胃食管反流性咳嗽的临床特征与诊断探讨

目的分析胃食管反流性咳嗽(GERC)的临床特征,为临床诊断GERC提供资料。方法收集我所2003年6月—2004年6月因慢性咳嗽而就诊的患者,对疑为GERC或诊断不明者行食管24hpH值监测,记录患者反流症状与呼吸道症状,包括监测期间出现的反胃、反酸、胸骨后烧灼感、胸闷和咳嗽等,记录食管上、下电极的Demeester总积分及24h食管pH<4的反流次数、反流时间>5min的次数、最长反流时间,计算总、立位、卧位pH<4的时间占监测时间的百分比,并与非GERC组患者(23例)进行比较。结果共评价250例慢性咳嗽,资料完整的192例,根据病情需要有50例行食管24hpH值监测,确诊GERC20例(GERC组),有13例存在进食相关性咳嗽,显著多于非GERC组(P<0.01),而伴反流相关症状、胃病史的发生率2组差异无统计学意义。进食相关性咳嗽对提示GERC诊断的特异性、阳性预计值和敏感性分别为91.3%、86.7%、65%。食管24hpH值监测结果显示:下电极立位pH<4的时间占监测时间的百分比显著大于卧位(P<0.05),餐后反流明显大于餐时反流(P<0.01)和立位反流(P<0.05)。结论进食相关性咳嗽对GERC的诊断有重要价值。食管24hpH值监测结果显示,GERC以餐后反流及立位反流为主,与临床表现相一致。

The clinical features and the diagnosis of gastro-esophageal reflux induced cough

OBJECTIVE: Gastro-esophageal reflux (GER) is an important etiological factor inducing chronic cough. This study aims to identify the clinical features for the diagnosis of GER induced cough (GERC). METHODS: A modified Irwin's diagnostic protocol and continuous 24-hour esophageal pH monitoring were performed in 50 patients with chronic cough. Twenty patients were diagnosed as having GERC. The clinical features were compared with those of non-GER (NGER) induced cough. RESULTS: One hundred and ninety-two patients met the chronic cough criteria and were fully evaluated. The x +/- s of age was (40.6 +/- 12.1) years (range, 10 - 69 years) and 101 were males and 91 were females, with a cough history of 25 months (range, 2 - 487 months). GER accounted for 10.4% (n = 20) of the causes and was the fourth common cause of chronic cough. The mean +/- SD of age was (37.7 +/- 13.9) years (range, 10 - 60 years) in the GERC group, with a cough history of 61 months (range, 3 - 360 months). Cough associated with having meals (occurring while eating or anytime during the subsequent 2 h) was present in 13 out of the 20 patients in GERC, significantly higher than that in NGER (2 out of 23 patients) (chi2= 14.29, P < 0.01). The specificity, the positive predictive value and the sensitivity of cough associated with meals for GERC were 91.3%, 86.7% and 65.0%, respectively. Regurgitation associated symptom was present in 11 out of the 20 patients in the GERC group, not significantly different from that in the NGER group (8 out of 23 patients). Continuous 24 hour ambulatory esophageal pH measurement showed that reflux events were more common in upright 8.9 (range, 1.9 - 71.9)%] than in supine position 1.4 (range, 0 - 41.2)%] as well as at post-meal 20.2 (range, 2.1 - 84.2)%] than during meal period 1.95 (range, 0 - 51.6)%] (P < 0.01 and P < 0.05). CONCLUSION: Cough associated with having meals is of diagnostic value for GERC. The reflux events are more frequent when patients are awake, with upright position and after meals.