| Part Ⅰ Clinical study of the correlation between chronic cough and laryngopharyngeal reflux in childrenObjective:To explore the relationship between chronic cough and laryngopharyngeal reflux in children,and to provide theoretical basis for clinicians in the diagnosis and treatment of chronic cough in children.Method:A retrospective analysis of 156 children in the First Affiliated Hospital of Xiamen University from December 2015 to November 2019,with a cough of more than or equal to 4 weeks and with poor effect after routine treatment in the outpatient department。The 24-hour laryngopharyngeal PH monitoring were performed in all patients.According to the diagnosis standard of the laryngopharyngeal reflux,it is divided into the laryngopharyngeal reflux group and the non-reflux group,the upright reflux and supine reflux;According to the result of the pulmonary ventilation function,it is divided into the normal group and the abnormal group;According to trachea under the bronchoscope,the patients were also divided into the tracheomalacia group and the non-tracheomalacia group.The correlation between the positive rate of the laryngopharyngeal reflux and the sex,the age,the season and the different diseases was analyzed,and the curative effect after the treatment with the drug and the lifestyle was evaluated.Result:1.A total of 156 children were collected,of which 91 were positive for laryngopharyngeal reflux,with a positive rate of 58.33%;The incidence of laryngopharyngeal reflux was not significantly related to the gender of the children(χ2=2.026,P=0.155);According to different ages,it is divided into three groups:<12m,12m～72m,≥72m.The incidence of laryngopharyngeal reflux is 67.35%(33/49),60.53%(46/76),38.71%(12/31),The difference was statistically significant(χ2＝6.700,P=0.035).2.There was no significant correlation between the duration of chronic cough and different seasons(χ2=7.500,P=0.585),and there was no significant difference in the positive rate of laryngopharyngeal reflux in each season(χ2=4.380,P=0.223).3.Laryngopharyngeal reflux accounted for 71.43%in upright position and 27.47%in supine position;The number of laryngopharyngeal reflux episodes in the upright and supine positions、the percentage of the PH below the baseline time、Ryan index and average PH were significantly different(P<0.05).4.The positive rates of laryngopharyngeal reflux were 74.07%and 40.00%in tracheomalacia group and non-tracheomalacia group,respectively(χ2=8.155,P=0.004),but there was no significant difference in the positive rate of laryngopharyngeal reflux between normal and abnormal pulmonary function test(χ2=0.662,p=0.430).5.The positive rates of laryngopharyngeal reflux in the pneumonia group,asthma group,and other groups were 61%,47.5%,and 58.7%,respectively.The positive rates of throat reflux among the three groups were not statistically significant(χ2=2.04,P=0.361).6.Among the 91 children,65 were treated with drugs(antacids and gastrointestinal motility),of which 60 were effective,accounting for 92.31%;26 of them were treated with diet and other lifestyles and 21 cases were effective in treatment,accounting for 80.77%.Conclusion:1.Laryngopharyngeal reflux is an important cause of chronic cough in children.The positive rate of laryngopharyngeal reflux in children with chronic cough is 58.3%and the positive rate of laryngopharyngeal reflux in children younger than 6 years old is higher than that in children older than 6 years old.2.The course of chronic cough is not related to season and the positive rate of laryngopharyngeal reflux is not related to season.3.Laryngopharyngeal reflux in the upright position is more common than that in the supine position,and the features of the upright reflux in the 24-hour laryngopharynx pH monitoring are more characteristic.4.The incidence of laryngopharyngeal reflux in children with tracheomalacia is higher than non-tracheomalacia;there is no correlation between pulmonary dysfunctio and the incidence of laryngopharyngeal reflux;there is no significant difference in the positive rates of laryngopharyngeal reflux caused by pneumonia and asthma.Part Ⅱ The research of salivary pepsin in the diagnosis of chronic cough in childrenObjective:To explore the diagnostic value of salivary pepsin in children with chronic cough.Method:From August 2019 to November 2019 in the First Affiliated Hospital of Xiamen University,26 children with cough greater than or equal to 4 weeks,accompanied by throat discomfort,were selected as the experimental group.The experimental group was divided into allergen positive group and allergen negative group,family history and no family history.A total of 29 children without respiratory disease were selected as the control group.All the study subjects collected 1 saliva sample at the time of consultation and used western blot to detect the concentration of salivary pepsin.The concentration of salivary pepsin in the experimental group and the control group were analyzed.The differences of pepsin concentrations in children with negative or positive allergens and family history in the experimental group were analyzed.The differences of pepsin concentration between the experimental group and the control group at different ages were analyzed.Result:1.The experimental group collected 26 children with chronic cough,a total of 26 saliva samples,of which 16 were boys and 10 were girls,with a median age of 6 years.The control group collected 29 healthy children who had a physical examination,a total of 29 saliva samples,of which 15 were boys and 22 were girls,with a median age of 7 years.There was no significant difference in age and gender between the two groups of children(P>0.05),The mean values of BMI in the two groups were(16.77±2.36)kg/m2,(16.52±2.73)kg/m2,respectively,The difference was not statistically significant(P=0.715)2.The concentrations of pepsin in the experimental group and the control group were 7.00～35.58ng/ml,4.48～15.07ng/ml,and the median was 12.91ng/ml,10.38ng/ml,respectively.The concentration of salivary pepsin in the experimental group was higher than that in the control group,and the difference analysis of salivary pepsin content in the two groups was statistically significant(Z=-2.444,P=0.015).3.The ROC curve was plotted with the concentration of salivary pepsin in 26 children in the experimental group and 29 children in the control group,the area under the curve was 0.672,and the 95%confidence interval was 55.0%to 83.4%and the yorden index was 0.351.The diagnostic threshold concentration of pepsin in saliva was 14.6 ng/ml,with a sensitivity of 38.5%and a specificity of 96.6%.4.There was no statistical difference in saliva pepsin concentration between the two groups of children<6 years old and≥6 years old(P>0.05);The median salivary pepsin in children with and without allergies was 12.58 ng/ml,12.91 ng/ml,respectively,there was no significant difference in salivary pepsin content between the two groups(Z=-0.386,P=0.700).The median salivary pepsin in children with and without family history of allergic diseases was 12.87 ng/ml,13,72 ng/ml,respectively,there was no significant difference in salivary pepsin content between the two groups(Z=-0.128,P=0.898).5.The median saliva pepsin content in the three groups of patients with cough course<6 months,6～12 months,and>12 months in the experimental group were 12.87ng/ml,11.29ng/ml,and 13.33ng/ml,respectively,there was no statistical difference in the content of salivary pepsin(Z=0.578,P=0.749).6.In the experimental group,34.61%of the children were treated with drugs and 55.56%were effective after treatment.Conclusion:1.Pepsin remains in saliva of healthy children.2.The content of salivary pepsin in children with chronic cough is higher than that in healthy children,but the sensitivity of diagnosis is not high.It is necessary to further study the concentration of salivary pepsin in children with chronic cough.3.Among the children with chronic cough,the history of allergies,the family history of allergic diseases and the course of cough were not related to the concentration of saliva pepsin. |
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