582例亚急性咳嗽患者的临床特点分析

Analysis of Clinical Characteristics of 582 Patients with Subacute Cough

目的 探讨亚急性咳嗽患者咳嗽、呼出气一氧化氮(FeNO)水平及气道高反应的特点。方法 回顾性分析2018年1月-2019年1月在厦门长庚医院门诊就诊的符合亚急性咳嗽的患者582例,计算夜间咳嗽和(或)咽喉瘙痒的发生率、FeNO增高(≥25 ppb)的比率及气道高反应的阳性率。对于FeNO增高和(或)存在气道高反应的患者给予吸入糖皮质激素药物治疗并计算咳嗽1周好转率。结果 582例患者中夜间咳嗽阳性率66.5%(387例),咽喉瘙痒阳性率81.1%(472例),同时有夜间咳嗽和咽喉瘙痒的阳性率为56.3%(328例);共255例患者FeNO增高(≥25 ppb),占43.9%。随机选取109例患者行支气管激发试验,阳性率为4.6%(5/109)。对于FeNO增高(≥25 ppb)和(或)存在气道高反应的患者吸入糖皮质激素药物治疗后1周咳嗽好转率91%,咳嗽评分降低[(4.08±0.53)分vs (2.37±0.56)分],差异有统计学意义(t=20.787,P<0.001)。结论 大部分亚急性咳嗽患者存在夜间咳嗽和(或)咽喉瘙痒症状,约一半患者FeNO增高;吸入糖皮质激素药物对于FeNO增高和(或)气道高反应的患者有一定的治疗效果。

Objective To investigate the characteristics of cough,fractionl exhaled nitric oxide(FeNO)levels and airway hyperresponsiveness in patients with subacute cough.Methods Retrospectively,582 patients who attended the outpatient clinic of Xiamen Chang Gung Hospital from January 2018 to January 2019 who were eligible for subacute cough were analyzed,and the incidence of nocturnal cough and/or throat pruritus,the rate of FeNO elevation(≥25 ppb),and the positive rate of airway hyperresponsiveness were calculated.Patients with elevated FeNO and/or airway hyperreactivity were treated with inhaled glucocorticoids and the 1-week improvement rate of cough was calculated.Results Of the 582 patients,the positive rate of nocturnal cough was 66.5%(387 cases),the positive rate of throat pruritus was 81.1%(472 cases),and the positive rate of having both nocturnal cough and throat pruritus was 56.3%(328 cases).A total of 255 patients had increased FeNO(≥25 ppb),accounting for 43.9%.Bronchial excitation test was performed in 109 randomly selected patients,and the positive rate was 4.6%(5/109).For patients with increased FeNO(≥25 ppb)and/or the presence of airway hyperreactivity the cough improvement rate was 91%and the cough score was reduced(4.08±0.53)points vs(2.37±0.56)points]after 1 week of inhaled glucocorticoid medication,the difference was statistically significant(t=20.787,P<0.001).Conclusion Most patients with subacute cough had nocturnal cough and/or pruritus,and about half of them had elevated FeNO;inhaled glucocorticoid drugs were effective in patients with elevated FeNO and/or airway hyperreactivity.