Study On The Correlation Between Gastrointestinal Heat Accumulation And Asthmatic Cough In Children With Pneumonia

ObjectiveGastrointestinal heat retention syndrome(GHRS)is a syndrome that is associated with increased gastrointestinal heat caused by a metabolic block in energy.Previous clinical observations suggested that children with GHRS might have a greater risk of catching respiratory tract infections(RTIs).Pneumonia is a common disease with a high incidence in pediatric and a major cause of mortality worldwide.Our primary aim was to explore the association between GHRS and pneumonia in children with clinical epidemiological methods for Chinese medicine etiology research.This study also aimed to explore the association between GHRS and recurrent respiratory tract infection(RRTI)in children,explore which diet-related factors were associated with GHRS,systematically access the risk factors of recurrent pneumonia in Chinese children and explore which diet-related and socio-related factors were associated to identify strategies that could improve patient outcome and prevent pneumonia and RRTI.Methods1.Exploring diet-related factors associated with GHRS in children:a cross-sectional studyA cross-sectional study has been conducted in pediatric clinic department of Beijing Dongfang Hospital.We consecutively recruited children according to selection criteria.Children who were eligible for inclusion in our study were those with age?1year old and?18 years old and with a history of 3 or more RTI episodes in the past 12 months.We excluded children with severe circulatory diseases,nervous diseases,urinary diseases,hematological disease.And we also excluded participants with serious digestive system diseases such as severe gastritis,peptic ulcers,colitis,and those who were involved in other clinical trials.TCM symptoms,demographic and physiological characteristics were recorded by using semi-structured questionnaire.Participants were enrolled into group with GHRS and group without GHRS according to whether they had GHRS or not.Screening of diet-related independent variables was used logistic regression model.2.Exploring association between GHRS and pneumonia in children:a prospective cohort studyA prospective cohort study has been conducted in pediatric clinic department of Beijing Dongfang Hospital.We consecutively recruited children according to selection criteria.Children who were eligible for inclusion in our study were those with age?1year old and?18 years old and with a history of 3 or more RTI episodes in the past 12 months.We excluded children with severe circulatory diseases,nervous diseases,urinary diseases,hematological disease.And we also excluded participants with serious digestive system diseases such as severe gastritis,peptic ulcers,colitis,and those who were involved in other clinical trials.TCM symptoms,demographic and physiological characteristics were recorded by using semi-structured questionnaire.GHRS was considered as a predisposing factor.Children were followed up for next 12 months.We contacted with their parents using a face-to-face questionnaire,via email or phone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.3.Exploring diet-related and socio-related factors associated with RRTI in children:a nested case-control studyIn this nested case-control study,participants were recruited from a prospective cohort study which was conducted in Beijing in 2014.Semi-structured questionnaires were used to collect TCM symptoms,demographic and physiological characteristics in children aged 1-11 with RRTI(case)compared with those without RRTI(control).Recurrent pneumonia participants(case)were matched with non-pneumonia participants(control)by age and gender.Recurrent pneumonia participants(case)were matched with single pneumonia participants(control)by age.4.Exploring risk factors of recurrent pneumonia in Chinese children:a systematic review Electronic databases such as CNKI,Wanfang,CBM,VIP,Pubmed were searched for studies on risk factors of recurrent pneumonia in Chinese children in recent 16 years.We screened studies according to the inclusion and exclusion criteria.We evaluated the quality of the included studies and extracted the data from the studies.Statistic analysis was performed with RevMan 5.2.Merged effect values and 95%CI were calculated in meta-analysis.Results1.In this cross-sectional study,275(50.46%)children with GHRS and 270(49.54%)without GHRS were enrolled and finished questionnaire survey according patient recruitment criteria.Beef eating frequency moderate(POR=1.26,95%CI[0.85,1.85]),beef eating frequency more(POR=3.48,95%CI[1.13,10.71]),duck eating frequency moderate(POR=1.66,95%CI[1.11,2.48]),duck eating frequency more(POR=1.84,95%CI[0.82,4.10]),eating other convenience foods(sesame paste et al)(POR=2.18,95%CI[1.07,4.41]),engorgement(POR=2.21,95%CI[1.47,3.32]),eating preferences(POR=1.49,95%CI[1.02,2.17])were positively correlated with GHRS;vegetables eating quantity moderate(POR=0.59,95%CI[0.39,0.88]),vegetables eating quantity more(POR=0.89,95%CI[0.49,1.60]),fruit eating frequency moderate(POR=0.71,95%CI[0.40,1.26]),fruit eating frequency more(POR=0.29,95%CI[0.10,0.81]),bean curd eating frequency moderate(POR=0.61,95%CI[0.42,0.88]),bean curd eating frequency more(POR=0.49,95%CI[0.17,1.42])were negatively correlated with GHRS in our logistic regression model.2.In this cohort study,420 children were enrolled and 370(88.10%)followed up for 12 months.The incidence