食管内灌酸对慢性咳嗽患者气道阻力与咳嗽敏感性的影响

目的 观察向食管下段灌注盐酸对慢性咳嗽患者咳嗽症状、咳嗽敏感性和气道阻力的影响.方法 17例慢性咳嗽患者经鼻插入5F胃管至食管下段,注入0.1 N盐酸共10 min,于灌酸前后测量肺通气功能、气道阻力和辣椒素咳嗽激发试验,记录灌酸期间患者自觉症状、咳嗽次数.比较灌酸前后咳嗽症状、咳嗽敏感性和肺通气功能、气道阻力的变化.结果 灌酸后呼吸阻抗Zrs、中央气道阻力R20显著增高,差异有统计学意义(P＜0.05);第一秒钟用力呼气容积(FEV1),用力肺活量(FVC)、共振频率(Fres)及外周气道阻力(R5-R20)无显著性变化(P＞0.05);灌酸前后患者咳嗽敏感性也无显著性差异.相关分析显示,远端电极多项反流指标与灌酸总量呈显著负相关(P＜0.05),而与停止灌酸后pH值恢复正常的时间呈显著正相关(P＜0.05或P＜0.01).结论 向慢性咳嗽患者食管下段灌注盐酸可使气道阻力增加,尤其是中央气道阻力,这可能与胃食管反流诱发咳嗽有关.     

慢性阻塞性肺疾病不同病程肺功能动态改变特点和机制的研究

目的　探讨慢性阻塞性肺疾病（COPD）急性加重期和稳定期肺功能的动态改变特点和机制。方法　对30例COPD患者分别于急性加重期和稳定期进行Borg气急指数评估、肺通气功能检测、肺容量检测、体积描记法总气道阻力（Rtot）测定和呼吸阻抗、呼吸阻力检测。结果　Borg气急指数稳定期较急性加重期显著下降（P〈0．001）。通气功能测定参数FVC、FVC／pre、FEVI、FEVI／pre和FEV1／FVC稳定期较急性加重期显著增加（P均〈0．05）。肺容量检测参数深吸气量（IC）稳定期较急性加重期显著增加（P〈0．001）,胸腔内气体容积（ITGV）和残气量（RV）稳定期较急性加重期显著下降（P均〈0．05）。Rtot稳定期较急性加重期显著下降（P〈0．01）。IOS测定参数共振频率（Fres）、呼吸总阻抗（Z5）、总气道阻力（R5）、中央气道阻力（R20）和外周气道阻力（R5-R20）稳定期较急性加重期显著下降（P均〈0．05）,5Hz时呼吸电抗（X5）稳定期较急性加重期显著增高（P〈0．001）。通气功能检测参数中FEV-改善率最高,肺容量检测IC改善率最高,呼吸阻抗和呼吸阻力检测R5—R20和X5改善率较高。IC、RV和ITGV稳定期较急性加重期的改善值与FVC的改善值显著相关（P均〈0．05）,IC和RV稳定期的改善值与FEV-的改善值显著相关。Z5、R5、R5-R20、X5和Fres稳定期的改善值与通气功能参数FVC、FEV-和FEV-／FVC的改善值显著相关（P均〈0．05）。结论 COPD急性加重期较稳定期肺功能显著下降,肺过度充气和外周气道阻力增加是急性加重期肺功能恶化的主要原因。     

