Chang Anne B, Cox Nancy C, Faoagali Joan, Cleghorn Geoffrey J, Beem Christopher, Ee Looi C, Withers Geoffrey D, Patrick Mark K, Lewindon Peter J
Department of Respiratory Medicine, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia.
BMC Pediatr. 2006 Feb 27;6:4. doi: 10.1186/1471-2431-6-4.
There are no prospective studies that have examined for chronic cough in children without lung disease but with gastroesophageal reflux (GER). In otherwise healthy children undergoing flexible upper gastrointestinal endoscopy (esophago-gastroscopy), the aims of the study were to (1) define the frequency of cough in relation to symptoms of GER, (2) examine if children with cough and reflux esophagitis (RE) have different airway cellularity and microbiology in bronchoalveolar lavage (BAL) when compared to those without.
Data specific for chronic cough (> 4-weeks), symptoms of GER and cough severity were collected. Children aged < 16-years (n = 150) were defined as 'coughers' (C+) if a history of cough in association with their GER symptoms was elicited before BAL were obtained during elective esophago-gastroscopy. Presence of esophagitis on esophageal biopsies was considered reflux esophagitis positive (E+).
C+ (n = 69) were just as likely as C- (n = 81) to have esophagitis, odds ratio 0.87 (95%CI 0.46, 1.7). Median neutrophil percentage in BAL was significantly different between groups; highest in C+E- (7, IQR 28) and lowest in C-E+ (5, IQR 6). BAL positive bacterial culture occurred in 20.7% and were more likely present in current coughers (OR 3.37, 95%CI 1.39, 8.08). Airway neutrophilia (median 20%, IQR 34) was significantly higher in those with BAL positive bacterial cultures than those without (5%, 4; p = 0.0001).
In children without lung disease, the common co-existence of cough with symptoms of GER is independent of the occurrence of esophagitis. Airway neutrophilia when present in these children is more likely to be related to airway bacterial infection and not to esophagitis.
目前尚无前瞻性研究对无肺部疾病但有胃食管反流（GER）的儿童慢性咳嗽进行调查。在接受柔性上消化道内镜检查（食管胃镜检查）的其他方面健康的儿童中，本研究的目的是：（1）确定与GER症状相关的咳嗽频率；（2）检查有咳嗽和反流性食管炎（RE）的儿童与无咳嗽和反流性食管炎的儿童相比，支气管肺泡灌洗（BAL）中的气道细胞组成和微生物学是否存在差异。
收集慢性咳嗽（>4周）、GER症状及咳嗽严重程度的相关数据。年龄<16岁的儿童（n = 150），如果在择期食管胃镜检查获取BAL之前，有与GER症状相关的咳嗽病史，则被定义为“咳嗽者”（C+）。食管活检发现食管炎则视为反流性食管炎阳性（E+）。
C+组（n = 69）和C-组（n = 81）患食管炎的可能性相同，比值比为0.87（95%CI 0.46, 1.7）。两组BAL中中性粒细胞百分比中位数有显著差异；C+E-组最高（7，四分位间距28），C-E+组最低（5，四分位间距6）。BAL细菌培养阳性率为20.7%，当前咳嗽者中更常见（OR 3.37，95%CI 1.39, 8.08）。BAL细菌培养阳性者的气道中性粒细胞增多（中位数20%，四分位间距34）显著高于培养阴性者（5%，四分位间距4；p = 0.0001）。
在无肺部疾病的儿童中，咳嗽与GER症状的常见共存与食管炎的发生无关。这些儿童出现气道中性粒细胞增多更可能与气道细菌感染有关，而非食管炎。
