慢性咳嗽患者吸入性变应原的调查分析

目的分析吸入性变应原在不同分组慢性咳嗽患者中的检出率,为临床慢性咳嗽的诊断和治疗提供依据。方法将460例慢性咳嗽病例按照嗜酸性粒细胞(EOS)计数、诱导痰检查比例、支气管激发试验结果以及临床症状分为咳嗽变异性哮喘(CVA)组、嗜酸性粒细胞性支气管炎(EB)组、上气道咳嗽综合征(UACS)组、胃食管反流性咳嗽(GERC)组和其他病因组,采用印迹法检测吸入性变应原特异性IgE抗体,以120名正常体检者为对照。结果 CVA组和EB组的吸入性变应原检出率明显增加,与其他病因组和对照组比较,差异有统计学意义(P0.05)。在所检测的变应原中,阳性率居前5位的分别为屋尘螨/粉尘螨(71.28%)、蟑螂(25.24%)、狗上皮(15.35%)、屋尘(13.86%)和猫毛(10.89%),存在多重检出现象。结论在EOS计数和诱导痰检查比例升高的慢性咳嗽患者中,吸入性变应原是其致病的主要因素,尘螨为最常见的吸入性变应原。     

常见慢性咳嗽病因及其诊断探讨

目的 探讨常见慢性咳嗽的病因及疾病表现的临床意义,为经验性治疗提供依据.方法 按慢性咳嗽的病因诊断流程对160例患者的病因构成进行分析,比较常见病因慢性咳嗽患者的咳嗽时相、性质、诱发因素及相关伴随症状,统计方法采用U检验,计算P值.结果 共入选160例2009年1月至12月宜昌市中心人民医院呼吸科门诊慢性咳嗽患者,其中常见病因分布依次为咳嗽变异性哮喘(CVA) 72例占45.00％、上气道咳嗽综合征(UACS) 54例占33.75％、嗜酸性粒细胞性支气管炎(EB) 14例占8.75％、胃食管反流性咳嗽(GERC)9例占5.63％,其他病因共11例、占6.87％.不同病因组临床表现有差异.CVA患者夜间咳嗽构成比为52.8(38/72),明显高于其他病因;UACS患者以白天咳嗽为主,70.2％伴有鼻后滴流症状,且绝大部分伴有鼻炎相关症状或有鼻炎病史,高于其他各组;GERC患者饮食相关咳嗽占66.7％,77.8％伴有反流症状明显高于其他病因组;上述症状差异均有统计学意义.但EB患者临床症状无特异性.结论 各种病因的慢性咳嗽具有一定的临床特征,慢性咳嗽病因构成及咳嗽时相、部分伴随症状对病因诊断具有一定的参考价值.     

嗜酸粒细胞性支气管炎和哮喘患者诱导痰微量元素的变化及意义

目的探讨嗜酸粒细胞性支气管炎(EB)和哮喘患者诱导痰微量元素水平的差异及其与气道炎性反应特征的关系。方法检测EB、咳嗽变异性哮喘(CVA)、支气管哮喘患者和健康对照组的诱导痰锌、铜、铁的水平并探讨其与痰炎性反应细胞比例的相关性。结果哮喘组的诱导痰锌、铜浓度显著低于健康对照组、EB和CVA组,差异有统计学意义(P<0.01);铁浓度显著高于健康对照组,差异有统计学意义(P<0.05),也高于EB和CVA组,差异也有统计学意义(P<0.01);CVA组的铜浓度亦显著低于健康对照组,差异有统计学意义(P<0.01)。诱导痰液中嗜酸性粒细胞的比例与锌和铜的水平存在一定的相关性。结论 EB和支气管哮喘患者的诱导痰液中微量元素锌、铜、铁水平存在的显著差异可能是二者病理生理特征差异的机制之一。     

