咳嗽与非咳嗽胃食管反流病的比较

Comparative analysis of gastroesophageal reflux disease in patients with and without cough

目的:探讨咳嗽与非咳嗽胃食管反流病(GERD)的临床特征,比较两者的差异,为GERD的诊治提供临床理论依据.方法:对65例伴有咳嗽的患者(呼吸科申请者58例)进行了24h食管pH及胆汁反流监测,取其中42例监测结果阳性者作为观察组.另取同期24h食管pH及胆汁监测阳性,不伴咳嗽的30例GERD患者进行对照.结果:(1)本组GERC的咳嗽多为刺激性干咳,76.2%(32/42)的患者伴有咽喉部的不适,如咽内异物感、咽痒、咽干,声音嘶哑等不适,69.0%(29/42)有胸骨后不适,如胸闷、胸骨后阻塞感、胸骨后疼痛等,但其他较典型的反流症状较少如反酸仅11.9%(5/42)、烧心19.0%(8/42)、上腹痛9.5%(4/42),其临床症状与无咳嗽的GERD比较有显著性差异(P<0.05);(2)24h食管pH及胆汁反流监测,两组反流时间及反流物性质无显著差别(P>0.05);(3)14d的抑酸治疗,咳嗽组73.8%的患者症状减轻或消失,非咳嗽组90.0%的患者症状减轻或消失,两组比较有显著性差异(P<0.05).提示GERC的治疗效果不及非咳嗽患者,特别是治疗无效者较多.结论:GERC有其独特的临床特征,部分患者除咳嗽外,其反流症状不典型,而且其治疗效果也不及典型的胃食管反流病.

AIM：To compare the clinical features of gastroesophageal reflux disease（GERD） between patients with and without cough. METHODS：The clinical data for 42 GERD patients with cough and 30 GERD patients without cough,who were positive for 24-h esophageal pH and bile monitoring,were analyzed in this study. RESULTS：The majority of GERD patients with cough had irritating cough.Of all the GERD patients with cough,76.2%（32/42） had throat discomfort,such as foreign body sensation,pharyngeal itching,and sound dumb,and 69.0%（29/42） had substernal discomfort,such as feeling of chest tightness,chest congestion and chest pain.Typical reflux symptoms such as acid reflux,heartburn and upper abdominal pain were seen only in 11.9%（5/42） ,19.0%（8/42） and 9.5%（4/42） of the patients,respectively.There was a significant difference in symptoms between GERD patients with and without cough（P〈0.05） .No significant differences were noted in the reflux time and reflux contents between the two groups of patients（P〉0.05） .After acid suppression therapy,the symptoms were relieved or disappeared in 14 d in 73.8%of patients with cough and in 90.0%of patients without cough. There is a significant difference in the percentage of patients achieving symptom improvement between the two groups（P〈0.05） . CONCLUSION：GERD patients with cough have unique clinical features.Besides cough,the majority of GERD patients with cough have no typical reflux symptoms.GERD patients with cough are less responsive to acid suppression treatment than those without cough.