胃食管反流性咳嗽的临床诊断分析

Clinical analysis of gastroesophageal reflux cough

目的:探讨胃食管反流(GER)性咳嗽的临床特征、诊断和治疗。方法:对33例X线胸片、组胺激发试验、鼻部检查正常的慢性咳嗽患者进行24h食管pH监测,并利用症状相关性概率(SAP)来分析咳嗽与反流的相关性。对Demeester总积分≥14.72,和(或)咳嗽与反流SAP≥75%者进行为期12周的抗反流治疗。结果:33例患者中,有23例诊断为GER性咳嗽,并给予抗反流治疗,完成疗程后,有12例患者咳嗽完全消失,咳嗽与反流的SAP(上电极为0.80±0.18,下电极为0.87±0.11)显著高于另11例对抗反流治疗反应较差或无效的患者(上电极为0.39±0.27,下电极为0.48±0.31;P<0.05)。结论:GER是不明原因慢性咳嗽的一个重要的独立原因。24h食管pH监测结合症状相关性分析有助于GER性咳嗽的诊断,抗反流治疗对其有较好的近期疗效。

Objective： To investigate the clinical features , diagnosis and management of gastroesophageal reflux induced cough （GERC）. Methods： The continuous ambulatory esophageal pH measurement was performed for 24 hour in 33 cases with chronic cough who had normal chest roentgenographic presentation, negative histamine provocation test and no abnormality of nasal cavity. The symptom association probability （ SAP ） was adopted to analyze the correlation of cough with gastroesophageal reflux. The anti-reflux treatment was given for 12 weeks to those patients with Demeester score ≥14.72 and/ or SAP ≥75 %. Results： Twenty three out of 33 cases were diagnosed as patients with gastroesophageal reflux.The cough was completely cured in 12 cases after antireflux treatment. The SAP of cough in this cured group （proximal probe0.80 ±0.18,distal probe0.87 ±0.11respectively） was significantly higher than that of patients who failed in response to antireflux treatment （proximal probe 0.39 ±0.27 ,distal probe 0.48 ±0.31, respectively , P 〈 0.05）. Conclusion： The gastroesophageal reflux may be an independent factor which could induce chronic cough. Not only the frequency and severity of gastroesophageal reflux but also the SAP were helpful in making the diagnosis of GERC. Satisfied effect was achieved after sufficient anti-reflux treatment in patients with GERC.