老年患者慢性咳嗽病因构成及咳嗽严重程度分析

目的探讨老年与非老年组患者慢性咳嗽病因构成及咳嗽严重程度。方法 58例老年和82例非老年不明原因慢性咳嗽患者,按照慢性咳嗽的解剖学诊断程序,根据病史、体格检查、实验室检查及相关辅助检查明确病因,咳嗽积分评价咳嗽严重程度。结果老年组常见病因依次为：咳嗽变异性哮喘（CVA）23例,上气道咳嗽综合征（UACS）16例,胃食管反流性咳嗽（GERC）8例;非老年组常见病因依次为：CVA 31例,UACS 26例,GERC 10例。两组主要病因构成比较差异无统计学意义（P〉0.05）。两组患者各病因间的日间咳嗽积分比较差异无统计学意义（P〉0.05）,CVA的夜间积分明显高于其他病因（P均〈0.01）。结论与非老年组类似,CVA、UACS、GERC也是老年不明原因慢性咳嗽的常见病因,不同病因慢性咳嗽的日间咳嗽程度类似,但CAV夜间咳嗽程度显著高于其他病因的咳嗽。     

典型哮喘与咳嗽变异性哮喘患者肺功能、气道嗜酸性粒细胞炎症及FeNO水平差异分析

目的分析肺功能、气道嗜酸性粒细胞炎症及呼出气一氧化氮(FeNO)对典型哮喘(CA)与咳嗽变异性哮喘(CVA)的鉴别诊断价值。方法回顾性分析CA患者40例(CA组)、CVA患者50例(CVA组)及健康人员30例(对照组)肺功能指标、FeNO、血清C反应蛋白(CRP)及痰中嗜酸性粒细胞比例(EOR)等资料。结果CA组、CVA组最大呼气峰流速(PEF)显著小于对照组,FeNO、痰EOR、血清CRP水平均高于对照组(P0.05);CA组第1s用力呼气量(FEV1)、PEF均小于CVA组,FeNO、痰EOR、血清CRP水平均显著大于CVA组(P0.05);三组用力肺活量(FVC)比较差异无统计学意义(P0.05);FeNO对CA与CVA鉴别诊断灵敏度、特异度分别为70.05%、77.52%。结论肺功能、气道嗜酸性粒细胞炎症、FeNO对CA与CVA鉴别诊断有一定的价值。     

诱导痰细胞学检查在慢性咳嗽病因诊断中的应用

目的探讨诱导痰细胞分类对慢性咳嗽患者病因诊断及气道炎症评价的作用。方法对335例慢性咳嗽患者，进行诱导痰细胞学分类检测，观察诱导过程的不良反应并同时结合通气功能、支气管激发试验等相关检查进行病因诊断分析。同时选择103名健康人作为对照。结果322例患者得到明确诊断，其中典型支气管哮喘（TA）84例，嗜酸粒细胞性支气管炎（EB）62例，过敏性咳嗽（AC）42例，咳嗽变异型哮喘（CVA）40例，胃食管反流性咳嗽（GERC）37例，鼻后滴漏综合征（PNDs）32例，其他病因25例，病因未明13例。AC、EB、CVA和TA等过敏性气道炎症患者的痰嗜酸粒细胞比例（0．005，0．052，0．059，0．234）与其他病因和正常对照者（0）比较差异有统计学意义（P〈0．01或P〈0．05），EB与CVA患者比较差异无统计学意义，但均显著低于TA患者。AC、EB、CVA和GERC患者的痰中性粒细胞比例（0．675，0．675，0．672，0．590）与正常对照者（0．430）比较差异有统计学意义（P〈0．01或P〈0．05），但不同病因患者问该指标差异无统计学意义。除PNDs外，常见病因导致的慢性咳嗽患者的痰巨噬细胞比例均低于正常对照者，差异有统计学意义（P〈0．01）。诱导痰成功率为97．3％，不良反应发生率为25．4％，主要表现为恶心、呕吐、咽干等不适，但反应较轻，大多数能耐受。结论不同病因慢性咳嗽患者的气道炎症的种类和程度各异，诱导痰细胞分类在慢性咳嗽病因诊断和气道炎症评价中起着重要作用。     

慢性咳嗽76例临床分析

目的:探讨慢性咳嗽的病因构成特点。方法:回顾了76例慢性咳嗽临床资料,采用慢性咳嗽解剖学诊断程序,对76例持续8周以上患者进行病因初步诊断,并通过诊断性治疗证实。结果:76例慢性咳嗽患者当中,男性36例,女性40例。咳嗽时间平均42个月。71例诊断明确。病因比例依次为鼻后滴流综合征(PNDS)34.6%(26/76),咳嗽变异性哮喘(CVA)26.4%(20/76),嗜酸性粒细胞性支气管炎(EB)23.7%(18/76),胃食道返流性咳嗽(GERC)10.5%(8/76),支气管内膜结核和药物引起的慢性咳嗽各2例,复合病因为5/76,诊断不明5例。结论:PNDS.CVA.EB.GERC是慢性咳嗽的常见原因,应结合病史,症状及相应的实验室检查综合分析,试验性病因治疗是确诊病因重要环节。     

