南方地区慢性咳嗽患者耳咳反射流行特征及对1年后预后的影响

Epidemic characteristics of Arnold nerve reflex in patients with chronic cough in southern China and its influence on prognosis after one year

目的 调查南方地区慢性咳嗽患者耳咳反射(Arnold nerve reflex,ANR)流行特征及对1年后慢性咳嗽预后的影响。方法 纳入南方医院2018年1月至2019年3月门诊诊断为慢性咳嗽的患者,进行ANR评估。比较慢性咳嗽组和健康对照组ANR差异,分析其与呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)等临床指标的关系,并比较两组随访1年后咳嗽预后。结果 共纳入200例慢性咳嗽患者及172例健康对照者。慢性咳嗽组ANR阳性率显著高于健康对照组(P<0.05)。慢性咳嗽组ANR阳性率在性别、吸烟史及过敏病史等比较差异均无统计学意义(P>0.05)。慢性咳嗽组内ANR阳性患者中单侧阳性率为64.52%(20/31),双侧阳性率为35.48%(11/31)增加。ANR阳性慢性咳嗽患者77.42%(24/31)FeNO处于低水平(<25 ppb)。ANR阳性在慢性咳嗽组咳嗽变异性哮喘和嗜酸粒细胞性支气管炎、上气道咳嗽综合征、胃食管反流性咳嗽及变应性咳嗽间差异均无统计学意义(P>0.05);ANR阳性且与咳嗽平均病程及1年后的咳嗽预后差异均无统计学意义(P>0.05)。结论 ANR在慢性咳嗽患者中阳性率较健康者高,在不同病因导致的慢性咳嗽患者中阳性率接近;ANR不能预测1年后的咳嗽预后,其临床意义尚需进一步研究。

Objective To investigate the epidemic characteristics of Arnold nerve reflex(ANR) in patients with chronic cough in southern China and its influence on prognosis after one year. Methods From January 2018 to March 2019, patients with chronic cough in Nanfang Hospital were enrolled. The ANR response was evaluated by stimulating bilateral external auditory canal with cotton swab. The difference of ANR response between the chronic cough group and the healthy control group was compared, and the relationship with FeNO and other clinical indexes was analyzed. The conditions of cough of patients after one year were followed-up and recorded.Results A total of 200 patients with chronic cough and 172 healthy controls were enrolled. The positive rates of ANR in the chronic cough group were significantly higher than the control group(P<0.05). The positive rate of ANR in the chronic cough group showed no significant difference in gender, smoking history and allergic history(P>0.05). In the chronic cough group, the positive rates of unilateral and bilateral cough reflex were 64.52%(20/31)and 35.48%(11/31), respectively. 77.42%(24/31)of patients with positive ANR had a low level of Fe NO(<25 ppb).And the ANR positive rates also showed no significant difference between cough variant asthma and eosinophil bronchitis, upper airway cough syndrome, gastroesophageal reflux cough and allergic cough and no significant correlation to the duration of cough and the cough prognosis after one year(P>0.05). Conclusion The positive rate of ANR in patients with chronic cough is higher than that in healthy people, and the positive rate is similar in patients with different etiologies. The prognosis of cough after 1 year can′t be predicted, and its clinical significance needs to be further studied.