中国胸闷变异性哮喘临床研究回顾及启示

Review and perspective of clinical research involving chest tightness variant asthma in China

胸闷变异性哮喘(CTVA)于2013年由我国学者首次报道并命名。是以胸闷为唯一或主要症状的一种全新哮喘临床类型,没有反复发作的喘息、气促等典型的哮喘表现,患者肺部听诊没有哮鸣音。CTVA目前尚无总体发病率的流行病学数据;其发病机制与典型哮喘类似,存在嗜酸性粒细胞气道炎症;由于CTVA缺乏典型哮喘的临床表现,部分临床医师对该疾病认知不足等原因容易导致误诊漏诊;目前CTVA的诊断标准是:以胸闷作为唯一或主要症状,无喘息、气促等典型哮喘的症状和体征,同时具备可变气流受限客观检查中的任一条,抗哮喘治疗有效,除外心血管、消化、神经肌肉、精神等其他疾病所引起的胸闷;CTVA治疗参照典型哮喘,但具体疗程不确定,可能需要长期治疗;中医中药对其有一定的治疗效果;多数CTVA患者经积极抗哮喘治疗后预后良好。本文对我国学者2013年以来CTVA相关研究进行回顾,为进一步探索CTVA提供新视角。

Chest tightness variant asthma(CTVA)was first reported and named by Chinese scholars in 2013.It is a new clinical type of asthma characterized by chest tightness as the only or primary symptom,without typical asthma manifestations such as recurrent wheezing and shortness of breath,and without wheezing sounds heard during lung auscultation.The overall epidemiological data on CTVA is currently unavailable.Its pathogenesis is similar to that of typical asthma,involving eosinophilic airway inflammation.Due to the lack of typical clinical manifestations,insufficient knowledge of this disease in some clinicians and some other reasons,CTVA is susceptible to misdiagnosis or missed diagnosis.Currently,the diagnostic criteria for CTVA are:chest tightness as the only or primary symptom,without typical asthma symptoms and signs such as wheezing and shortness of breath,and with any one of the objective indicators of variable airflow limitation.Effective anti-asthma treatment is required,and other diseases that cause chest tightness,such as cardiovascular,digestive,nervous,muscular,and mental diseases should be excluded.CTVA treatment follows that of typical asthma,but the specific treatment duration is uncertain and may require long-term management.Traditional Chinese medicine has shown some therapeutic effects on CTVA.Most CTVA patients have a good prognosis after active anti-asthma treatment.This paper analyzes and summarizes the research of CTVA in China from 2013 and provides new perspectives for further exploration of CTVA.