变应性咳嗽的临床特征与气道炎症特点

Clinical features and airway inflammation in atopic cough

目的探讨变应性咳嗽(AC)的诊断、治疗及其气道炎症特点。方法采用《咳嗽的诊断与治疗指南(草案)》的病因诊断程序,对158例慢性咳嗽患者进行病因诊断;结合诱导痰方法,分析痰液中细胞分类,分别采用荧光酶免疫法、酶联免疫吸附法测定诱导痰上清液中总IgE、嗜酸粒细胞阳离子蛋白(ECP)、白细胞介素-8(IL-8)的浓度。并以13例正常人和20例嗜酸粒细胞性支气管炎患者作对照;口服氯雷他定10 mg/d,2周,部分患者同时口服泼尼松10～15 mg/d或甲基氢化泼尼松8～12 mg/d,1周。结果 22例符合AC诊断,占慢性咳嗽的13.9%,多表现为慢性干咳,肺功能正常,组胺激发试验阴性。AC患者中性粒细胞(57.62±29.35)%较正常人(30.70±16.04)%显著增高(P<0.01),巨噬细胞(37.62±29.49)%较正常人(67.98±15.83)%明显降低(P<0.01),嗜酸粒细胞和淋巴细胞与正常人比较差异无统计学意义。AC患者诱导痰上清液中ECP浓度19.30(2.00～200.00)mg/L和IL-8浓度12.82(1.92～118.92)mg/L较正常人显著升高(P<0.01,P<0.05)。AC患者糖皮质激素或抗过敏治疗1周后,大部分患者的咳嗽消失。结论 AC是引起慢性咳嗽的一个重要原因,气道具有以中性粒细胞为主的炎症,抗过敏或抗炎治疗效果良好。

Objective To investigate the clinical features and airway inflammation in atopic cough （AC） and its treatment. Methods In addition to the anatomic protocol for the diagnosis and treatment of cough （ draft guidelines） , induced sputum by hypertonic saline aerosol inhalation was performed in 158 cases with chronic cough, while 13 healthy and 20 eosinophilic bronchitis controls were included. Differential cell counts in induced sputum were performed. Totel IgE and eosinophils cationic protein （ECP） was measured with fluonoimmunoassay, and interloukine -8 （IL- 8 ） was measured with enzyme - linked adsorbed immunoassay in the supernatant of induced sputum. Atopic cough was diagnosed according to and treated by antihistamine loratadine 10 mg once daily for two to four weeks, with additional oral prednisone 10 ~ 15 mg/d or methyl - prednisone 8 - 12 mg/d for three or seven days to some cases. Results Twenty - two out of 158 patients with chronic cough were diagnosed as AC; all with normal lung function and negative histamine provocation test, as some presenting dry cough. The percentage of neutrophils and the concentrations of ECP and IL - 8 in induced sputum were significantly higher in patients with AC as compared with normal subjects （P 〈 0. 05 ）. Conclusion AC is an important cause of chronic cough, presenting neutrophils airway inflammation, which responds well to corticorsteroid and anti - histamine.