纤维支气管镜检查对不明原因慢性咳嗽诊断价值的临床研究

Clinical investigation on utility of fibrobronchoscopy for etiological diagnosis of adults with unexplained chronic cough

目的探讨纤维支气管镜检查对成年人不明原因慢性咳嗽的诊断价值。方法对2004年10月至2006年12月在咳喘专科门诊就诊、胸片、免疫功能正常、无咯血症状并且经慢性咳嗽诊断程序仍病因未明的成年慢性咳嗽患者，经纤维支气管镜进行病因诊断。结果37例患者平均年龄（38±13）岁，中位咳嗽时间6个月。经纤维支气管镜检查，59．5％获得了病因诊断：支气管结核（6例），气管肿瘤（4例）、气管骨化症（3例）、化脓性支气管炎（3例）、支气管异物（2例）、侵袭性气管支气管曲菌病、气管息肉、声带下囊肿、原发性气管支气管淀粉样变各1例。纤维支气管镜检查未确诊的15例患者中，6例组织病理为慢性非特异性气道炎症。全部患者术中、术后无显著不良反应。结论作为一项安全的诊疗手段，纤维支气管镜检查能在不明原因慢性咳嗽的病因诊断中发挥重要作用。

Objective To evaluate the utility of fibrobronehoscopy for etiological diagnosis of unexplained chronic cough in adults. Methods From October 2004 to December 2006,in this specialist cough clinic, immunocompetent, hemoptysis-absent adult patients with normal chest radiograph underwent fibrobronchoscopy for etiological diagnosis of refractory unexplained chronic cough following the anatomic diagnostic protocol. Results Patients＇ mean age： （38±13） years, median course of chronic cough ： 6 months. Fibrobronchoscopy achieved definitive diagnosis in 59.5% of 37 patients： endobronchial tuberculosis （6 cases）, tracheal tumors （4 cases）, tracheobronchopathia osteochondroplastica （ 3 cases）, suppurativetracheobronchitis （3 cases）, unsuspected foreign body aspiration （2 cases）, and one each case of primary tracheal amyloidosis, invasive traeheobronehial Aspergillosis, sub-vocal fold cyst and tracheal polyp. Of the 15 patients with undetermined chronic cough,6 patients demonstrated nonspecific chronic airway inflammation. No significant complications were observed during and after bronchoscopy. Conclusions This study demonstrates that fihrobronchoseopy is a very useful and well-tolerated procedure for etiology diagnosis of refractory chronic cough in adults.