Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy.
Pediatr Pulmonol. 2013 Mar;48(3):295-302. doi: 10.1002/ppul.22581. Epub 2012 May 2.
To evaluate whether the proportion of acid and weakly acidic refluxes preceding cough bursts could be different in infants, preschool- and school-aged children with chronic, unexplained cough.
One hundred six children with unexplained chronic cough, not receiving acid suppressive therapy, underwent impedance-pH monitoring. They were divided into Group A: <2 years (21 pts), Group B: ≥2 to ≤6 years (41 pts), and Group C: >6 years (44 pts). Reflux was defined as acid (pH <4), weakly acidic (WA; pH 4-7), and weakly alkaline (pH >7).Cough episodes were considered temporally associated with gastroesophageal reflux (GER) when occurring within 2 min after a GER episode.
Impedance-pH detected 55.50 (39.00-76.00) reflux episodes/patient with an acid-to-WA reflux event ratio of 3.31 (1.55-8.33). This parameter was significantly lower in Group A (1.33 [0.41-3.40]) than in Group B (3.06 [2.00-6.50]; P < 0.05] and Group C (5.09 [2.34-12.43; P < 0.001]). No cough episode was preceded by weakly alkaline refluxes in any patient. During impedance-pH recording, 93 patients (87.7%) had at least one cough episode that had been preceded by impedance refluxes in 83 patients. In this latter group (83 pts), the median number of cough episodes was 12.0 (5.0-25.5), of which 48.15% (30.15-71.43%) were preceded by refluxes; GER-preceded cough episodes were similar in the three groups. The majority of children had cough episodes preceded by acid refluxes in the total population (78.3%), in Group B (80.5%) and in Group C (93.7%), but not in Group A (40.0%; P < 0.001).
In addition to acid, also a significant proportion of WA GER may precede cough episodes in young children with persistent cough, possibly explaining the inconstant effects of anti-acid treatment on respiratory symptoms.
评估在患有慢性、不明原因咳嗽的婴儿、学龄前儿童和学龄儿童中，咳嗽前酸反流和弱酸性反流的比例是否不同。
106 名未经抑酸治疗的慢性不明原因咳嗽患儿接受了阻抗 pH 监测。他们被分为 A 组（<2 岁，21 例）、B 组（≥2 岁至≤6 岁，41 例）和 C 组（>6 岁，44 例）。反流定义为酸（pH<4）、弱酸性（WA；pH4-7）和弱碱性（pH>7）。当 GER 事件后 2 分钟内发生咳嗽时，咳嗽事件被认为与胃食管反流（GER）有时间相关性。
阻抗 pH 检测到每个患者有 55.50（39.00-76.00）次反流事件，酸与 WA 反流事件的比值为 3.31（1.55-8.33）。A 组（1.33[0.41-3.40]）明显低于 B 组（3.06[2.00-6.50]；P<0.05）和 C 组（5.09[2.34-12.43；P<0.001）。任何患者均未出现弱碱性反流前的咳嗽事件。在阻抗 pH 记录期间，93 名患者（87.7%）中有至少一次咳嗽事件，83 名患者的咳嗽事件均由阻抗反流引起。在这后一组（83 例）中，咳嗽事件的中位数为 12.0（5.0-25.5），其中 48.15%（30.15-71.43%）由反流引起；三组的 GER 引起的咳嗽事件相似。在总人群（78.3%）、B 组（80.5%）和 C 组（93.7%）中，大多数儿童的咳嗽事件均由酸反流引起，但在 A 组（40.0%）中则无（P<0.001）。
除了酸之外，在持续咳嗽的幼儿中，WA GER 也可能导致相当大比例的咳嗽发作，这可能解释了抗酸治疗对呼吸道症状的影响不一致。
