以经验性治疗为主的慢性咳嗽诊治研究

目的通过经验性治疗为主的慢性咳嗽症治方法的研究,探索易于临床广泛推广应用的慢性咳嗽诊治方法提供帮助。方法研究对象为具备以下特征的患者:①慢性咳嗽超过8周;②X线胸片正常;③正在或近期服用血管紧张素转换酶抑制剂(angiotensin convirting enzymelngibitors,ACEI)类药物;④胸部恶性肿瘤;⑤慢性心肺疾病;⑥目前吸烟大于10支/d;⑦有粉尘和职业刺激物质接触史。进行相关病史采集及支气管激发试验后,根据经验性治疗结果进行相关疗效评价及病因学分析。结果 101例患者接受了随访,失访35例。支气管激发试验阳性率为28.7%(29/101例)。拟诊咳嗽变异型哮喘(cough variability asthma,CVA)30例(29.7%,30/101例),针对性治疗有效率77.8%;拟诊上气道咳嗽综合征(upper airway cough syndrome,UACS)54例(53.5%,54/101例),经验性治疗有效率57.4%;拟诊胃食道相关性咳嗽(gastro-esophagealregurgitation cough,GERC)17例(16.8%,17/101例),经验性治疗有效率76.4%。经以上流程诊治后,症状缓解1/3为有效,其治疗总有效率为66.3%(67/101)。结论以经验性治疗为主的策略治疗有效率高,诊疗费用低,适合在中国等发展中国家推广。

The study of diagnosis and treatment of chronic cough based empirical therapy

Objective To study the chronic cough diagnosis and treatment ways for easy- to-be widely using in clinical work based on the empirical treatment. Methods The subjects were patients with the following characteristics： （1） chronic cough more than 8 weeks; （2） X-ray normal; （3）current angiotensin-converting enzyme inhibitor （ACEI） drugs treatment; （4） breast cancer; （5） chronic heart and lung disease; （6） current smoking more than 10/d; （7） with dust and occupational history of exposure to irritant substances. Acquisition medical history from all subjects and bronchial provocation tests were test, and then the efficacy evaluation and etiologies were analyzed based on the targeted treatment results. Results 101 patients received follow-up, 35 patients lost. Bronchial provocation test positive rate was 28.7% （ 29/101 ）. Suspected CVA were 30 patients （ 29.7%, 30/101 cases）, and 77.8% of them were effective targeted therapies; Suspected UACS were 54 cases （53.5%, 54/101 cases）, and 57.4% of them were effective targeted therapies; suspected GERC were 17 cases （ 16.8% , 17/101 cases） , 76.4% of them were effective empirical therapy. After treatment by the above process, symptoms 〉 1/3 to be valid, the overall response rate was 66.3% （67/101）. Conclusion The empirical treatment strategy based treatment was effective rate and low cost, and it was the suitable way for use in China and other developing countries.