神经调节剂治疗难治性慢性咳嗽的研究进展

Study progress of treatment of refractory chronic cough with neuromodulators

难治性慢性咳嗽可能主要由中枢高敏引起,导致咳嗽高敏综合征诊断新概念的提出。神经递质γ-氨基丁酸受体和N-甲基-D-天冬氨酸受体参与咳嗽中枢高敏的发生,与神经病理性疼痛的中枢高敏有相通性,因此神经调节剂也用于难治性慢性咳嗽的治疗。目前常用的神经调节剂有加巴喷丁、普瑞巴林、巴氯芬和阿米替林,临床证实对难治性慢性咳嗽有一定的疗效。但相当部分难治性慢性咳嗽患者神经调节剂治疗无效,这些药物的中枢神经系统不良反应也限制了其使用。因此,如何筛选适合神经调节剂治疗的难治性慢性咳嗽患者人群,对于提高治疗成功率、避免不必要的不良反应是非常必要的,需要今后进一步研究探索。

Refractory chronic cough may be mainly caused by central hypersensitivity,leading to a new concept of diagnosis of cough hypersensitivity syndrome.The neurotransmitters includingγ-aminobutyric acid receptor and N-methyl-D-aspartic acid receptor are involved in the pathogenesis of cough hypersensitivity,which is highly similar to the central sensitization of neuropathic pain.Therefore,the neuromodulator has also been used for the treatment of refractory chronic cough.Currently,the commonly used neuromodulators such as gabapentin,pregabalin,baclofen and amitriptyline have been confirmed to be effective in the treatment of refractory chronic cough.However,a considerable part of the patients with refractory chronic cough do not respond to the therapy with the neuromodulators.The adverse effects on central nervous system also limit their clinical application.Thus,to screen the patients with refractory chronic cough suitable for the treatment with neuromodulators is necessary to improve their therapeutic success rate and minimize the adverse effects,which needs further research in the future.