非支气管哮喘性嗜酸粒细胞性支气管炎在亚急性咳嗽患者中的诊断

Identify nonasthmatic eosinophilic bronchitis among patients with subacute cough

目的探讨非支气管哮喘性嗜酸粒细胞性支气管炎(nonasthmatic eosinophilic bronchitis,NAEB)在呼吸科门诊的亚急性咳嗽患者中的诊断情况。方法收集2016年6月至2016年11月间于首都医科大学宣武医院呼吸科门诊就诊的以咳嗽为主诉且胸部影像无异常,持续时间在3~8周的患者94例,行呼出气一氧化氮(fractional exhaled nitric oxide,Fe NO)、肺功能及支气管激发试验检查,气道反应正常的患者进一步行诱导痰检查。在气道反应正常的患者中,分析NAEB组与其他病因组临床资料的差异。结果 94例亚急性咳嗽患者中,诊断感染后咳嗽40例(42.6%),NAEB 25例(26.6%),咳嗽变异性哮喘21例(22.3%),上气道咳嗽综合征5例(5.3%),胃食管反流2例(2.1%),支气管内膜结核1例(1.1%)。支气管激发试验阴性71例,其中诱导痰成功55例(成功率77%)。NAEB组与其他病因组在性别、年龄、体重指数、吸烟指数、咳嗽持续时间、1秒钟最大力气呼出的气体量(forced expiratory volume in one second,FEV1.0)/用力肺活量(forced vital capacity,FVC)、FEV1.0%预计值等指标比较差异无显著性。诱导痰嗜酸粒细胞百分比中位数在NAEB组是6.6(3.7,9.5),在其他病因组是1.2(0.0,1.9),两组间差异具有显著性(P=0.001)。Fe NO在NAEB组的中位数是61(29.0,137.0)ppb,在其他病因组的中位数是27(19.5,32.7)ppb,两组间差异具有显著性(P=0.018)。结论在亚急性咳嗽患者中应注意识别NAEB患者,对亚急性咳嗽患者开展诱导痰及Fe NO检查有助于NAEB的及早诊断。

Objective To explore the diagnostic status of nonasthmatic eosinophilic bronchitis （NAEB） among the patients with subacute cough in the respiratory outpatient clinic of our hospital. Method 94 patients with persistent cough for 3-8 weeks without chest X abnormalities were enrolled from June to November 2016 in Xuanwu hospital Capital Medical University. Exhaled nitric oxide （FeNO）, pulmonary function test and pulmonary provocation test were examined, and those with normal airway responsiveness further received sputum induction. For patients with normal airway responsiveness, the NAEB group and the group with other etiologies were compared for differences in the clinical characteristics. Result Among the 94 patients with subacute cough,the diagnosis was post-infection cough for 40 patients, NAEB for 25 patients, cough variant asthma for 21 patients, upper airway cough syndrome for 5 patients,gastroesophageal reflux for 2 patients,and endobronchial tuberculosis for 1 patient. 71 patients were negative for bronchial provocation test, including 55 who received successful sputum induction. There were no statistically significant differences between the NAEB group and the group with other etiologies in gender, age, BMI, smoking index, cough duration, FEV1.0/FVC, or FEV1.0% predicted. The median of eosinophil% in induced sputum was 6.6 （3.7, 9.5） in NAEB group and 1.2（0.0, 1.9） in the group with other etiologies, with statistically significant difference between the two groups （P=0.001）. The median FeNO was 61（29.0, 137.0）ppb in NAEB group and 27（19.5, 32.7）ppb in the group with other etiologies, with statistically significant difference between the two groups（P=0.018）. Conclusion Attention should be paid to identify NAEB in patients with subacute cough, and sputum induction and FeNO are useful for early diagnosis of NAEB.