冷刺激人体食道对咳嗽敏感性和气道功能的影响

目的通过比较正常人和慢性咳嗽患者冷刺激食道前后咳嗽敏感性、肺功能的变化来探讨冷刺激与咳嗽的关系。方法对慢性咳嗽患者按慢性咳嗽病因诊断程序进行病因诊断,分为胃食管反流性咳嗽组(GERC组)和非胃食管反流性咳嗽组(非GERC组),同时入选正常人作为对照。首先对所有受试者检测肺通气功能、气道阻力和辣椒素咳嗽敏感性,间隔24 h后,受试者取坐位,记录10 min内的咳嗽次数,再经鼻饲管灌注0℃生理盐水300 ml,持续15 min。记录刺激过程中和刺激结束后10 min内的咳嗽次数,刺激结束40 min后所有受试者需再次检测肺通气功能、气道阻力和咳嗽敏感性。比较冷刺激前后咳嗽次数、咳嗽敏感性、肺通气功能和气道阻力的变化。咳嗽敏感性检测采用辣椒素定量吸入激发试验,结果以诱发≥5次咳嗽的最低激发浓度的对数值(Lg C5)表示。结果纳入试验的慢性咳嗽患者共17例,其中GERC 8例,非GERC 9例,同时纳入正常人9例。三组受试者在年龄、性别、咳嗽病程上没有显著差异。冷刺激食道前GERC、非GERC和正常受试者的10 min咳嗽次数分别为4.5(0~20)、7(0~35)、0(0~2),刺激食道后10 min的咳嗽次数分别为9(0~25)、11(0~70)、0(0~5),刺激前后比较均无显著变化(P0.05)。冷刺激食道前GERC、非GERC和正常受试者的咳嗽敏感性(Lg C5)分别为1.34(0.29~3.00)、3.00(1.19~3.00)、3.00(3.00~3.00),刺激食道后咳嗽敏感性分别为1.50(0.59~3.00)、3.00(0.59~3.00)、3.00(2.70~3.0),刺激前后比较均无显著变化(P0.05)。冷刺激食道后慢性咳嗽患者呼吸阻抗Zrs较刺激前显著增高[3.75±0.91(cm H_2O)·L~(-1)·S~(-1)vs.3.46±0.78(cm H_2O)·L~(-1)·S~(-1),P0.05],以GERC患者冷刺激后呼吸阻抗增高为主[3.94±1.04(cm H_2O)·L~(-1)·S~(-1)vs.3.44±0.83(cm H_2O)·L~(-1)·S~(-1),P0.05]。冷刺激食道前后GERC、非GERC和正常受试者的其它气道阻力指标和肺通气功能指标均无显著变化(P0.05)。结论冷刺激食道可以增高GERC患者的呼吸阻抗,但对咳嗽敏感性和肺通气功能无明显影响。     

无创双水平正压通气治疗COPD稳定期的疗效观察

目的 探讨无创双水平正压通气治疗慢性阻塞性肺疾病（COPD）稳定期的临床疗效。方法 63例患者随机分为两组,在常规治疗基础上,治疗组给予无创BiPAP呼吸机辅助呼吸,每天早、晚各2h,疗程为4周。结果 治疗组肺功能、血气分析改善率明显大于对照组（P〈0．05）,外周气道阻力明显改善（P〈0．05）。结论 无创双水平正压通气可以明显改善COPD稳定期患者的通气功能和外周气道阻力。     

新疆地区不明原因慢性咳嗽的病因分布

目的观察新疆地区不明原因慢性咳嗽的病因分析。方法对于入选的慢性咳嗽患者,在询问病史和查体的基础上,进行诱导痰、肺通气功能、气道高反应性测定、X线胸片、鼻窦X线片或CT、24h食管PH值监测等检查。结果共收集慢性咳嗽患者148例,年龄17～72岁,平均咳嗽时间（64±76）个月（2～280个月）。慢性咳嗽病因依次为：嗜酸粒细胞性支气管炎33例次（22．5％）,鼻炎／鼻窦炎25例次（17．2％）,咳嗽变异性哮喘20例次（13．8％）,变异性咳嗽18例次（12．2％）,胃食管反流性咳嗽17例次（11．7％）,其他病因28例次（18．7％）,病因未明6例次（4．0％）。结论嗜酸粒细胞性支气管炎和变异性咳嗽是新疆地区慢性咳嗽的重要病因。     