嗜酸粒细胞性支气管炎与咳嗽变异性哮喘患者的气道炎症特征的研究

目的研究嗜酸粒细胞性支气管炎以及咳嗽变异性哮喘病人气道炎性细胞因子与炎性介质的主要特性。方法嗜酸粒细胞性支气管炎(EB)组16例患者、咳嗽变异性哮喘(CVA)组16例患者、哮喘组15例患者以及对照组15例正常体检者,检测这4组人员诱导痰中的嗜酸粒细胞即嗜酸粒细胞(EOS)比例;流式检测白细胞介素-5(IL-5)和γ-干扰素(IFN-γ)刺激的EOS表面CD69蛋白的表达;酶联免疫吸附(ELISA)法检测各组患者诱导痰上清液中前列腺素E2(PGE2)、白三烯C4(LTC4)的蛋白表达量。结果 EB组、CVA组、哮喘组患者诱导痰中EOS表面CD69蛋白的表达量差异无统计学意义,与对照组相比差异有统计学意义(均P<0.05)。EB组、CVA组、哮喘组患者诱导痰中PGE2浓度比较差异有统计学意义(均P<0.05);与对照组相比,CVA组患者、EB患者以及哮喘组患者的诱导痰中LTC4浓度显著增高(均P<0.05),EB组患者的LTC4的蛋白表达量和CVA组患者以及哮喘组患者的差异进行比较,同样具有统计学意义(均P<0.05)。CVA组患者以及哮喘组患者诱导痰中LTC4/PGE2的比值与EB组患者相比显著增高(均P<0.05)。结论 EB组患者的诱导痰中PGE2的表达水平增高,CVA组患者的LTC4/PGE2比值与EB组患者相比也是明显升高,推测这两个因素是EB缺乏气道反应性的潜在炎症基础。     

成人慢性咳嗽患者86例临床分析

目的：探讨成人慢性咳嗽（CPC）的常见病因及其治疗方法。方法：通过询问病史、体格检查、胸部X线、肺功能、诱导痰检查、食道pH监测等检查,对病因进行分类,并针对病因进行特异性治疗。结果：通过对86例成人CPC病因分析发现,咳嗽变异性哮喘（CVA）占31.40%,上气道咳嗽综合征（UACS）占27.91%,胃食管反流性咳嗽（GERC）占13.95%,嗜酸细胞性支气管炎（EB）占11.63%,（UACS＋CVA）占3.49%,（GERC＋CVA）占2.32%,药物因素占2.32%,支气管内膜结核占1.16%,心源性咳嗽占1.16%,心理性咳嗽占1.16%,病因未明者占3.49%。经针对病因治疗后,95.18%的患者咳嗽症状明显减轻或消失。结论：CPC病因主要为CVA、UACS、GERC、EB,占总病因的90.70%;指南推荐诊断程序有助于CPC的诊断。其中详细询问病史结合针对性病因治疗是确诊病因的重要环节。     

