不同细胞类型咳嗽变异型哮喘的临床特征分析

Analysis of the clinical features of different types of cough-variant asthma with different cell types

目的比较不同细胞类型的咳嗽变异型哮喘患者的临床特征差别。方法选择2014年12月至2017年3月在本院咳嗽门诊就诊的慢性咳嗽患者,遵循中国慢性咳嗽指南(2015版)诊治流程,在询问病史、临床症状和获得体征的基础上,进行血常规、胸片、肺通气功能+气道反应性、诱导痰细胞学分类等相关检查,依据检查结果和治疗反应,确定病因诊断,筛选出咳嗽变异型哮喘,依据诱导痰细胞学分类计数检查结果进行分组,比较不同细胞类型的成人咳嗽变异型哮喘患者的临床特征差别。结果共收集诊断明确且病因单一的成人咳嗽变异型哮喘患者114例,占所有慢性咳嗽患者的32.95%,其中男性56例(48.7%),女性58例(51.3%)。按细胞类型分类:嗜酸性粒细胞增多型23例(20.2%),中性粒细胞增多型53例(46.5%),寡细胞型14例(12.3%),混合细胞型24例(21.1%);分组比较显示:中性粒细胞增多型年龄最长(P=0.042),而嗜酸性粒细胞增高型患者的FeNo值水平最高(P<0.001);混合细胞型患者咳嗽时间最长(P=0.012),与寡细胞型相比较,混合细胞型患者有明确体育锻炼史(P=0.007)。结论不同细胞类型的成人咳嗽变异型哮喘患者的临床特征存在较明显的差别,可以用于指导临床疾病管理。

Objective To compare the clinical characteristics of cough variant asthma with different cell types.Methods During the period from December 2014 to March 2017,patients with chronic cough who visited respiratory outpatient clinics were selected to follow the diagnostic and treatment process of the 2015 edition of China's chronic cough guidelines.On the basis of medical history,clinical signs and physical signs,they were given routine blood analysis,chest radio-graph,pulmonary ventilation function,airway reactivity,and induced sputum cell analysis.According to the test results and treatment outcome,the etiological diagnosis was made clear and cough variant asthma was screened out,and the clinical characteristics of different cell types of cough variant asthma were compared according to the results of induced sputum cytology classification examination.Results A total of 114 cases of CVA(cough variant asthma)were collected,accounting for 32.95%of all chronic cough patients,including 56 males(48.7%)and 59 females(51.3%).The distributions of airway inflammatory phenotypes of the asthmatic patients were as follows:neutrophilic asthma(46.5%,53/114),eosinophilic asthma(20.2%,23/114),mixed granulocytic asthma(21.1%,24/114),and paucigranulocytic asthma(12.3%,14/114).In this contrast,the patients with neutrophilic asthma had the longest average age(P=0.042),eosinophilic asthma had the highest level in FeNo(P=0.000),and the patients with mixed granulocytic asthma had the longest coughing time(P=0.012).Compared to paucigranulocytic asthma,the mixed granulocytic asthma had a clear history of excise(P=0.007).Conclusion The clinical characteristics of cough variant asthma of different cell types are obviously different,it could be used to guide clinical disease management.