不同病因慢性咳嗽临床特征的诊断价值

Diagnostic values of the clinical characteristics of chronic cough

目的比较不同病因慢性咳嗽患者的特征及伴随症状，探讨其对临床慢性咳嗽的病因诊断的价值。方法按慢性咳嗽病因诊断程序对2003年6月至2007年12月广州呼吸疾病研究所专科门诊的慢性咳嗽患者进行病因诊断。对单一病因的患者按常见病因进行分组，分析比较不同单一病因的慢性咳嗽患者的咳嗽时相、性质、诱发因素等特征及相关伴随症状。计量资料用面x±s表示，计数资料以率表示，统计采用方差分析及卡方检验。结果共入选196例单一病因的慢性咳嗽患者，男108例，女88例；年龄14—72岁，平均（40±12）岁。其中咳嗽变异性哮喘（CVA）50例，嗜酸粒细胞性支气管炎（EB）55例，上气道咳嗽综合征（UACS）45例、胃食管反流性咳嗽（GERC）46例。不同病因组慢性咳嗽患者年龄、性别及病程差异无统计学意义（均P〉0．05）。CVA患者以夜间为主的咳嗽发生率为26．0％（13／44），明显高于EB组[9．1％（5／55），χ^2=5．272，P〈0．05]、UACS组[2．2％（1／45），χ^2=10．657，P〈0．01]及GERC组[0％（0／46），χ^2=13．833，P〈0．01]，其诊断CVA的特异度为95．9％。GERC的进食相关咳嗽、反流相关症状的发生率分别为52．2％（24／46）和69．6％（32／46），均高于其他病因组（均P〈0．05），诊断GERC的特异度分别为83．3％、80．0％。UACS的鼻后滴流感、鼻炎相关症状及鼻病史发生率为66．7％（30／45）、88．9％（40／45）及82．2％（37／45），均高于其他病因组（均P〈0．05），诊断UACS的特异度分别为89．4％、65．6％及63．6％。结论咳嗽的时相特征及部分伴随症状对单一病因慢性咳嗽的诊断具有一定的参考价值。

Objective To evaluate whether the clinical characteristics of chronic cough were helpful in determining its specific causes. Methods Patients with chronic cough were evaluated by a validated systematic diagnostic protocol. The patients with identified single cause were divided into 4 groups accordingly： cough-variant asthma （CVA）, upper airway cough syndrome （UACS） or post-nasal drip syndrome （PNDS）, eosinophilic bronchitis（EB）, gastroesophageal reflux related cough （GERC） , and the characteristics of the timing, character, onset and associated manifestations of chronic cough in different causes were compared. Results A total of 196 patients met the inclusion criteria, including 55 with EB, 45 with UACS, 50 with CVA and 46 with GERC. No significant difference was found in age, gender and course among EB, UACS, CVA and GERC. The incidence of nocturnal cough in CVA was 26. 0% （13/44） , significantly higher than in EB （ 9. 1% （5/55）, χ^2= 5. 272, P 〈 0. 05 ）, UACS （2. 2% （ 1/45 ）, χ^2 = 10. 657, P 〈 0. 01 ） and GERC （0% （0/46）, χ^2 = 13. 833, P 〈 0. 01 ）. The specificity of nocturnal cough for CVA was 95.9%. The sensitivity and specificity of cough associated with meals in GERC was 52. 2% （24/46） and 83.3%, and regurgitation associated symptom in GERC were 69. 6% （32/46） and 80. 0%, which were significantly higher than other groups. The incidence of postnasal drip, rhinitis associated symptom and case history of nasal diseases in UACS were 66. 7% （30/45） , 88.9% （40/45） and 82. 2% （37/45）, and the specificity of them were 89.4% ,65.6% and 63.6% respectively. Conclusion The timing character and some associated symptoms of chronic cough are useful in predicting a single cause.