呼出气一氧化氮检测联合诱导痰嗜酸性粒细胞计数对ACO的诊断效能分析

目的探讨呼出气一氧化氮(FeNO)检测联合诱导痰嗜酸性粒细胞计数对哮喘-慢性阻塞性肺疾病重叠(ACO)的诊断效能。方法采用前瞻性的研究方法,依诊断标准连续纳入慢性阻塞性肺疾病患者137例,ACO患者67例和非ACO(NACO)患者70例。采用一氧化氮电量法测定患者FeNO,计数诱导痰嗜酸性粒细胞百分比,比较2组患者的FeNO水平和诱导痰嗜酸性粒细胞百分比,并用受试者工作特征曲线(ROC曲线)分析2个指标对ACO的诊断效能。结果 ACO组有效完成FeNO检测67例和诱导痰嗜酸性粒细胞计数52例,而NACO组分别为70例和47例。ACO组FeNO和诱导痰嗜酸性粒细胞百分比以中位数(四分位间距)表示分别为36.50(21.25)ppb和4.25%(13.12%),明显高于NACO组的21.00(10.00)ppb和0.50%(1.50%),差异有统计学意义(Z=-7.089,P0.05;Z=-5.979,P0.05)。ACO组患者FeNO和诱导痰嗜酸性粒细胞百分比的水平分布与NACO组比较差异均有统计学意义(均P0.05)。经ROC曲线分析,FeNO、诱导痰嗜酸性粒细胞百分比诊断ACO的ROC曲线下面积(AUC)分别为0.837和0.847,最佳临界值为25.50ppb和2.30%。联合检测FeNO和诱导痰嗜酸性粒细胞百分比,以任一指标大于临界值为ACO诊断标准,诊断灵敏度为0.942,特异度为0.638。结论 FeNO和诱导痰嗜酸性粒细胞百分比是用于ACO诊断的良好指标,两者联合检测可以明显提高诊断灵敏度。     

Eosinophilic bronchitis: an imortant cause of prolonged cough

The recent development of noninvasive techniques to measure airway inflammation has led to the recognition of eosinophilic bronchitis, a condition characterized by a sputum eosinophilia identical to that seen in asthma, but without any of the functional abnormalities associated with asthma. The condition is interesting for a number of reasons. Firstly, eosinophilic bronchitis is a common cause of chronic cough, which is important to recognize as it responds well to corticosteroids. However, recognition is not straightforward because it requires assessment of airway inflammation. Secondly, the natural history of eosinophilic bronchitis is uncertain. Some patients with chronic obstructive pulmonary disease without a history of previous asthma have sputum eosinophilia, thus one possibility is that eosinophilic bronchitis may develop into fixed airflow obstruction. Finally, the difference in the association of eosinophilic airway inflammation to airway dysfunction between eosinophilic bronchitis and asthma is of interest as it is possible that it reflects important differences in the nature or site of the airway inflammation. Further study of this interesting condition may shed light on the relationship between airway inflammation and airway responsiveness, leading to a greater understanding of both eosinophilic bronchitis and asthma.     

Eosinophilic bronchitis: an important cause of prolonged cough

The recent development of noninvasive techniques to measure airway inflammation has led to the recognition of eosinophilic bronchitis, a condition characterized by a sputum eosinophilia identical to that seen in asthma, but without any of the functional abnormalities associated with asthma. The condition is interesting for a number of reasons. Firstly, eosinophilic bronchitis is a common cause of chronic cough, which is important to recognize as it responds well to corticosteroids. However, recognition is not straightforward because it requires assessment of airway inflammation. Secondly, the natural history of eosinophilic bronchitis is uncertain. Some patients with chronic obstructive pulmonary disease without a history of previous asthma have sputum eosinophilia, thus one possibility is that eosinophilic bronchitis may develop into fixed airflow obstruction. Finally, the difference in the association of eosinophilic airway inflammation to airway dysfunction between eosinophilic bronchitis and asthma is of interest as it is possible that it reflects important differences in the nature or site of the airway inflammation. Further study of this interesting condition may shed light on the relationship between airway inflammation and airway responsiveness, leading to a greater understanding of both eosinophilic bronchitis and asthma.     

哮喘患者诱导痰嗜酸细胞趋化因子的改变及其意义

目的探讨嗜酸细胞趋化因子（嗜酸细胞趋化因子）在嗜酸细胞性气道炎症和气流阻塞发生中的作用。方法收集支气管哮喘（A组）急性发作期患者30例和健康对照者（B组）20例，分别给予肺功能检测和痰诱导检查。用酶联免疫吸附法（ELISA）测定诱导痰上清液中嗜酸细胞趋化因子浓度。结果A组诱导痰嗜酸细胞占白细胞百分比（EOS／Leu％）与B组比较，差异有显著性（P〈0．05）；A组嗜酸细胞趋化因子浓度与B组比较，差异有显著性（P〈0．05）。A组EOS／Leu％、嗜酸细胞趋化因子浓度与一秒钟用力呼气容积占预计值百分比（FEV1％）均呈负相关；A组嗜酸细胞趋化因子浓度与EOS／Leu％呈正相关。结论嗜酸细胞趋化因子可能通过对嗜酸细胞（EOS）的选择性趋化作用使其释放一系列炎性介质参与了嗜酸细胞性气道炎症和气流阻塞的发生机制。     

