胃蛋白酶在胃食管反流性咳嗽中应用的研究进展

Research Progress on the Application of Pepsin in Gastroesophageal Reflux-Related Cough

胃食管反流性咳嗽(gastroesophageal reflux-related cough, GERC)是指由于胃酸和其他胃内容物反流进入食管引起的反射性咳嗽,为胃食管反流病(gastroesophageal reflux disease, GERD)的一种的食管外表现, 是慢性咳嗽的常见病因之一。GERD患者咳嗽的发病机制主要涉及气道微吸入、食管–支气管反射、反流物的直接损伤和刺激、食管运动功能失调等。反流包括酸性反流及非酸性反流,而既往的观察性研究发现,使用质子泵抑制剂(PPI)治疗合并慢性咳嗽的胃食管反流患者后咳嗽症状并不一定得到相应的改善,考虑该类患者的慢性咳嗽可能与非酸反流相关性更大。而胃蛋白酶是非酸反流的主要成分之一,许多研究发现胃蛋白酶比酸性物质对上呼吸道粘膜的伤害更大。这表明胃蛋白酶不仅是存在食管外反流的客观生物学标志,亦可能在反流相关性咳嗽中起重要病理作用。

Gastroesophageal reflux-related cough (GERC) is a reflex cough caused by the reflux of gastric acid and other gastric contents into the esophagus. It is an extraesophageal manifestation of gastroesophageal reflux disease (GERD) and one of the common causes of chronic cough. The pathogenesis of cough in patients with GERD is mainly related to airway microinhalation, esophagobronchial reflex, direct injury and stimulation of reflux, esophageal motor dysfunction and so on. Reflux includes acid reflux and non-acid reflux. Previous observational studies have found that cough symptoms may not be improved after proton pump inhibitor (PPI) treatment in gastroesophageal reflux patients with chronic cough, and chronic cough may be more related to non-acid reflux. Pepsin is one of the main components of non-acid reflux. Many studies have found that pepsin is more harmful to the mucosa of the upper respiratory tract than acid. This suggests that pepsin is not only an objective biological marker of extraesophageal reflux, but also may play an important pathological role in reflux-related cough.