哮喘患者血清转化生长因子β1水平与脉冲振荡肺功能指标的相关性分析

目的探讨不同程度支气管哮喘（哮喘）患者的血清转化生长因子β1（TGF-β1）变化，及其与脉冲振荡（IOS）技术测定呼吸阻抗指标间的关系。方法用酶联免疫吸附试验检测29例轻度、27例中重度哮喘患者的血清TGF-β1；用IOS技术检测其呼吸阻抗指标呼吸总阻抗（Zrs）、总气道黏性阻力（R5）、中央气道黏性阻力（R20）、周边气道总黏性阻力（R5-R20）、周边弹性阻力（X5）及共振频率（Fres）。并设30例健康者作为对照组。结果哮喘组血清TGF—β1与对照组比较、轻度与中重度哮喘患者比较，均有统计学差异（P〈0．05，〈0．01）；哮喘组Zrs、Fres、R5、R20、R5-R20、X5负值均高于对照组（P〈0．05，〈0．01）；血清TGF-β1水平与Zrs、Fres、R5、R5-R20呈显著负相关，与X5呈显著正相关（P〈0．01，〈0．05）。结论哮喘患者血清TGF—β1下降及呼吸阻抗升高与其病情严重程度有相关性，血清TGF-β1水平能间接反映哮喘患者的气道阻力变化，作为哮喘诊断及病情判断的参考指标。     

抑郁症伴功能性食管病患者临床应用抗抑郁药物治疗价值探讨

目的探讨抑郁症伴功能性食管病患者采用抗抑郁药物帕罗西丁治疗的临床价值。方法对32例抑郁症伴功能性食管病患者（观察组）进行帕罗西丁治疗,动态监测治疗前24h食管pH值以及治疗前后食管动力的变化,并与相关文献报道的正常人组结果进行对照。根据临床症状评定治疗前后消化系统评分,并进行比对。结果观察组治疗前24h食管pH值酸暴露6项指标与高萍等的正常国人对照组比较,差异无统计学意义（P〉0．05）;观察组治疗前食管上段括约肌静止压（58．1±15．9）mmHg与丁元伟的正常国人对照组（56．0±20．0）mmHg相似（P〉0．05）,但治疗后较治疗前明显降低（T=2．826,P〈0．01）;观察组治疗前后食管体部运动紊乱发生率分别为81．25％（26／32）和25．00％（8／32）,差异有统计学意义（χ^2=16．05,P〈0．01）。观察组治疗后消化系统评分为（6．75±4．05）分,较治疗前的（12．37±4．05）分明显降低（T=6．225,P〈0．01）。结论抑郁症伴功能性食管病患者无病理性的反流,但存在食管运动功能紊乱,帕罗西丁抗抑郁治疗能有效地恢复食管运动功能,改善消化系统症状。     

非糜烂性反流病患者食管内脏高敏感性与食管下括约肌局部降钙素基因相关肽阳性神经纤维的关系

背景：食管内脏高敏感性是非糜烂性反流病（NERD）最重要的病理生理特征之一，但引起食管内脏感觉过敏的确切机制仍不甚清楚。目的：通过测定NERD患者食管对机械扩张刺激和对酸刺激的敏感性变化和降钙素基因相关肽（CGRP）在食管下括约肌（LES）局部组织中的表达，探讨食管感知阈值与LES局部黏膜CGRP表达之间的关系。方法：采用Synectics内脏刺激器／电子气压泵行食管气囊扩张术以检测食管对机械扩张刺激的敏感性；采用食管酸灌注试验（betastein test）检测食管对酸的敏感性；采用免疫组化法和罔像分析技术观察LES局部组织中CGRP的表达。结果：根据对酸刺激和（或）机械扩张刺激的感知过敏，NERD患者可分为感知过敏组（21例）和感知正常组（10例）。感知过敏组患者食管对气囊扩张刺激的初始感知闽值和最大耐受疼痛阈值较感知正常组和正常对照组显著降低（P〈0．05）。感觉过敏组LES黏膜中CGRP阳性纤维数和平均吸光度（A）值较感知正常组和正常对照组显著增高（P〈0．05）。LES局部组织中CGRP阳性产物A值与食管初始感知阈值和最大耐受疼痛阈值呈直线负相关（r分别为-0．68和-0．79．P〈0．03）。结论：多数NERD患者存在对食管机械扩张刺激和（或）对食管酸刺激感知过敏；感知过敏的NERD患者其LES局部黏膜中CGRP表达增加，提示LES肽能神经的改变可能与食管内脏高敏感性有关。     