The Evolving Clinical Practice of Chronic Cough

Chronic cough, defined as a cough lasting for greater than 8 weeks, accounts for a substantial number of primary care and specialist consultations in the United States. Although cough can arise from a myriad number of serious respiratory diseases, attention has traditionally focused on diagnosing and treating gastroesophageal reflux, upper airway cough syndrome, and eosinophilic airway inflammation (asthma and nonasthmatic eosinophilic bronchitis) in patients with normal chest imaging. The newly described paradigm and entity of cough hypersensitivity syndrome (CHS) becomes useful when the etiology of cough remains elusive or when the cough remains refractory despite appropriate therapy for underlying causes. We present an update on the evolving understanding of refractory chronic cough and/or unexplained chronic cough as manifestations of laryngeal hypersensitivity and CHS. This includes a focus on understanding the pathophysiology underlying current and novel therapeutics for CHS, while also ensuring that common causes of chronic cough continue to be evaluated and treated in a systematic multidisciplinary manner.     

白三烯受体拮抗剂在慢性咳嗽治疗中的临床价值

目的 探讨白三烯受体拮抗剂在慢性咳嗽临床治疗中的意义.方法 选择81例慢性咳嗽患者(根据慢性咳嗽诊断流程诊断),所有患者均符合咳嗽时间≥8周,不吸烟或戒烟4周以上,无服用血管紧张素转换酶抑制剂类药物史,服用者停药观察4周,X线胸片检查未见异常,并除外胃食管反流性咳嗽、除变应性鼻炎的其他上气道咳嗽综合征、支气管内膜结核等其他慢性咳嗽病因.对诊断为咳嗽变异性哮喘、变应性鼻炎、嗜酸粒细胞性支气管炎及感染后咳嗽的患者给予孟鲁司特钠10 mg,每晚1次进行治疗4周并观察疗效.结果 81例入选患者中咳嗽变异性哮喘36例,变应性鼻炎30例,嗜酸粒细胞性支气管炎5例,感染后咳嗽10例.经孟鲁司特钠治疗后,67例患者咳嗽症状临床控制,12例患者显效,2例无效,有效率97.5%(79/81).结论 气道炎症是慢性咳嗽患者常见的病理特征,白三烯受体拮抗剂孟鲁司特钠有显著的抗炎作用,能明显改善咳嗽变异性哮喘、嗜酸粒细胞性支气管炎、感染后咳嗽、变应性鼻炎等慢性咳嗽患者的气道炎症,减轻咳嗽症状,是治疗慢性咳嗽的重要药物.     

Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma

Objective: A proportion of asthmatic patients can achieve total control according to the Global Initiative for Asthma/National Institute of Health guidelines. The aim of this study was to investigate whether total control of asthma is accompanied by the remission of airway inflammation and bronchial hyperresponsiveness. Methods: We assessed the number of eosinophil and the levels of eosinophil cationic protein (ECP) and interleukin (IL)‐5 in induced sputum and bronchial responsiveness to methacholine in 76 patients with totally controlled asthma in comparison with 30 current untreated asthmatics and 20 healthy subjects. Results: We found significantly higher number of eosinophil and higher levels of ECP and IL‐5 in the total control group than those in healthy subjects (6.9% ± 3.6% and 1.3% ± 1.1%, 129.0 ± 53.8 μg/l and 48.9 ± 20.4 μg/l, 22.1 ± 15.2 μg/l and 10.6 ± 5.2 μg/l, respectively; p < 0.001), but lower than those in current asthma group (16.2% ± 8.6%, 362.2 ± 151.6 μg/l, 50.6 ±25.8 μg/l, respectively; p < 0.001). Sixty‐five (85.5%) patients with totally controlled asthma showed positive methacholine challenge test. In the total control group, number of eosinophil and the levels of ECP and IL‐5 in induced sputum of patients with negative methacholine challenge test were significantly lower than those in subjects with positive methacholine challenge test (p < 0.001), whereas sputum number of eosinophil and the levels of ECP and IL‐5 in patients with negative methacholine challenge test and those of healthy subjects were similar (p > 0.05). Conclusion: The results of this study suggest that airway inflammation and bronchial hyperresponsiveness still persisted during total control of asthma.     

