摘要
目的研究不同病因咳嗽患者对辣椒素刺激的咳嗽敏感性,探讨辣椒素咳嗽激发试验在咳嗽诊疗中的临床意义。方法选择我科2010年2～9月门诊确诊的上气道咳嗽综合征(upper airway cough syndrome,UACS)、咳嗽变异性哮喘(cough variability asthma,CVA)和胃食道反流性咳嗽(gastro-esophageal regurgitation cough,GERC)、感冒后咳嗽、职业性刺激性咳嗽和血管紧张素酶抑制剂(ACEI)相关性咳嗽患者169例,以无咳嗽症状的健康人38例作对照,进行辣椒素咳嗽激发试验检测,统计并比较确诊的不同病因咳嗽的咳嗽激发试验的定性(阳性率)及定量(log C2和log C5)指标差异。结果确诊的不同病因的咳嗽共148例。正常对照组有近半数的患者(47.4%,18/38)咳嗽激发呈阳性。不同病因咳嗽组的阳性率以GERC组最高,GERC组和感冒后咳嗽组与正常对照组比较有显著性差异(P<0.05)。辣椒素刺激的咳嗽阈值(C5)测定结果为GERC组最低(1.61±0.25)。GERC组和感冒后咳嗽组的Log C5值与正常对照组比较有显著性差异(P<0.05),UACS、职业性刺激、ACEI相关性咳嗽组之间无显著差异。不同病因咳嗽组与正常对照组的C2值比较结果与C5值完全相似。从Log C5值的95%置信区间数值看,正常对照组与GERC组、感冒后咳嗽组间没有相互重叠,与CVA组有部分重叠,与UACS组、职业性刺激组、ACEI相关性咳嗽组之间则重叠较多。结论不同病因咳嗽患者的咳嗽敏感性存在显著差异,辣椒素咳嗽激发试验结合患者的临床特征对于明确咳嗽的病因具有一定的辅助诊断价值。
Objective To study the sensitivities of patients with different causes of cough to capsaicin-stimulated cough and to investigate the clinical significance of capsaicin cough provocation test in diagnosis and treatment of different causes of cough.Methods We selected 169 patients with different causes of cough from the outpatients in Chongqing Xinqiao Hospital of Third Military Medical University,including upper airway cough syndrome（UACS）,cough variability asthma（CVA）,gastro-esophageal regurgitation cough（GERC）,cough after a cold,occupational irritant cough and angiotensin-converting enzyme inhibitor（ACEI）-related cough.Thirty-eight healthy volunteers of our hospital were enrolled as controls.All the subjects were examined by capsaicin cough provocation test,and the results were analyzed to compare the differences of the qualitative（positive rate） and quantitative（log C2 and log C5） indices in different causes of cough.Results A total of 148 patients who were diagnosed as cough by different causes completed the study.Nearly half of the patients（47.4%,18/38） in the normal control group were cough provocation positive.GERC group had the highest positive rate among the groups with different causes of cough,and the GERC group and cough after a cold group had a significant difference compared with the control group（P〈0.05）.The threshold（C5） of Capsaicin cough provocation was the lowest in the GERC group.LogC5 values of the GERC group and the cough after a cold group were significantly different from that of the normal control group（P〈0.05）.LogC5 values of the UACS group,occupational irritant cough group and ACEI-related cough group（P〈0.05） were not significantly different.Comparison of C2 values in different groups was similar to that of C5 values.According to the 95% confidence intervals of log C5 values,no overlap was detected between the normal control group and the GERC group and cough after a cold group,but there was some overlap between the normal control group and the CVA group.More overlaps were detected between the normal control group and the UACS group,occupational irritant cough group and ACEI-related cough group.Coclusion Cough sensitivities of patients with different causes of cough are significantly different.Capsaicin cough provocation test combined with clinical features of patients have a certain diagnostic value for understanding different causes of cough.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2011年第21期2286-2289,共4页
Journal of Third Military Medical University
关键词
咳嗽
辣椒素咳嗽激发试验
cough
capsaicin cough provocation test
