慢性咳嗽患者随访一年转归分析

Outcome of chronic cough:a one-year follow-up study

目的通过慢性咳嗽患者一年的随访数据分析,探讨慢性咳嗽的自然病程及患者用药依从性。方法收集2008年2月至2009年5月在第三军医大学新桥医院、大坪医院、西南医院和重庆医科大学附属第一医院就诊的173例慢性咳嗽患者,入选标准:咳嗽时间>8周,X线胸片或CT检查正常。排除标准:①高血压病服用ACEI类药物;②患有慢性心肺疾病;③近期粉尘接触史。依据自制随访问卷,所有患者由一位呼吸科专科医师通过电话就咳嗽好转情况、针对病因治疗情况、咳嗽对患者的影响等方面进行随访,随访期间2010年7-9月。结果共104例患者完成1年期随访研究。平均40岁(12～78岁),平均病程31.8(2～360)个月,性别比例59(男)/45(女)。不管病因是否明确的慢性咳嗽,在我们1年后的随访时,咳嗽完全消失占51.9%(54/104),部分好转占18.3%(19/104),时好时坏占6.7%(7/104),无好转或加重占23.1%(24/104)。在不同慢性咳嗽病因中,症状完全消失的比例最高的是咳嗽变异性哮喘(cough variability asthma,CVA),达58.3%;上气道咳嗽综合征(upper airway cough syndrome,UACS)患者最低,仅为45.2%;咳嗽完全无好转的病例中,胃食道反流相关性咳嗽(gastro-esophageal regurgitation cough,GERC)的比例最高30.8%,CVA最低19.4%。UACS的患者采用针对病因进行治疗的患者仅占16.7(7/42),CVA和GERC的患者采用病因针对性治疗的比较较高,达2/3左右。仅近半数的患者认为咳嗽对他们的生活、工作、情绪以及对他人有影响,而且影响程度以轻度影响为主。结论 不同病因的慢性咳嗽中UACS患者的转归最差,加强此类疾病的认识及提高对因治疗依从性具有迫切的临床需求。

Objective To investigate the natural history of chronic cough and medication compliance by analyzing the clinical data of chronic cough patients during one-year of follow-up.Methods One hundred and seventy-three chronic cough cases from respiratory medicine clinic in Xinqiao Hospital,Daping Hospital,and Southwest Hospital of Third Military Medical University,and in First Affiliated Hospital of Chongqing Medical University from Feb 2008 to May 2009 were enrolled in this study.Inclusion criteria were cough time8 weeks,and normal chest X film or CT image.Exclusion criteria： ① taking hypertensive drugs as angiotensin converting enzyme inhibitor（ACEI）;② chronic heart or lung diseases;③ the recent history of exposure to dust.Based on our follow-up questionnaire,all patients were visited by a respiratory specialist by telephone for the improvement in cough or not,or treatment to the causes,or the impact of cough on life during the one-year follow-up（December 2008 to June 2010）.Results A total of 104 patients completed the 1-year follow-up study.The average age of them was 40（12 to 78） and average course of cough was 31.8 months（2 to 360 months）,and their sex ratio was about 4/3 [59（male）/45（female）].When our follow-up after 1 year,regardless of whether the specific cause of chronic cough,the cough disappeared completely accounted for 51.9%（54/104）,partial improvement in 18.3%（19/104）,good times and bad in 6.7%（7/104）,and no improvement or increased in 23.1%（24/104）.In different causes of chronic cough,the symptoms disappeared completely was the highest proportion of cough variability asthma（CVA）,up 58.3%;upper airway cough syndrome（UACS） was the lowest,only 45.2%.In the cases with no improvement in cough,gastro-esophageal regurgitation cough（GERC） covered the highest proportion of 30.8%,and CVA the lowest of 19.4%.UACS patients treated for the cause accounted for only 16.7%（7/42）,but CVA and GERC patients had the higher percentage,up to 66.7%.Only half of the patients thought the cough influenced their lives,work,mood and their surrounding peoples,but the main impact was mild.Conclusion In different causes of chronic cough,the patients with UACS have the worst outcome.Strengthening education and improving treatment compliance of the disease are of urgent clinical needs.