Role of nitric oxide in chronic allergen-induced airway cell proliferation and inflammation

Chronic cellular inflammation and airway wall remodeling with subepithelial fibrosis and airway smooth muscle thickening are features of chronic asthma. We determined the role of nitric oxide in the pathogenesis of allergen-induced airway cell proliferation and inflammation by studying the effects of a relatively selective prodrug inhibitor of nitric-oxide synthase type 2 (NOS2), L-N6-(1-iminoethyl)-lysine-5-tetrazole amide (SC-51). Brown-Norway rats were sensitized to ovalbumin and were exposed to ovalbumin aerosol every 3rd day on six occasions and were treated orally with either vehicle or SC-51 (10 mg. kg(-1); 12 doses). We measured inflammatory cell accumulation in the airways and proliferation of cells by incorporation of bromodeoxyuridine. There was an increase in the total number of airway smooth muscle cells expressing bromodeoxyuridine from 1.3% of airway smooth muscle cells in saline exposed to 5.4% after allergen-exposure (P < 0.001) and airway epithelial cells from 3.3 cells/mm basement membrane to 9.6 after allergen-exposure (P < 0.001). SC-51 had no effect on airway smooth muscle or epithelial cell proliferation. SC-51 attenuated the allergen-induced increase in major basic protein (MBP+) eosinophil (P < 0.05) and CD4+ T-cell (P < 0.05) accumulation. We conclude that nitric oxide derived during allergic inflammation is involved in the expression of eosinophilic inflammation and not in epithelial or airway smooth muscle cell DNA synthesis induced by chronic allergen exposure.     

布地奈德联合沙丁胺醇雾化吸入对急性哮喘发作患者诱导痰液炎性细胞和细胞因子的影响

目的布地奈德（普米克令舒）联合沙丁胺醇雾化吸入治疗哮喘急性发作前后气道炎性细胞、嗜酸细胞趋化因子（eotaxin）、嗜酸性细胞阳离子蛋白（ECP）的变化，探讨其影响机制。方法收集急性哮喘发作患者38例和健康对照者20例进行诱导痰和肺功能检测，哮喘患者采用上述联合治疗2周，测定治疗前后诱导痰液中嗜酸性粒细胞（Eos）比例、嗜酸细胞趋低因子（eotaxin）、ECP水平以及肺功能。结果哮喘组治疗前的嗜酸粒细胞比例、eotaxin和ECP水平均高于正常对照组（P〈0．01）。治疗后嗜酸粒细胞比例、eotaxin和ECP水平与治疗前比较明显下降（P〈0．01），但仍然高于正常对照组（P〈0．05）。第1s用力呼气容积（FEV1）占预计值的百分比与Eos比例、eotaxin浓度和ECP水平呈负相关（P〈0．001）；eotaxin浓度与ECP浓度呈正相关（P〈0．001）。结论Eotaxin可能通过对Eos的选择性趋化作用使其释放ECP等一系列炎性介质参与了嗜酸细胞性气道炎症和气流阻塞的发生机制。普米克令舒联合沙丁胺醇雾化吸入可显著降低急性哮喘发作患者气道分泌物内Eos数量及eotaxin、ECP水平。     

肺炎支原体感染与咳嗽变异型哮喘的关系

目的　探讨肺炎支原体 (MP)感染与咳嗽变异性哮喘 (CVA)发生、发展的关系。方法　对 83例临床确诊的咳嗽变异性哮喘患者及 5 0名健康体检者 ,分别采静脉血 ,采用ELISA方法测定MP抗体IgM浓度 ,深咳嗽咳痰观察痰中嗜酸细胞变化。结果　临床确诊的咳嗽变异性哮喘患者的MP感染率为 5 5 4%(4 6/ 83 ) ,明显高于正常对照组 14 0 %(7/ 5 0 ) (P <0 0 5 ) ,咳嗽变异性哮喘患者的痰嗜酸细胞 (Eosinophil,EOS) ,计数明显高于正常人 ,达 74 7%。结论　肺炎支原体 (MP)感染与CVA有关 ;MP是CVA发病的重要病原体。