血管紧张素转换酶抑制剂所致咳嗽机制研究结果的回顾分析

目的：按照循证医学标难，对国内外血管紧张素转换酶抑制剂(ACEI)所致咳嗽机制研究的结果予以总结和评价，指导临床工作。方法：检索近13a来5种中文医学杂志、并登录美国国立医学图书馆网站检索关于ACEI所致咳嗽机制的临床研究文章，从实验设计方法、观察指标等多方面进行逐篇分析。结果：共检出13篇文章，均为国外学者研究，涉及基因多态性、P物质、缓激肽、气道反应性、血清血管紧张素转换酶、血栓素等多种因素与咳嗽的关系研究，4项研究为随机对照试验(RCT)，除一项为大样本研究外，其余均为小样本研究，存在基线资料、纳入及排除标难不全，交叉对照实验无洗脱期等问题。结论：我国需开展一些大样本RCT临床研究，对可能导致咳嗽的因素进行前瞻性观察，以明确ACEI导致咳嗽的机制所在。

A comment on the clinical studies of cough mechanism induced by angiotensin-converting enzyme inhibitors

Objective:To summarize and evaluate the current situation of clinical studies on cough mechanism induced by angiotensin converting enzyme inhibitors (ACEI)according to evidence based medicine standards.Methods:All articles on cough induced by ACEI published in Chinese Journal of Cardiology, Chinese Journal of Internal Medicine, Chinese Circulation Journal, Chinese Journal of Hypertension, Chinese Pharmaceutical Journal or searched on line (www.ncbi.nlm.nih.gov) in the past 13 years were searched with the following aspects:the study design, the evaluation indexes and so on. 61 papers were found.Results:13 articles out of the 61 papers all written by foreign doctors were related to the cough mechanism study, of which included gene polymorphisms, substance P, bradykinin, bronchial reactivity,and angiotensin converting enzyme level in blood serum and thromboxane. 4 articles were randomized control trials. Most trials were small scale researches except one. There were other quality problems such as base condition imbalance between groups, absence of washout period, etc. There is no paper written by Chineses doctors.Conclusion:Large scale randomized control clinical prospective trials are necessary to investigate the cough mechanism in China.