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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (7): 33-41.doi: 10.6040/j.issn.1671-7554.0.2024.0435

• 呼吸系统疾病精准诊疗专题 • 上一篇    下一篇

山东省儿童百日咳感染与哮喘的相关性

闫金燕1,2*,杨春2*,李雷3,吴福玲4,焦永莉5,张晓蔚6,李晶7,张瑞珍8,王磊9,马香2,10   

  1. 1.山东大学附属儿童医院感染性疾病科, 山东 济南 250022;2.济南市儿童呼吸病重点实验室, 山东大学附属儿童医院, 山东 济南 250022;3.山东第一医科大学附属济南妇幼保健院儿科, 山东 济南 250001;4.滨州医学院附属医院儿科, 山东 滨州 256600;5.枣庄市市中区妇幼保健院儿科, 山东 枣庄 277100;6.济南市章丘区人民医院儿科, 山东 济南 250200;7.济宁市任城区妇幼保健院儿科, 山东 济宁 272005;8.德州市齐河县妇幼保健院儿科, 山东 德州 251100;9.泰安市妇幼保健院儿科, 山东 泰安 271000;10.山东省儿童疾病及健康研究中心, 济南市儿童医院, 山东 济南 250022
  • 发布日期:2024-09-20
  • 通讯作者: 马香. E-mail:maxiang0176@163.com*共同第一作者.
  • 基金资助:
    济南市卫生健康委科技计划项目(2022-2-163);山东省医药卫生科技项目(202306011027);山东省儿童健康与疾病临床医学研究中心立项项目(SDPRC009);济南市卫生健康委大数据科技计划项目(2022-YBD-1-06,2022-BD-13);济南市临床科技创新项目(202225022)

Correlation between asthma and pertussis infection in children of Shandong Province, China

YAN Jinyan1,2*, YANG Chun2*, LI Lei3, WU Fuling4, JIAO Yongli5, ZHANG Xiaowei6, LI Jing7, ZHANG Ruizhen8, WANG Lei9, MA Xiang2,10   

  1. 1. Department of Infectious Diseases, Childrens Hospital Affiliated to Shandong University, Jinan 250022, Shandong, China;
    2. Jinan Key Laboratory of Pediatric Respiratory Diseases, Childrens Hospital Affiliated to Shandong University, Jinan 250022, Shandong, China;
    3. Department of Pediatrics, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan 250001, Shandong, China;
    4. Department of Pediatrics, Binzhou Medical University Hospital, Binzhou 256600, Shandong, China;
    5. Department of Pediatric, Shizhong District Maternal and Child Health Care Hospital, Zaozhuang 277100, Shandong, China;
    6. Department of Pediatrics, Peoples Hospital of Zhangqiu District, Jinan 250200, Shandong, China;
    7. Department of Pediatric, Jining Rencheng District Maternal and Child Care Hospital, Jining 272005, Shandong, China;
    8. Department of Pediatric, Qihe Maternity and Childrens Health Care Hospital, Dezhou 251100, Shandong, China;
    9. Department of Pediatrics, Taian Maternity and Child Health Care Hospital, Taian 271000, Shandong, China;
    10. Shandong Provincial Clinical Research Center for Childrens Health and Disease, Jinan Childrens Hospital, Jinan 250022, Shandong, China
  • Published:2024-09-20

