慢性咳嗽常见病因之间嗽敏感性的差异研究进展

慢性咳嗽是临床中的常见病,临床中将持续时间超过8周,胸片或CT影像学检查后,提示胸部未发现明显病灶的咳嗽为慢性原因咳嗽,简称慢性咳嗽。慢性咳嗽的主要表现是在理化刺激下,因子呈现出异常增高的咳嗽反应,由于其发生原因较多,如鼻后滴漏(流)综合征、上气道咳嗽综合征、咳嗽变异型哮喘、胃食管反流性咳嗽、嗜酸粒细胞性支气管炎、变应性咳嗽以及感染均会导致咳嗽的发生,而不同原因之间咳嗽敏感性不同,因此,研究慢性咳嗽常见病因之间咳嗽敏感性的差异,对临床治疗起到了重要的意义。虽然相关研究发现气道感觉神经末梢释放的神经肽,导致气道神经源性炎症,使咳嗽敏感性增加,但目前临床中对于慢性咳嗽的发生机制仍不十分的明确,且不同病因的慢性咳嗽咳敏感性改变改变还么没有定论。基于该情况,本文阐述了慢性咳嗽常见病因之间的咳敏感性的差异,旨在为临床有效治疗提供参考依据。

Efficacy of Chaihu Jisang decoction on post-infection cough and its effect on cough reflex sensitivity

OBJECTIVE:To investigate the efficacy of Chaihu Ji Sang Decoction(CJSD),(a modification of Xiao Chaihu Tang(Minor Decoction of Bupleurum) was evaluated in patients with post-infection cough(PIC).Its effect on cough reflex sensitivity(CRS) was also described.METHODS:One hundred and eighteen patients with PIC were enrolled and randomly divided into an experimental group and control group(54 patients in each group).The experimental group was given CJSD orally,and the control group was given cetirizine hydrochloride for 7 d.Cough symptom scores and TCM symptom scores were compared before and after treatment.Efficacy,cough onset time,recurrence,and adverse drug reactions were additionally evaluated.Finally,CRS was evaluated before and after treatment of PIC patients in the experimental group.RESULTS:Fifty-two patients in the experimental group and fifty control patients completed the study.Cough symptom scores and the TCM symptom scores of the two groups were significantly improved after treatment,however cough symptoms in the experimental group 1(0,2) were significantly lower than the control group 2(1,2) after treatment(P < 0.05).Similarly,TCM symptom scores 4(0,7) in the experimental group were significantly lower than the control group 6(3,12)(P < 0.01).Overall,the effective rate of the experimental treatment(84.60%) was significantly higher than that of the control treatment(68.00%)(P < 0.01).The onset time of efficacy of the experimental treatment was one day faster than the control treatment [2(2,3) d vs 3(2,3) d,P < 0.01].The relapse rate in the experimental group(9.09%) was lower than that of the control group(29.41%)(P < 0.05).39 PIC patients in the experimental group completed a capsaicin cough challenge test before treatment.The lgC2 and lg C5 of the experimental group prior to treatment was 1.19(0.59,1.49) and 1.80(1.49,2.10),respectively.The lgC2,lg C5 of the healthy control group was 1.49(0.89,2.40) and 2.70(2.40,3.00),respectively.The differences in lgC2 and lg C5 between experimental group and healthy groups were significant at this time point(both P < 0.01).After treatment,34 patients in the experimental group received re-examination.lg C5 increased from 1.80(1.49,2.10) to 2.10(1.49,3.00).CRS after treatment/re-examination was significantly lower than those of baseline in the experimental group(P < 0.05).CONCLUSION:CJSD could effectively improve the clinical symptoms of PIC patients,with demonstrable low recurrence and safety.CJSD also significantly decreased the CRS in patients with PIC.