胃食管返流病慢性咳嗽的发病机制

不明原因的慢性咳嗽常与无症状的胃食管返流有关。作者旨在明确远端食管存在酸与慢性咳嗽的关系。 22例慢性咳嗽患者,均经24小时pH检测,证实有胃食管返流存在。用双盲法,设对照组,对食管进行0.1N盐酸和生理盐水灌注,每次15分钟。咳嗽由麦克风记录,经计算机处理。12例健康人作为对照组,也进行食管24小时pH检测及食管酸灌注试验。 作者发现:食管内灌注盐酸时,患者组咳嗽次数多,中位数为36.5(6～111)次/15分,对照组为0.0(0～11)次/15分(P相似文献   

非糜烂性反流病与反流性食管炎症状及食管酸暴露情况

目的比较非糜烂性反流病（NERD）与反流性食管炎（RE）的临床症状及食管酸暴露情况。方法具有反流症状的患者155例,进行胃镜检查和食管24hpH动态监测。结果155例患者中诊断RE76例（49．0％）,其中A、B、C、D级分别为40、24、8和4例;诊断NERD79例（51．0％）;RE组中pH监测阳性57例（75．0％）,NERD组26例（32．9％）,差异有统计学意义（P〈0．05）;NERD组食管外症状发生率较RE组高,差异有统计学意义（P〈0．05）,而典型的反流症状发生率两组比较差异无统计学意义（P〉0．05）;RE组各项酸反流指标均大于NERD组,差异有统计学意义（P〈0．05）;轻度RE（LA-A）组各项酸反流指标低于中度RE（LA—B）和重度RE（LA—C＋D）,差异有统计学意义（P〈0．05）,但中度RE（LA—B）与重度RE（LA—C＋D）之间的差异无统计学意义（P〉0．05）;79例NERD中,依据监测当日症状计算SI值,pH阴性sI阳性（NERDpH^-SI^＋）15例,pH阴性sI阴性（NERDpH^-SI^-）28例,NERDpH^-SI^＋组的pH〈4．0（％）和酸反流次数明显高于NERDpH^-SI^-组,差异有统计学意义（P〈0．05）。结论胃酸反流是RE形成的重要因素,其中胃酸的浓度及长反流与食管黏膜接触的次数是直接造成食管黏膜损伤的重要因素;酸反流的程度与RE的严重程度之间可能相关;NERD根据酸反流与症状的关系可分为不同的亚型,病理性酸反流所占比例相对较低,酸反流的强弱在其发病机制中可能未起到决定性作用。     

Effects of esophageal acid perfusion on cough responsiveness in patients with bronchial asthma

STUDY OBJECTIVES: The effect of gastroesophageal reflux (GER) on cough responsiveness in patients with bronchial asthma has yet to be studied in significant detail. The purpose of this study was to assess the effect of distal esophageal acid perfusion on cough responsiveness in patients with bronchial asthma. PATIENTS AND INTERVENTIONS: In seven patients with mild persistent bronchial asthma (mean +/- SD age, 57.7 +/- 3.7 years; four women and three men), esophageal pH was monitored by a pH meter and cough responsiveness was evaluated by single-breath aerosol inhalation of capsaicin with increasing dosage from 0.30 to 9.84 nmol. Simultaneously, esophageal perfusion was performed through an esophageal tube filled with either saline solution or 0.1 N hydrochloric acid (HCl), the order of which was selected at random, in 1-week intervals. Results were expressed as the lowest concentration of capsaicin eliciting three coughs (PD3). Spirometry was also performed during esophageal pH monitoring. RESULTS: A significant decrease in the geometric mean of log PD3 was observed during distal esophageal HCl perfusion (0.45 +/- 0.04 nmol) compared with that of the saline solution perfusion (0.04 +/- 0.06 nmol) [p < 0.01]. However, no significant changes were observed either in FVC, FEV1, or peak expiratory flow during the periods of the saline solution or HCl perfusion. CONCLUSION: The present data demonstrate that an increase in cough responsiveness may be induced when HCl stimulates the distal portion of esophagus in patients with bronchial asthma, suggesting that the GER would be one of the important factors that influence asthmatic status.     

