慢性咳嗽的病因诊断及治疗效果

目的分析慢性咳嗽患者的病因诊断和特异性治疗的效果。方法采用中华医学会呼吸病学分会制订的《咳嗽的诊断与治疗指南》中慢性咳嗽病因诊断流程,在询问病史和体格检查的基础上,对106例慢性咳嗽患者进行常规胸部X线、肺功能和气道反应性、鼻窦X线或CT、24h食管pH监测、诱导痰细胞分类等检查,根据临床表现、检查结果及特异性治疗的反应确定病因诊断。结果106例慢性咳嗽患者中,101例(95.3%)诊断明确,单一病因咳嗽者81例(80.2%),复合病因者20例(19.8%)。其中咳嗽变异性哮喘(CVA)66例(62.3%),鼻后滴漏综合征(PNDs)15例(14.1%),胃食管反流性咳嗽(GERC)11例(10.4%),感染后咳嗽(PIC)4例(3.8%),血管紧张素转换酶抑制剂(ACEI)类药物诱导的药物性咳嗽3例(2.8%),嗜酸性粒细胞性支气管炎(EB)2例(1.9%),病因未明5例(4.7%)。经特异性治疗后92例(91.1%)患者咳嗽得到控制,9例(8.9%)咳嗽部分缓解。结论CVA、PNDs、GER是慢性咳嗽的主要病因,大部分患者经特异性治疗后咳嗽症状消失。

Etiological diagnosis and specific treatment of chronic cough in 106 patients

Objective To analyze the etiological diagnosis and efficacy of specific therapy of chronic cough.Methods Totally 106 patients with chronic cough were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association,which included history inquiry,physical examination,pulmonary function tests,X-ray or CT of paranasal sinuses or chest,24-hour esophageal pH monitoring,and sputum cell differentials.The etiological diagnosis was made according to clinical manifestations,examination results,and response to specific therapy.Results The cause of chronic cough was confirmed in 101 patients(95.3%).Cough due to a single cause was found in 81 patients(80.2%),and due to multiple causes in 20 patients(19.8%).The causes included cough variant asthma(CVA) in 66 patients(62.3%),postnasal drip syndrome(PNDs) in 15 patients(14.1%),gastroesophageal reflux(GERC) in 11 patients(10.4%),post-infection cough(PIC) in 4 patients(3.8%),angiotensin converting enzyme inhibitor(ACEI) induction in 3 patients(2.8%),and eosinophilic bronchitis(EB) in 2 patients(1.9%).Five patients(4.7%) had not been definitely diagnosed.After specific therapy based on diagnosis,cough disappeared in 92 patients(91.1%) and alleviated in 9 patients(8.9%).Conclusions CVA,PNDs,and GERC are the most common causes of chronic cough.Specific therapy based on definite cause can result in good outcome.