough include cough variant asthma, postinfection cough, upper airway cough syndrome and so on.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R725.6

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