慢性咳嗽和/或胸闷并气道高反应性的诊断

Diagnosis of Chronic Cough and(or) Chest Tightness and Airway Hyper-Responsiveness

目的:探讨具有气道高反应性的慢性咳嗽和/或胸闷的病人诊断思路。方法:应用乙酰甲胆碱激发试验筛查了378名慢性咳嗽和/或胸闷病人,112名激发试验阳性者作进一步的检查,包括血清IgE、过敏原皮试。排除其它疾病后,这些病人被拟诊为支气管哮喘,根据GINA方案进行规范治疗,并追踪24个月。结果:83名患者诊断为哮喘,25名诊断为非哮喘,4名未明确诊断。非哮喘病人中,上气道咳嗽综合征6例、胃食管反流5例、肺气肿4例、支气管内膜结核3例、慢性肺栓塞和支气管炎各2例,肿瘤、过敏性支气管肺曲菌病气道高反应综合征各1例;哮喘和非哮喘病人的临床特征如性别、吸烟史、哮喘家族史、症状和过敏性鼻炎的发生率等均无差异;两组间过敏原皮试的阳性率和血清中IgE的量无显著性差异。结论:有近1/3的具有咳嗽、胸闷等不典型症状的病人激发试验阳性,其中大部分病人诊断为哮喘;在临床实践中,根据排他性诊断和对药物治疗的反应,并进行相当长时间的追踪观察才能作出可靠的诊断。

Objective： To study retrospectively the diagnosis of chronic cough and/or chest tightness and airway hyper-responsiveness （AHR）. Methods： A total of 378 subjects with mild respiratory symptoms from March, 2002 to March, 2007 were screened through Methaeholine challenge test （MCT）, and 112 MCT positive subjects were underwent further laboratory studies, including serum IgE and skin-prick tests. All the patients with AHR were diagnosed as asthma primarily and were systematicly treated according to GINA. A final diagnosis of asthma was made by responsiveness to therapy during 24 months＇ follow-up. Results： Of the 112 patients, 83 subjects （74.1%） were diagnosed as asthma finally, and 25 subjects （22.3%） were considered non-asthmatics who were attributed to nine different kinds of diseases （6 cases to UACS, 5 cases to GERD, 4 cases to emphysema, 3 cases to EBTB, 2 cases to bronchitis, 2 cases to CPE, and one case to tumor, ABPA, and RADS respectively）. Four subjects remained no definitive diagnosis. Compared between the asthma and non-asthmatic group, no difference were found in gender, smoke history, family history of asthma, and symptoms （all P〉0.05）. In addition, no differ- ence were found in skin prick tests rates and serum IgE level between the two groups （all P〉 0.05）. Conclusion： Less than one third subjects with chronic cough and/or chest tightness had positive MCT results. The therapeutic reactivity, exclusive diagnosis and follow-up play an important role in the diagnosis of asthma for these patients.