兰州地区不明原因慢性咳嗽的病因

The distribution characteristics of etiology of chronic cough in Lanzhou

目的分析兰州地区慢性咳嗽的病因分布及特点。方法选择2011年1月至2014年6月在兰州大学第一医院呼吸科门诊就诊的慢性咳嗽患者，遵循我国慢性咳嗽指南诊断流程，在询问病史和获得体征的基础上，进行X线胸片、肺通气功能＋气道反应性、诱导痰嗜酸粒细胞、鼻窦x线片或cT、24h食管pH值监测、胸部高分辨率cT和支气管镜等检查，依据检查结果和治疗反应，确定病因诊断，并与国内其他地区研究结果进行比较。结果共收集资料齐全的慢性咳嗽患者173例，其中男性90例，女性83例。病因分布依次为：咳嗽变异性哮喘45例（26．01％）、上气道咳嗽综合征35例（20．23％）、变应性咳嗽20例（11．56％）、慢性咽炎17例（9．83％）、胃食管反流14例（8．09％）、感染后咳嗽14例（8．09％）、嗜酸粒细胞性支气管炎13例（7．51％）、慢性支气管炎8例（4．62％）、血管紧张素转换酶抑制剂相关性咳嗽4例（2．31％）、支气管结核3例（1．73％）、肺间质纤维化及支气管扩张各2例（1．16％）、病因未明14例（8．09％）。明确病因159例（91．91％）其中单一病因141例（88．68％），多病因18例（11．32％）。本组病例咳嗽变异性哮喘比例高于广州（13．6％，x2=5．60，P=0．018），低于沈阳（39．4％，）（x2=7．91，P=0．004）；变应性咳嗽比例高于北京（3．3％，x2=6．66，P=0．010）；嗜酸粒细胞性支气管炎比例低于广州（22．4％，x2=22．38，P=0．000）及沈阳（12．5％，x2=8．09，P=0．005）；食管反流性咳嗽比例低于北京（20．3％，x2=9．40，P=0．002），高于沈阳（1．9％，x2=3．98，P=0．036）。结论兰州地区慢性咳嗽主要病因为咳嗽变异性哮喘、上气道咳嗽综合征、变应性咳嗽、慢性咽炎和胃食管反流，与广州、北京、沈阳等地存在一定差异。

Objective To explore the distribution characteristics of etiology and clinical feature of chronic cough in Lanzhou. Methods Based on the guidelines of the diagnostic process of chronic cough in China, data of medical history and physical examinations were collected, and chest X-ray, pulmonary function plus airway hyperresponsiveness, induced sputum eosinophils, sinus X-ray or CT, 24 h esophageal pH monitoring, chest high-resolution CT and bronehoscopy were performed accordingly for outpatients with chronic cough. The cause of chronic cough was identified by the test results and treatment response. The results were compared with those reported previously in other areas of China. Results A total of 173 patients with completed data were collected, including 90 males and 83 females. The causes were as follows ： 45 cases （26. 01% ） of cough variant asthma, 35 （20. 23% ） upper airway cough syndrome, 20 （ 11.56% ） allergic cough, 17 （ 9. 83% ） chronic pharyngitis, 14 （ 8.09% ） gastroesophageal reflux, 14 （ 8.09% ） postinfectious, 13 （7.51% ） eosinophilic bronchitis, 8 （ 4. 62% ） chronic bronchitis, 4 （ 2. 31% ） cough associated with ACEI, 3 （ 1.73% ） bronchial tuberculosis, 2 （ 1.16% ） pulmonary fibrosis and bronehiectasis repectively. The causes of the remaining 14 patients （8.09%） were unknown. The causes of chronic cough were identified in 159 patients （91.91%） ,of which 141 （88.68%） with a single cause and 18 （11.32% ）with more than 2 etiological factors. The percentage of cough variant asthma in our series was significantly higher than that reported in Guangzhou （ 13.6%, X2 = 5.60, P = 0. 018, P 〈 0.05 ）, but lower than that reported in Shenyang （39.4%, X2 = 7.91, P = 0,004, P 〈 0.01 ）. The percentage of allergic cough was higher than that reported in Beijing （ 3.3 %, X2 = 6. 66, P = 0. 010, P 〈 0. 05 ）, and that of eosinophilic bronchitis was lower than those reported in Guangzhou （22. 4% , X2 = 22. 38, P = 0. 000, P 〈 0. 01 ） and Shenyang （12. 5%, X2 = 8.09 ,P = 0. 005 ,P 〈 0. 01 ）. The percentage of esophageal reflux cough was lower than that reported in Beijing （ 20. 3% , X2 = 9.40, P = 0. 002, P 〈 0. 01 ） but higher than that reported in Shenyang （1.9% ,X2 =3.98,P =0.036,P 〈0.05）. Conclusion In Lanzhou, cough variant asthma, upper airway cough syndrome, allergic cough, chronic pharyngitis and gastroesophageal reflux were the main causes of chronic cough, and the etiological distribution was different from Guangzhou, Beijing, Shenyang and other areas.