常见慢性咳嗽病因及其诊断探讨

Common causes of chronic cough and the diagnostic value of clinical symptoms

目的探讨常见慢性咳嗽的病因及疾病表现的临床意义，为经验性治疗提供依据。方法按慢性咳嗽的病因诊断流程对160例患者的病因构成进行分析，比较常见病因慢性咳嗽患者的咳嗽时相、性质、诱发因素及相关伴随症状，统计方法采用U检验，计算P值。结果共入选160例2009年1月至12月宜昌市中心人民医院呼吸科门诊慢性咳嗽患者，其中常见病因分布依次为咳嗽变异性哮喘（CVA）72例占45．00％、上气道咳嗽综合征（UACS）54例占33．75％、嗜酸性粒细胞性支气管炎（EB）14例占8．75％、胃食管反流性咳嗽（GERC）9例占5．63％，其他病因共11例、占6．87％。不同病因组临床表现有差异。CVA患者夜间咳嗽构成比为52．8（38／72），明显高于其他病因；UACS患者以白天咳嗽为主，70．2％伴有鼻后滴流症状，且绝大部分伴有鼻炎相关症状或有鼻炎病史，高于其他各组；GERC患者饮食相关咳嗽占66．7％，77．8％伴有反流症状明显高于其他病因组；上述症状差异均有统计学意义。但EB患者临床症状无特异性。结论各种病因的慢性咳嗽具有一定的临床特征，慢性咳嗽病因构成及咳嗽时相、部分伴随症状对病因诊断具有一定的参考价值。

Objective To evaluate the common causes of chronic cough and the diagnostic value of clinical symptoms, and provide evidences for empirical treatment. Methods The causes of patients with chronic cough were evaluated by a validated systematic diagnostic protocol. The characteristics of the cough timing, characters, incentives and associated manifestations of chronic cough with different causes were compared. Results A total of 160 patients with at least 8 weeks of chronic cough and normal chest radiographs were recruited from the Department of respiratory diseases of Yichang Central Hospital between Jan. to Dec. 2009. The most common causes of chronic cough were cough variant asthma（ CVA, n = 72,45% ）, upper airway cough syndrome （ UACS, n = 54, 33.75% ）, eosinophilic bronchitis （ EB, n = 14,8. 75% ）, gastroesophageal reflux-related chronic cough （ GERC, n = 9,5.63% ）, other etiologies （ n = 11,6. 87% ）. Significant differences were observed in different etiological subtypes. The incidence of nocturnal cough in CVA was 52. 8% （38/72）, significantly higher than others types; URCS patients manifested more day coughs, with 70. 2% postnasal drip syndrome and significantly more cases had the history of nasal diseases compared with other types. The specificity of cough associated with meals in GERC were 66.7% , and the regurgitation associated symptom in GERC were 77.8%, significantly higher than other types. However no special syndromes were observed in EB patients. Conclusion All kinds of chronic coughs have specific symptoms. The spectrnm of causes and clinical features of chronic cough are important in the diagnostic procedure of chronic cough.