新疆地区150例不明原因咳嗽临床病因分析

目的 分析新疆地区不明原因咳嗽的病因及治疗效果.方法 采用Irwin慢性咳嗽解剖学诊断程序,并补充诱导痰细胞分类检查,对慢性咳嗽的病因进行分类,并针对病因进行特异性治疗.结果 应用该方法对150例慢性咳嗽患者进行分析发现,病因确诊率为96%（144/150）.患者中单一咳嗽者125例（86.8%）,复合咳嗽者19例（13.2%）,慢性咳嗽病因比例依次为：上气道咳嗽综合征58例（34.3%）,咳嗽变异型哮喘41例（24.3%）,嗜酸粒细胞性支气管炎为24例（14.2%）,胃食管反流为14例（8.3%）,支气管结核10例（5.9%）,其他病因16例（9.5%）,病因未明6例（3.6%）,经过针对病因特异性治疗,有93%（140/150）患者的咳嗽症状明显减轻或消失.结论 在本地区除上气道咳嗽综合征、咳嗽变异型哮喘、嗜酸粒细胞性支气管炎和胃食管反流等病因外,支气管结核亦是慢性不明原因咳嗽的重要病因,诊断性治疗有效是确诊病因的重要环节.     

胃食管反流性咳嗽的发病机制及诊疗

胃食管反流性咳嗽为胃食管反流病的一种特殊类型,是慢性咳嗽常见病因之一.与典型胃食管反流病相比,胃食管反流性咳嗽在发病机制、诊疗方面有其特点.胃食管反流性咳嗽的发病机制可能是高位反流、低位反流和气道高敏感性等多因素共同作用的结果,诊断需结合临床表现和辅助检查建立,多通道食管腔内阻抗联合pH监测可以区分酸与非酸性反流,是有前景的诊断技术,抗反流药物治疗是目前胃食管反流性咳嗽的主要治疗方法.     

新疆地区儿童慢性咳嗽病因构成分析

目的分析新疆地区儿童慢性咳嗽的病因特点。方法对收集的653例慢性咳嗽患儿的临床资料进行前瞻性研究,包括主要病因、年龄、民族、过敏原、家族史、环境因素、肺功能情况。结果新疆地区儿童慢性咳嗽病因多为呼吸道感染和感染后咳嗽192例(29.40%)、咳嗽变异性哮喘158例(24.20%)和上气道咳嗽综合征140例(21.44%)。另外,其他病因163例(24.96%),其中双重病因84例(12.87%),病因不明5例(0.77%);慢性咳嗽的主要病因在不同年龄、不同民族亦不同:婴幼儿(0~3岁)慢性咳嗽的主要病因为感染/感染后咳嗽,学龄前儿童(4~6岁)主要病因亦为感染/感染后咳嗽(PIC),学龄期儿童(6~14岁)主要病因为咳嗽变异性哮喘(CVA)和上气道咳嗽综合征(UACS);汉族和哈萨克族儿童慢性咳嗽主要病因以PIC最多,维吾尔族、回族和蒙古族儿童中则以CVA多见。结论新疆地区儿童慢性咳嗽的主要病因依次为呼吸道感染和感染后咳嗽、咳嗽变异性哮喘和上气道咳嗽综合征,不同年龄、不同民族慢性咳嗽的病因构成比不同。具有个人过敏史、家族过敏史、不良外界环境接触史及肺功能异常的患儿更易诊断为咳嗽变异性哮喘。     

The utility of ambulatory pH monitoring in patients presenting with chronic cough and asthma.

