【摘要】 目的建立一种初级而简易的慢性咳嗽诊治方法,并初步了解成都地区慢性咳嗽的病因构成。方法引入"慢性气道炎症咳嗽综合征"(chronic airway inflammatory cough syndrome,CAICS)的概念,CAICS包括慢性咳嗽的几个常见病因:咳嗽变异性哮喘(CVA)、嗜酸细胞性支气管炎(EB)、变应性咳嗽(AC)及不典型的慢性支气管炎等。随机收集2011年7月至2012年5月在四川省人民医院门诊就诊的慢性咳嗽患者,对其进行拟诊病因诊断,并通过经验性治疗,分析患者的咳嗽病因及疗效。结果共观察慢性咳嗽患者148例,平均年龄(43.0±13.0)岁。其中男72例,女76例,男女患者平均年龄分别为(39.7±10.7)岁及(45.0±14.2)岁,两者比较差异有统计学意义(t=2.582,P<0.05),提示男性患者发生慢性咳嗽的年龄较女性小。所有患者的平均咳嗽时间为(24.7±42.1)个月(2～360个月),总的拟诊率为96.6%(143/148),不明原因者5例(3.4%)。慢性咳嗽拟诊病因依次为(共186例次):总CAICS 107例次(57.5%),上气道咳嗽综合征(UACS)40例次(21.5%),胃食管反流性咳嗽(GERC)17例次(9.1%),其余病因16例次(8.4%)。其中单一拟诊病因咳嗽者95例(64.2%),二重拟诊病因者41例(27.7%),三重拟诊病因者3例(2.0%)。有12.2%的慢性咳嗽患者合并变应性鼻炎(AR),拟诊CAICS及UACS且合并AR者均为18%,而确诊CVA合并AR者为33.3%,其余病因鲜有合并AR者。提示AR与CVA、CAICS及UACS关系密切。该方法经验性治疗慢性咳嗽总有效率为83.7%。结论本研究显示成都地区慢性咳嗽的病因分布与国内某些研究结果基本一致,CAICS(即累计CVA、EB、AC及不典型慢性支气管炎)、UACS及GERC是慢性咳嗽的三大主要病因。该方法简易有效,经济适用,可做为一种慢性咳嗽的初级诊治方法。更多还原

【Abstract】 Objective Using a simple management strategy to investigate the etiologic spectrum of chronic cough in Chengdu city and its suburbs.Methods Chronic cough patients were randomly recruited from the outpatient clinic of Sichuan Provincial People’s Hospital between July 2011 to May 2012.A conception of "Chronic Airway Inflammatory Cough Syndrome,CAICS" was established including several common causes of cough such as cough variant asthma(CVA),eosinophilic bronchitis(EB),atopic cough(AC),and atypical chronic bronchitis.Based on CAICS,a simplified suspected diagnosis procedure of chronic cough was conducted.Patients were empirically treated.Etiology and efficiency of chronic cough was analyzed.Results A total of 148 patients of chronic cough were recruited.The mean age was(43.0±13.0) years old.There were 72 male and 76 female patients with mean ages of(39.7±10.7) and(45.0±14.2) years old respectively.The males were younger than the females(P<0.05).There was 96.6%(143/148) of patients suspectedly diagnosed and 3.4%(5/148) patients were undiagnosed.The suspected causes of these chronic cough patients were as follows,ie.CAICS(57.5%),upper airway cough syndrome(UACS,21.5%),gastroesophageal reflux cough(GERC,9.1%),and others(8.4%).A single possible cause was found in 95 patients(64.1%),two possible causes in 41 patients(27.7%),and three possible causes in 3 patients(2.0%).12.2% of chronic cough patients were combined with allergic rhinitis(AR).Among the diseases,CVA,CAICS and UACS were disposed to coexist with AR.The overall efficiency of empiric management strategy of chronic cough was 83.7%.Conclusions The etiological spectrum of chronic cough in Chengdu acquired by this strategy was generally consistent with previous findings in China.The three most important causes of chronic cough in Chengdu were CAICS,UACS and GERC.This strategy was simple,effective,economic and feasible.It could be a primary management for chronic cough in some hospital.更多还原