of RTI was 5.37 episodes per child-year(95%CI[5.14,5.60]).The risk ratio(RR)value of pneumonia occurrence in 6 months follow-up visit was 1.58(95%CI[0.94,2.65],P=0.081),RR value of pneumonia occurrence in 12 months follow-up visit was 1.54(95%CI[0.91,2.59],P=0.107).RR value of RRTI occurrence was 1.27(95%CI[1.01,1.59],P=0.037).Excess head sweating(P=0.014),foul breath(P=0.058),and fingerprint red or purple(P=0.004)were positively correlated with pneumonia occurrence in 6 months follow-up visit in linear regression model.Swift digestion with increased appetite(P=0.069),excess head sweating(P=0.006),foul breath(P=0.085),and fingerprint red or purple(P=0.021)were positively correlated with pneumonia occurrence in 12 months follow-up visit in linear regression model.Severe swift digestion with increased appetite(OR=15.69,95%CI[1.21,203.46]),severe foul breath(OR=1.76,95%CI[0.97,3.22]),mild dry stool(OR=1.937,95%CI[1.01,3.71]),and fingerprint red or purple(OR=7.48,95%CI[1.23,45.66])were positively correlated with pneumonia occurrence in 12 months follow-up visit in logistic regression model.Mild irritability(OR=1.96,95%CI[1.08,3.56]),mild feverish feeling in the palms and soles(OR=2.11,95%CI[1.27,3.51]),and moderate feverish feeling in the palms and soles(OR=2.63,95%CI[1.49,4.64])were positively correlated with RRTI occurrence in 12 months follow-up visit in logistic regression model.Feverish feeling in the palms and soles(P=0.000)and slippery or rapid pulse(P=0.084)were positively correlated with RTI occurrence in 6 months follow-up visit in linear regression model.Feverish feeling in the palms and soles(P=0.003),smelly stool(P=0.050),and fingerprint red or purple(P=0.083)were positively correlated with RTI occurrence in 12 months follow-up visit in linear regression model.3.In nested case-control study,178 children in RRTI case group and 192 children in control group were enrolled.Parental chronic digestive system disease(OR=1.940,95%CI[0.928,4.055]),passive smoking(OR=2.055,95%CI[1.286,3.283]),GHRS score(OR=1.008,95%CI[1.002,1.013]),picky eating(OR=1.511,95%CI[0.938,2.433]),and diet controlled by parents(OR=1.850,95%CI[1.173,2.920])were positively correlated with RRTI in logistic regression model;eating other legumes(OR=0.453,95%CI[0.205,0.998])and eating honey(OR=0.636,95%CI[0.394,1.025])were negatively correlated with RRTI in logistic regression model.9 children in recurrent pneumonia case group and 27 children with non-pneumonia in control group were enrolled matched by age and gender(case:control=1:3).BMI,influenza vaccination,excess head sweating,foul breath,intolerance to heat,GHRS score,and pastries eating frequency were statistically significant differences between the two groups.9 children in recurrent pneumonia case group and 27 children with single pneumonia in control group were enrolled matched by age(case:control=1:3).Mass,influenza vaccination,parental chronic digestive system disease,swift digestion with increased appetite,GHRS score,and soybean milk eating frequency were statistically significant differences between the two groups.4.10 Chinese case-control studies were included in this study.The Newcastle-Ottawa Scale(NOS)was used to assess the quality of the non-randomized studies,and 2 studies were scored 3 points,3 studies were scored 5 points,5 studies were scored 6 points.The meta-analysis revealed that food or drugs allergy history ORM-H=6.37(95%CI[4.69,8.65]),eczema history ORM-H=2.50(95%CI[1.82,3.43]),wheezing history ORM-H=16.92(95%CI[11.76,24.34]),breast-feeding history ORM-H=0.69(95%CI[0.48,0.99]),preterm labor history ORM-H=1.75(95%CI[0.83,3.68]),passive smoking history ORM-H=9.95(95%CI[3.65,27.14]),granulocytopenia ORM-H=3.16(95%CI[2.25,4.26]),eosinophilia ORM-H=2.09(95%CI[1.26,3.46]),mycoplasma antibody positive ORM-H=1.03(95%CI[0.74,1.43]),IgA reduced ORM-H=1.26(95%CI[0.80,1.99]),IgG reduced ORM-H=1.00(95%CI[0.55,1.85]),IgM reduced ORM-H=1.02(95%CI[0.57,1.84]),IgE increased ORM-H=1.35(95%CI[0.86,2.13]).Conclusion1.GHRS is risk factor of pneumonia in children.GHRS may be associated with pneumonia,and GHRS is associated with RRTI in this cohort.Swift digestion with increased appetite,excess head sweating,irritability,foul breath,feverish feeling in the palms and soles,dry stool,smelly stool,and fingerprint red or purple were positively associated with RTI.Studies with larger sample size and longer follow up are needed to further evaluate association between GHRS and pneumonia.2.Beef eating frequency,duck eating frequency,eating other convenience foods(sesame paste et al),engorgement,eating preferences were positively associated with RRTI.3.Parental chronic digestive system disease,passive smoking,GHRS score,picky eating,and diet controlled by parents were positively correlated with RRTI.Studies with larger sample sizes and longer follow up are needed to further evaluate association between recurrent pneumonia and GHRS.4.Food or drugs allergy history,eczema history,wheezing history,passive smoking history,granulocytopenia,eosinophilia,and mycoplasma were risk factors of recurrent pneumonia in Chinese children.Breast-feeding history was protective factor of recurrent pneumonia in Chinese children.5.Children with RRTI could be treated GHRS for better treatment effect,relieving heat from lung and gastrointestinal during the acute phase,relieving GHRS during remission period.The principle of treatment for GHRS in children is tonifying spleen,removing stagnancy,clearing heat.