痰诱导在慢性咳嗽中的临床应用

目的观察痰诱导的可行性及不良反应的发生率,探讨其在慢性咳嗽诊断、治疗中的价值。方法按照慢性咳嗽解剖学诊断程序进行诊断,对于仍不能确诊的42例慢性咳嗽患者行痰诱导及支气管舒张或激发试验。结果42例慢性咳嗽患者中41例痰诱导成功,成功率为97.6%;4例发生不良反应,发生率为9.8%。41例慢性咳嗽患者中痰嗜酸粒细胞增高的有25例,约占61.0%,其中咳嗽变异性哮喘(CVA)22例(53.7%),嗜酸粒细胞性支气管炎(EB)3例(7.3%);痰嗜酸粒细胞不高的有16例(39.0%),其中感染后咳嗽(PIC)4例(9.8%),CVA 2例(4.8%),胃食管反流(GER)5例(12.2%),原因未明5例(12.2%)。CVA及EB患者治疗后痰嗜酸粒细胞百分比均显著下降。结论痰诱导可行性好、不良反应发生率低,为慢性咳嗽的诊断、治疗提供了一项可靠的评价气道炎症的指标。

The Clinical Application of Induced Sputum in Patients with Chronic Nonproductive Cough

Objective To investigate the important role of induced sputum in the diagnosis and treatment of chronic nonproductive cough by assessing its feasibility and the side effects which may occur during the procedure.Methods The diagnosis procedure was based on the anatomical protocol for diagnosing chronic nonproductive cough,42 patients who still could not be diagnosed would undertake induced sputum and bronchodilation or bronchial provocation test.Results Appropriate sputum samples were obtained by inducing sputum method in 41 of 42 patients with chronic nonproductive cough(41/42,97.6%).Side effects occurred in 4 patients(4/41,9.8%).The percentage of eosinophil counts in induced sputum was high in 25 of 41(25/41,61.0%),including cough variant asthma(CVA)(22/41,53.7%),eosinophilic bronchitis(EB)(3/41,7.3%);And the percentage of eosinophil counts in patients with induced sputum was not high in 16 of 41(16/41,39.0%),including post infectious cough(PIC)(4/41,9.8%),CVA(2/41,4.8%),gastroesophageal reflux(GER)(5/41,12.2%),indeterminate diagnosis(5/41,12.2%).After treatment,the percentage of eosinophil counts in patients with induced sputum was significantly reduced in CVA and EB.Conclusion Induced sputum procedure was an effective method for diagnosing chronic nonproductive cough and little side effects occurred during the procedure.Induced sputum can provide a reliable data of airway inflammation for the patients with chronic nonproductive cough in clinical diagnosis and treatment.