OBJECTIVE: To evaluate the prevalence of gastroesophageal reflux disease (GERD) in patients presenting with asthma and chronic cough. PATIENTS AND METHODS: The charts of 358 consecutive patients who were referred for ambulatory gastroesophageal pH monitoring to the Lung Centre in Vancouver, British Columbia, were reviewed, and the data of 108 (30%) patients with asthma and 134 (37%) patients with chronic cough were analyzed. The maintenance treatment for GERD was discontinued before patients underwent the pH monitoring study. One hundred eighteen (33%) patients were excluded. RESULTS: Reflux episodes identified reflux events as the percentage of time where the pH was less than four. For asthma patients, 70 (64.8%) had distal total reflux, 50 (46.3%) had distal upright reflux, 41 (38.3%) had distal supine reflux and 73 (67.6%) had other distal refluxes. Proximal total reflux in asthmatic patients was present in 56 (52%), proximal upright reflux in 55 (51%) and proximal supine reflux in 56 (52%) patients. For chronic cough patients, 70 (52.6%) had distal total reflux, 59 (44.4%) had distal upright reflux, 45 (34.4%) had distal supine reflux and 75 (56%) patients had other distal refluxes. In chronic cough patients, proximal total reflux was present in 70 (52%), proximal upright reflux in 80 (60%) and proximal supine reflux in 59 (44%). Presenting respiratory and/or reflux symptoms were absent in approximately 25% of patients with asthma and reflux, and in approximately 50% of patients with chronic cough and reflux. During pH monitoring, symptoms did not differ significantly between those with and without distal reflux in both study groups, except for more significant heartburn in patients with chronic cough and reflux (RR 2.0). CONCLUSIONS: The data of the present study support the observation that there is a high prevalence of GERD in patients with asthma or chronic cough. The use of different pH parameters for detecting acid reflux during 24 h ambulatory pH monitoring, such as proximal esophageal acid measurement, should be considered as part of the routine interpretation of such testing. A low threshold for diagnosing GERD in patients with asthma or chronic cough is essential, because respiratory and/or reflux symptoms can be absent or atypical in some of these patients.     

Reflux episode reaching the proximal esophagus are associated with chronic cough

Background/Aims

Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic cough. The aims of this study were to evaluate the diagnostic usefulness of multichannel intraluminal impedance combined with pH monitoring (MII/pH monitoring) in patients with suspected symptoms of gastroesophageal reflux disease (GERD) and to assess the correlation between GER symptoms and reflux nature.

Methods

Seventy patients with suspected symptoms of GERD (such as heartburn, acid regurgitation, non-cardiac chest pain, globus and chronic cough) were enrolled. All patients were asked to discontinue medications that would influence esophageal motor function and gastric acid secretion at least one week ago. All subjects underwent MII/pH monitoring.

Results

Forty-five patients (64.3%) were diagnosed with GERD. Among these patients, eleven patients (15.7%) had pathologic acid reflux by pH data and thirty-four patients (48.6%) had pathologic bolus exposure by impedance. Subjects with chronic cough had a higher DeMeester score (p=0.009), percentage of acid exposure time (p=0.007), acid bolus exposure % time (p=0.027), distal acid reflux episodes (p=0.015) and proximal acid reflux episodes (p=0.030) than subjects without chronic cough.

Conclusions

The results of this study showed that the impedance monitoring enhanced diagnostic sensitivity than pH-monitoring alone by 48.6%. In addition, reflux episodes at the distal and proximal esophagus were noted to be important factors associated with chronic cough.     

激素敏感性咳嗽和非激素敏感性咳嗽的临床特征分析

目的 探讨激素敏感性咳嗽（CSRC）和非激素敏感性咳嗽（NCSRC）的临床特征差异.方法 收集2003年至2013年在广州医科大学第一附属医院呼吸科就诊的病因明确的357例慢性咳嗽患者的临床资料,进行回顾性分析.依据病因分为激素敏感性咳嗽组和非激素敏感性咳嗽组,将两组的临床特征进行比较.结果 与非激素敏感性患者相比,激素敏感性咳嗽患者的咳嗽病程更短（24 vs.36个月,P=0.025）,CSRC组日间咳嗽积分更低（P＜0.05）.NCSRC组的咳嗽常于白天出现（87.85％ vs.78.15％,P=0.006）,而CSRC组的咳嗽则常出现于夜间（43.13％ vs.32.60％,P=0.018）.与NCSRC组相比,CSRC组胃食管反流症状的发生率更低（26.33％ vs.54.14％,P=0.000）,咳嗽与饮食相关的比例更低（11.43％ vs.37.08％,P=0.000）,伴有鼻部症状的比例更低（40.06％ vs.55.8％,P=0.001）,气促的比例更高（18.21％ vs.11.05％,P=0.032）.感冒和讲话引起咳嗽或咳嗽加重的比例均为NCSRC组高于CSRC组（48.62％ vs.38.94％,28.73％ vs.17.65％,P均＜0.05）.CSRC组咽部异物感、频繁清喉和咽喉壁黏液附着感的比例显著低于NCSRC组（分别为8.68％ vs.18.23％,20.73％ vs.40.88％,3.64％ vs.10.50％,P均＜0.01）.CSRC组的MMEF/pred显著低于NCSRC组（72.29±31.22vs.84.09±31.64,p=0.000）,且气道高反应性的比例高于NCSRC组（29.9％ vs.4.26％）.CSRC组中痰嗜酸粒细胞百分比明显高于NCSRC组（中位数5％ vs.0.25％,P=0.001）.结论 激素敏感性咳嗽和非激素敏感性咳嗽的临床特征存在一定差异,但单纯从临床特征上无法完全区分二者,仍需结合相关实验室检查来明确诊断.     

