激素敏感性咳嗽和非激素敏感性咳嗽的临床特征分析

Clinical characteristic of corticosteroid-responsive cough and non corticosteroid-responsive cough

目的探讨激素敏感性咳嗽(CSRC)和非激素敏感性咳嗽(NCSRC)的临床特征差异。方法收集2003年至2013年在广州医科大学第一附属医院呼吸科就诊的病因明确的357例慢性咳嗽患者的临床资料,进行回顾性分析。依据病因分为激素敏感性咳嗽组和非激素敏感性咳嗽组,将两组的临床特征进行比较。结果与非激素敏感性患者相比,激素敏感性咳嗽患者的咳嗽病程更短(24 vs.36个月,P=0.025),CSRC组日间咳嗽积分更低(P<0.05)。NCSRC组的咳嗽常于白天出现(87.85%vs.78.15%,P=0.006),而CSRC组的咳嗽则常出现于夜间(43.13%vs.32.60%,P=0.018)。与NCSRC组相比,CSRC组胃食管反流症状的发生率更低(26.33%vs.54.14%,P=0.000),咳嗽与饮食相关的比例更低(11.43%vs.37.08%,P=0.000),伴有鼻部症状的比例更低(40.06%vs.55.8%,P=0.001),气促的比例更高(18.21%vs.11.05%,P=0.032)。感冒和讲话引起咳嗽或咳嗽加重的比例均为NCSRC组高于CSRC组(48.62%vs.38.94%,28.73%vs.17.65%,P均<0.05)。CSRC组咽部异物感、频繁清喉和咽喉壁黏液附着感的比例显著低于NCSRC组(分别为8.68%vs.18.23%,20.73%vs.40.88%,3.64%vs.10.50%,P均<0.01)。CSRC组的MMEF/pred显著低于NCSRC组(72.29±31.22vs.84.09±31.64,P=0.000),且气道高反应性的比例高于NCSRC组(29.9%vs.4.26%)。CSRC组中痰嗜酸粒细胞百分比明显高于NCSRC组(中位数5%vs.0.25%,P=0.001)。结论激素敏感性咳嗽和非激素敏感性咳嗽的临床特征存在一定差异,但单纯从临床特征上无法完全区分二者,仍需结合相关实验室检查来明确诊断。

Objective To compare the clinical characteristics between corticosteroid-responsive cough （CSRC） and non corticosteroid-responsive cough （NCSRC）.Methods In this retrospective study,total of 357 patients with chronic cough,who refer to our pulmonary outpatient clinic were recruited.Details of history were recorded.The diagnosis for all patients were confirmed by the laboratory test results.According to the cause of chronic cough,patients were divided into two groups,corticosteroid-responsive cough and non corticosteroid-responsive cough.Results Compared with NCSRC group,patients with CSRC had shorter cough duration（24 vs.36 months,P =0.025）,lower daytime cough score（P ＜ 0.05）.Cough timing between two groups were different,CSRC group showed more cough in the daytime （87.85％ vs.78.15％,P =0.006）,while NCSRC group showed more nocturnal cough（43.13％ vs.32.60％,P =0.018）.CSRC group had higher proportion of gastroesophageal reflux related symptoms （26.33％ vs.54.14％,P =0.000）,lower proportion of nasal symptoms （40.06％ vs.55.8％,P =0.001）,lower proportion of diet related cough （11.43％ vs.37.08％,P =0.000）,and higher proportion of chest tightness （18.21％ vs.11.05％,P =0.032）.The proportion of common cold/talk induced or worsened cough is higher in NCSRC group （48.62％ vs.38.94％,28.73％ vs.17.65％,P all ＜ 0.05）.Sense of foreign body in pharynx,throat clearing and Sense of mucus adhesion were more common in NCSRC group（8.68％ vs.18.23％,20.73％ vs.40.88％,3.64％ vs.10.50％,P all ＜ 0.01）.MMEF/pred in CSRC group was significantly lower than NCSRC group （72.29-± 31.22 vs.84.09 ± 31.64,P =0.000）.CSRC group showed higher proportion of airway hyperresponsiveness（29.9％ vs.4.26％） and higher sputum eosinophil count （5％ vs.0.25％,P =0.001）.Conclusions There are significant differences in the clinical characteristics between corticosteroid-responsive cough and non corticosteroid-responsive cough; however,clinical characteristic alone is insufficient to distinguish between NCSRC and CSRC.Laboratory test results is necessary in confirming the diagnosis of NCSRC or CSRC.