质子泵抑制剂联合促胃动力药治疗胃食管反流相关性咳嗽的研究

Study on Proton Pump Inhibitor Combined with Prokinetic Agent in Treating Gastroesophageal Reflux-related Cough

背景:胃食管反流相关性咳嗽发病机制复杂,部分患者采用质子泵抑制剂(PPI)治疗临床疗效不佳。目的:评价PPI联合促胃动力药对胃食管反流相关性咳嗽的疗效。方法:采用随机对照试验设计。60例反复咳嗽伴烧心、胸骨后疼痛、反酸、反食症状者随机进入试验组和对照组,分别餐前口服奥美拉唑20 mg bid或奥美拉唑20 mg bid+多潘立酮10 mg tid,疗程12周。于治疗前和治疗结束后行咳嗽症状评分,同时以反流性疾病问卷(RDQ)行胃食管反流症状评分。结果:经治疗后,试验组和对照组咳嗽症状评分和RDQ评分均较治疗前显著降低(P<0.05)。试验组两种评分分别降低1.33±0.14和6.23±0.92,对照组分别降低0.64±0.31和3.57±0.38,组间差异有统计学意义(P<0.05)。所有患者对治疗药物耐受性良好。结论:PPI联合促胃动力药对胃食管反流相关性咳嗽的疗效优于单独使用PPI。

Background： The pathogenesis of gastroesophageal reflux-related cough is complex, thus the response to proton pump inhibitor （PPI） is not satisfactory in some patients. Aims： To investigate the efficacy of PPI combined with prokinetic agent in the treatment of gastroesophageal reflux-related cough. Methods： A randomized controlled trial was performed. Sixty patients with chronic cough accompanied by heartburn, substernal pain and regurgitation or food reflux were randomly allocated into the test group and control group, and received oral omeprazole 20 mg bid a.c. or omeprazole 20 mg bid plus domperidone 10 mg tid a.c., respectively, for 12 weeks. The severity of cough was scored before and after treatment, and the reflux symptoms were assessed by reflux disease questionnaire （RDQ） simultaneously. Results： The severity of cough and RDQ score decreased markedly after treatment in both the test group and control group （P〈0.05）, the decrease of scores in test group was significantly more than that in control group （1.33-＋0.14 vs. 0.64-＋0.31 and 6.23-＋0.92 vs. 3.57_＋0.38, P〈0.05）. All patients were well tolerated to the drugs used. Conclusions： For treating gastroesophageal reflux-related cough, the efficacy of PPI combined with prokinetic agent is definitely superior to PPI alone.