不伴变应性鼻炎的咳嗽变异性哮喘80例临床分析

Clinical Analysis of 80 Cases of Cough Variant Asthma without Allergic Rhinitis

目的探讨和分析无变异性鼻炎咳嗽变异性哮喘(cough variant asthma,CVA)患者的治疗情况。方法2015年10月—2018年10月在该院诊断为无变异性鼻炎咳嗽变异性哮喘80例患者的治疗情况进行临床治疗和分析。根据治疗方式分为A组(27例)、B组(27例)、C组(26例)。A组:布地奈德+福莫特罗粉吸入剂+茶碱/短效B2受体激动剂;B组:布地奈德或氟替卡松气雾剂+茶碱/短效B2受体激动剂。C组:丙卡特罗+茶碱/短效B2受体激动剂。评价指标主要包括:治疗前后的咳嗽评分、治疗前后的FeNO数值、治疗前后的肺功能。结果80例无变异性鼻炎CVA患者中。吸入性糖皮质激联合支气管扩张剂组咳嗽评分及FeNO数值较治疗前明显改善.VAS评分3组分别从(8.52±0.33)分vs(2.31±0.48)分,(8.33±0.32)分vs(3.43±0.40)分和(8.48±0.34)分vs(4.29±0.26)分(t=53.22、54.03、55.60,P<0.001,F=116.44,P<0.001)。FeNO值治疗前后3组分别为(55.37±12.30)分vs(22.78±5.90)分,(55.52±8.89)分vs(30.70±5.96)分,(53.54±8.54)分vs(35.00±5.83)分(t=11.76,11.79,9.53,P<0.001,F=88.26,P<0.01)。肺功能3组治疗前后为(78.51±4.12)%vs(85.24±4.56)%,(79.32±4.10)%vs(84.17±3.48)%,(79.52±4.22)%vs(83.12±2.45)%(t=-5.05、-5.71、-4.77,P<0.001,F=5.54,P>0.05),3组组间治疗前后的VAS评分、治疗前后的FeNO数值改变以布地奈德+福莫特罗粉吸入剂组为优,3组治疗前后的肺功能改变未有明显区别,1年随访转变为典型哮喘的比例小于5%。结论对不伴变异性鼻炎的CVA患者建议吸入性糖皮质激素联合支气管扩张剂治疗能有效改善症状,防止转为典型哮喘,其特点和临床预后有待进一步研究。

Objective To investigate and analyze the treatment of patients with cough variant asthma (CVA) without mutated rhinitis. Methods The clinical treatment and analysis of 80 patients with non-variant rhinitis cough variant asthma diagnosed in our hospital from October 2015 to October 2018 were convenient selected and conducted. According to the treatment, they were divided into group A (27 cases), group B (27 cases), and group C (26 cases). Group A: budesonide + formoterol powder inhalation + theophylline )vs( short-acting B2 receptor agonist;group B: budesonide or fluticasone aerosol + theophylline )vs( short-acting B2 receptor agonist. Group C: Procaterol + theophylline)vs(short-acting B2 receptor agonist. The evaluation indicators mainly include: cough score before and after treatment, FeNO values before and after treatment, and lung function before and after treatment. Results Of 80 patients with CVA without variant rhinitis. The cough score and FeNO value of inhaled glucocorticoid combined with bronchodilator group were significantly improved compared with before treatment. The VAS scores of the three groups were (8.52±0.33)points vs(2.31±0.48)points, (8.33±0.32)points vs(3.43±0.40)points and (8.48±0.34)points vs(4.29±0.26)points, respectively(t=53.22, 54.03, 55.60, P<0.001, F=116.44, P<0.001). Before and after treatment, the FeNO values were (55.37±12.30)points vs(22.78±5.90)points, (55.52±8.89)points vs(30.70±5.96)points, (53.54±8.54)points vs(35.00±5.83)points, respectively,(t=11.76, 11.79, 9.53, P<0.001, F=88.26, P<0.01). Before and after treatment, the pulmonary function group was (78.51±4.12)% vs(85.24±4.56)%, (79.32±4.10)% vs(84.17±3.48)%, (79.52±4.22)%vs(83.12±2.45)% (t=-5.05, -5.71, -4.77, P<0.001).(F=5.54, P>0.05). The VAS scores before and after treatment in the three groups, and the FeNO values before and after treatment were changed to budesonide + formoterol. The powder inhalation group was excellent, and there was no significant difference in lung function changes before and after treatment in the three groups. The proportion of typical asthma changed to 1 year was less than 5%. Conclusion In patients with CVA without variability rhinitis, inhaled glucocorticoid combined with bronchodilator therapy can effectively improve symptoms and prevent conversion to typical asthma. Its characteristics and clinical prognosis need to be further studied.