不同病因慢性咳嗽临床特征的诊断价值
불동병인만성해수림상특정적진단개치
Diagnostic values of the clinical characteristics of chronic cough
  • 万方数据
    中华结核和呼吸杂志 중화결핵화호흡잡지
    Chinese Journal of Tuberculosis and Respiratory Diseases
    2009年 6期 418-421 ,共4页

    赖克方%陈如冲%林玲%沈璐%郑燕冰%王法霞%李斌恺%姜华%肖焕%刘春丽%张清玲%谢佳星%罗炜%陈桥丽%曾运祥%钟淑卿%钟南山

    뢰극방%진여충%림령%침로%정연빙%왕법하%리빈개%강화%초환%류춘려%장청령%사가성%라위%진교려%증운상%종숙경%종남산

    咳嗽%诊断%症状 咳嗽%診斷%癥狀
    해수%진단%증상
    Cough,chronic%Diagnosis%Symptoms
    目的 比较不同病因慢性咳嗽患者的特征及伴随症状,探讨其对临床慢性咳嗽的病因诊断的价值.方法 按慢性咳嗽病因诊断程序对2003年6月至2007年12月广州呼吸疾病研究所专科门诊的慢性咳嗽患者进行病因诊断.对单一病因的患者按常见病因进行分组,分析比较不同单一病因的慢性咳嗽患者的咳嗽时相、性质、诱发因素等特征及相关伴随症状.计量资料用x±s表示,计数资料以率表示,统计采用方差分析及卡方检验.结果 共入选196例单一病因的慢性咳嗽患者,男108例,女88例;年龄14～72岁,平均(40±12)岁.其中咳嗽变异性哮喘(CVA)50例,嗜酸粒细胞性支气管炎(EB)55例,上气道咳嗽综合征(UACS)45例、胃食管反流性咳嗽(GERC)46例.不同病因组慢性咳嗽患者年龄、性别及病程差异无统计学意义(均P>0.05).CVA患者以夜间为主的咳嗽发生率为26.0%(13/44),明显高于EB组[9.1%(5/55),x2=5.272,P<0.05]、UACS组[2.2%(1/45),x2=10.657,P<0.01]及GERC组[0%(0/46),x2=13.833,P<0.01],其诊断CVA的特异度为95.9%.GERC的进食相关咳嗽、反流相关症状的发生率分别为52.2%(24/46)和69.6%(32/46),均高于其他病因组(均P<0.05),诊断GERC的特异度分别为83.3%、80.0%.UACS的鼻后滴流感、鼻炎相关症状及鼻病史发生率为66.7%(30/45)、88.9%(40/45)及82.2%(37/45),均高于其他病因组(均P<0.05),诊断UACS的特异度分别为89.4%、65.6%及63.6%.结论 咳嗽的时相特征及部分伴随症状对单一病因慢性咳嗽的诊断具有一定的参考价值.
    목적 비교불동병인만성해수환자적특정급반수증상,탐토기대림상만성해수적병인진단적개치.방법 안만성해수병인진단정서대2003년6월지2007년12월엄주호흡질병연구소전과문진적만성해수환자진행병인진단.대단일병인적환자안상견병인진행분조,분석비교불동단일병인적만성해수환자적해수시상、성질、유발인소등특정급상관반수증상.계량자료용x±s표시,계수자료이솔표시,통계채용방차분석급잡방검험.결과 공입선196례단일병인적만성해수환자,남108례,녀88례;년령14～72세,평균(40±12)세.기중해수변이성효천(CVA)50례,기산립세포성지기관염(EB)55례,상기도해수종합정(UACS)45례、위식관반류성해수(GERC)46례.불동병인조만성해수환자년령、성별급병정차이무통계학의의(균P>0.05).CVA환자이야간위주적해수발생솔위26.0%(13/44),명현고우EB조[9.1%(5/55),x2=5.272,P<0.05]、UACS조[2.2%(1/45),x2=10.657,P<0.01]급GERC조[0%(0/46),x2=13.833,P<0.01],기진단CVA적특이도위95.9%.GERC적진식상관해수、반류상관증상적발생솔분별위52.2%(24/46)화69.6%(32/46),균고우기타병인조(균P<0.05),진단GERC적특이도분별위83.3%、80.0%.UACS적비후적류감、비염상관증상급비병사발생솔위66.7%(30/45)、88.9%(40/45)급82.2%(37/45),균고우기타병인조(균P<0.05),진단UACS적특이도분별위89.4%、65.6%급63.6%.결론 해수적시상특정급부분반수증상대단일병인만성해수적진단구유일정적삼고개치.
    Objective To evaluate whether the clinical characteristics of chronic cough were helpful in determining its specific causes. Methods Patients with chronic cough were evaluated by a validated systematic diagnostic protocol. The patients with identified single cause were divided into 4 groups accordingly: cough-variant asthma (CVA), upper airway cough syndrome (UACS) or post-nasal drip syndrome (PNDS), eosinophilic bronchitis(EB), gastroesophageal reflux related cough (GERC), and the characteristics of the timing, character, onset and associated manifestations of chronic cough in different causes were compared. Results A total of 196 patients met the inclusion criteria, including 55 with EB, 45 with UACS, 50 with CVA and 46 with GERC. No significant difference was found in age, gender and course among EB, UACS, CVA and GERC. The incidence of nocturnal cough in CVA was 26.0% (13/44), significantly higher than in EB (9.1% (5/55), x2= 5.272, P<0.05), UACS (2.2% (1/45), x2= 10.657, P<0.01 ) and GERC (0% (0/46), x2=13.833, P<0.01). The specificity of nocturnal cough for CVA was 95.9%. The sensitivity and specificity of cough associated with meds in GERC was 52.2% (24/46) and 83.3%, and regurgitation associated symptom in GERC were 69.6% (32/46) and 80.0%, which were significantly higher than other groups. The incidence of postnasal drip, rhinitis associated symptom and case history of nasal diseases in UACS were 66.7% (30/45), 88.9% (40/45) and 82.2% (37/45), and the specificity of them were 89.4%, 65.6% and 63.6% respectively. Conclusion The timing character and some associated symptoms of chronic cough are useful in predicting a single cause.
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