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摘要： 目的 通过多中心、前瞻性调查,评估不同分期、不同类型哮喘儿童百日咳的感染情况,并分析哮喘与百日咳的相关性。 方法 通过调查问卷收集因咳嗽持续时间≥1周而就诊的哮喘儿童相关信息,并进行百日咳毒素(pertussis toxin, PT)IgG抗体浓度和/或百日咳核酸检测,对结果进行判读。根据年龄、哮喘分期、是否合并百日咳感染等进行分组,分析不同分组间百日咳抗体分布、感染情况及临床特点等。 结果 1 049例哮喘患儿中,PT-IgG总阳性率为26.22%,其中≥6岁组显著高于3个月~<3岁组和3岁~<6岁组(P均<0.001);百日咳感染率为25.17%,其感染率随年龄段增长而升高(P均<0.001)。咳嗽变异性哮喘合并百日咳感染者显著高于经典哮喘(28.00% vs. 22.59%, P=0.040)。对656例患儿临床特点进行分析发现,哮喘急性发作期患儿合并百日咳感染率高于慢性持续期及临床缓解期(26.15% vs. 10.46%, P<0.001; 26.15% vs. 8.00%, P=0.042);是否合并百日咳在哮喘初诊与复诊患儿之间差异无统计学意义(P=0.189)。哮喘合并百日咳者更易出现痉挛性咳嗽、面红、鸡鸣样回声、呕吐症状(P均<0.05)。哮喘未合并百日咳者以晨起咳嗽多见(9.36% vs. 4.20%, P=0.047),而在夜间、晨起及夜间、日间、运动后等的咳嗽时相性特点在两组中差异无统计学意义(P均>0.05)。两组间白细胞计数、中性粒细胞计数、淋巴细胞计数、嗜酸性粒细胞计数及IgE水平差异均无统计学意义(P均>0.05)。 结论 哮喘儿童百日咳检出率高,尤其是哮喘急性发作与百日咳密切相关,临床症状对两者有一定的鉴别意义,实验室检查结果对两种疾病无鉴别意义。建议对咳嗽持续时间>2~4周的哮喘患儿常规筛查百日咳,以更好地鉴别或判断,指导治疗。

关键词: 儿童, 百日咳, 感染, 哮喘, 相关性

Abstract: Objective To assess the prevalence of pertussis infection in children with asthma across different stages and subtypes and to analyze the correlation between the two diseases via a multicenter prospective investigation. Methods Information was collected from children with asthma who had a cough ≥1 week through questionnaires, and pertussis toxin(PT)IgG antibodies levels and/or pertussis nucleic acid tests were performed to interpret the results. The distribution of pertussis antibody, infection and clinical characteristics of different groups were analyzed according to different age, asthma stage and pertussis infection. Results Among the 1,049 asthmatic children, the positive rate of PT-IgG was 26.22%, and the rate was significantly higher in ≥6 years old group compared with 3 months -< 3 years old group and 3 years -< 6 years old group(both P<0.001). The overall rate of pertussis infection in asthmatic children was 25.17%, with an increasing trend in infection rates corresponding to advancing age(P<0.001). The incidence rate of cough variant asthma combined with pertussis infection was significantly higher than classical asthma(28.00% vs. 22.59%, P=0.040). According to the clinical characteristics of 656 children, the incidence rate of pertussis infection was higher in patients with acute asthma attack than in chronic duration and clinical remission(26.15% vs. 10.46%, P<0.001; 26.15% vs. 8.00%, P=0.042). There was no significant difference between newly diagnosed and recurrent cases of asthma(P=0.189). Asthmatic children with pertussis were more likely to have spasmodic cough, facial redness, chickenlike echo and vomiting symptoms than those without pertussis(all P< 0.05). Morning cough was more common in asthmatic children without pertussis(9.36% vs. 4.20%, P=0.047). There was no significant difference in other cough phase characteristics at night, morning or night, day and after exercise between the two groups(all P>0.05). There were no significant differences in leukocyte count, neutrophil count, lymphocyte count, eosinophilic count, and IgE levels between the two groups(all P> 0.05). Conclusion The pertussis detection is prevalent in children with asthma, especially during acute asthma exacerbation. Clinical symptoms have certain significance to distinguish the two diseases, but laboratory examination results show no significance between the two diseases. It is recommended that routine screening for pertussis should be conducted for asthmatic children with cough for more than 2-4 weeks to better identify or judge and guide treatment.

Key words: Child, Pertussis, Infectious disease, Asthma, Correlation

中图分类号: 

  • R725.6
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