Chronic cough as the sole presenting manifestation of gastroesophageal reflux

Nine patients complaining only of chronic cough of unknown cause were prospectively studied with prolonged esophageal pH monitoring (EPM) before and after cough had disappeared as a complaint in order to determine if and why gastroesophageal reflux (GER) was causing their coughs. Coughs disappeared as a complaint an average of 161 +/- 75 days after medical therapy for GER. Comparisons of pretreatment and post-treatment EPM data revealed the following: numbers of coughs (p = 0.029), total refluxes (p = 0.001), refluxes greater than or equal to 5 min (p = 0.019), and reflux-induced coughs (p = 0.005) had significantly decreased in the distal esophagus, and total refluxes (p = 0.05) had significantly decreased in the proximal esophagus. During the entire study period, the number of coughs were significantly correlated with the number of total refluxes (p = 0.039), longest reflux (p = 0.019), number of refluxes greater than or equal to 5 min (p = 0.006), and percent of total time that pH was less than 4 (p = 0.017) in the distal esophagus. On the basis of these results, we conclude that (1) cough can be the sole presenting manifestation of GER, and it gradually responds to standard GER therapy; (2) prolonged EPM is safe, well-tolerated, and extremely useful in diagnosing clinically silent GER; (3) the mechanism by which GER causes cough is related to a critical number and/or duration of reflux episodes in the distal and/or proximal esophagus.     

Temporal correlation between chronic cough and gastroesophageal reflux disease

Reflux disease (GERD) and chronic cough often coexist, but a temporal correlation using the symptom association probability has not been reported. Our aim was to determine if a temporal correlation exists between cough and GERD. Sixty-one patients with chronic cough had esophageal pH monitoring with sensors 5 and 20 cm above the LES. The symptom (SI) and symptom sensitivity (SSI) indices and the symptom association probability (SAP) were used to test cough–reflux association. Pathological reflux was defined as the percentage of time pH <4 exceeded 4.2%. A significant temporal association between cough and distal reflux was made in 35% of patients by SAP compared with only 14.8% by SI and SSI alone (P < 0.002). Patients with pathologic reflux had a greater likelihood of a temporal symptom correlation (57.1%) when not on acid-blocking medications. In conclusion, a temporal association between cough and distal reflux exists in one third of patients, especially those with pathological reflux. The SAP is a more sensitive measure of temporal association than SI or SSI.     

儿童上气道咳嗽综合征60例诊治分析

目的探讨儿童上气道咳嗽综合征(upper airway cough syndrome,UACS)的临床特点。方法对60例确诊为UACS的患儿的临床表现、辅助检查及治疗进行回顾性分析。结果所有患儿的主要症状为慢性咳嗽。慢性鼻窦炎39例(65%),变应性鼻炎21例(35%);其中11例(18.33%)患儿合并腺样体肥大。36例(60%)患儿曾被误诊。经过积极的抗变态反应、抗感染治疗,54例(90%)患儿咳嗽症状消失,6例(10%)患儿咳嗽明显减轻。结论 UACS是儿童慢性咳嗽的主要原因。