CAJ | 학술논문

目的深入研究咳嗽变异性哮喘(CVA)患者的临床特征以及治疗反应对临床诊断的意义,提高对CVA的诊治水平.方法 2009年10月到2010年8月期间在第三军医大学新桥医院门诊及涪陵中心医院就诊诊断为慢性咳嗽,并且支气管激发试验阳性拟诊为CVA的患者,记录其咳嗽的临床特点、伴随症状和咽部体征.并给予沙美特罗/氟替卡松干粉剂50/100 μg,2次/d吸入,1～2周后门诊或电话随访,评价疗效和确定诊断.结果共46例患者入选本试验,41例完成随访研究.CVA患者大多数有夜间咳嗽(87.9%)和咽部瘙痒等症状(87.9%),近半数患者咳嗽剧烈,干咳患者仅占39.0%,45.5%合并鼻炎或鼻窦炎.治疗有效率为80.5%(33/41).治疗无效组与有效组患者的临床特征比较,显示两组患者夜间咳嗽情况和叫部阳性症状的比例无明显差异,但治疗无效组患者伴随的胃病或反流症状,清喉和咽部体征有明显高于有效组患者的趋势.结论夜间咳嗽和咽部瘙痒等是大多数CVA具有的症状特点,气道反应性测定和抗哮喘治疗反应是确诊CVA的主要依据.对抗哮喘治疗无效的患者,还需要深入研究影响疗效的原因,不宜简单地排除CVA诊断.
목적 심입연구해수변이성효천(CVA)환자적림상특정이급치료반응대림상진단적의의,제고대CVA적진치수평.방법 2009년10월도2010년8월기간재제삼군의대학신교의원문진급부릉중심의원취진진단위만성해수,병차지기관격발시험양성의진위CVA적환자,기록기해수적림상특점、반수증상화인부체정.병급여사미특라/불체잡송간분제50/100 μg,2차/d흡입,1～2주후문진혹전화수방,평개료효화학정진단.결과 공46례환자입선본시험,41례완성수방연구.CVA환자대다수유야간해수(87.9%)화인부소양등증상(87.9%),근반수환자해수극렬,간해환자부점39.0%,45.5%합병비염혹비두염.치료유효솔위80.5%(33/41).치료무효조여유효조환자적림상특정비교,현시량조환자야간해수정황화규부양성증상적비례무명현차이,단치료무효조환자반수적위병혹반류증상,청후화인부체정유명현고우유효조환자적추세.결론 야간해수화인부소양등시대다수CVA구유적증상특점,기도반응성측정화항효천치료반응시학진CVA적주요의거.대항효천치료무효적환자,환수요심입연구영향료효적원인,불의간단지배제CVA진단.
Objective To investigate the clinical features and the response to treatment for clinical diagnosis of cough variant asthma (CVA) for the raising the level of clinical treatment. Methods We selected the CVA cases from the chronic cough cases with bronchial provocation test positive from respiratory medicine clinic in our hospital and Fuling central hospital from October 2009 to August 2010. The clinical features of cough and symptoms and throat symptoms from the suspected CVA cases were recorded, and then the cases were treated with Salmeterol/fluticasone dry powder (50/100 μg, twice a day) for 1-2 weeks. After 1-2 weeks, the results of treatments and clear diagnosis were evaluated through telephone or clinic follow-up. In addition to its study,the anti-asthma or cough drugs were disable during the treatment. It was statistics effect when cough improved 1/2 or more effective for the treatment. Results 46 patients were selected into this study, and 41 patients completed the follow-up study. Most of CVA patients were with nocturnal cough (87. 9%) and throat itching and other symptoms (87. 9%).Nearly half of CVA patients were with severe cough, and only 39. 0% of patients were with dry cough, and 45. 5% of patients were combined with rhinitis or sinusitis. Therapeutic efficacy was 80.5% (33/41). The clinical features of effective treatments patients and ineffective treatments patients showed that positive symptoms of cough and throat had no significant difference between two groups of patients, but the rate of patients with stomach or gastroesophageal reflux symptoms, there are signs of larynx and pharynx in ineffective treatment group was significantly higher trend than that in effective group.Conclusions Nighttime cough and throat itching symptoms are the majority features CVA.Determination of airway reactivity and anti-asthma treatment response are the main basis for diagnosis of CVA.The reasons of efficacy treatment should be in-depth study in the patients with ineffective treatment against asthma,not simply rule out the diagnosis of CVA.