咳嗽变异性哮喘的临床特征及其与典型哮喘的关系_席寅VIP免费

·论著·作者单位:510120呼吸疾病国家重点实验室(广州医学院)广州医学院第一附属医院广州呼吸疾病研究所通信作者:赖克方,Email:klai@163.com咳嗽变异性哮喘的临床特征及其与典型哮喘的关系席寅赖克方陈如冲罗炜陈桥丽王法霞林玲许丹媛杨业【摘要】目的分析成年咳嗽变异性哮喘(CVA)患者的临床特征及其发展为哮喘的情况,探讨CVA进展为哮喘的危险因素。方法收集2002年1月至2010年1月于广州呼吸疾病研究所门诊就诊的CVA患者,记录患者的基本临床资料,包括咳嗽时相、咳嗽性质、诱发因素、伴随症状、过敏史、随访情况等。并行肺功能、支气管激发试验/PEF检测、诱导痰细胞学分类、皮肤过敏原点刺试验等检查。所有入选患者年龄≥18岁、符合我国《咳嗽的诊断与治疗指南》中CVA的诊断标准。同时给予规律吸入中等剂量的布地奈德或等效剂量的吸入激素,至少治疗8周。通过门诊及电话随访,若患者出现胸闷、喘息等典型哮喘症状或出现哮鸣音则确认其进展为哮喘,分为单纯CVA组和发展为典型哮喘组(哮喘组);比较两组患者一般资料及实验室检查情况。结果91例CVA患者咳嗽时相以夜间或清晨为主的发生率为74.7%,伴变应性鼻炎病史的比例为46.2%;咳嗽的主要诱发因素包括:烟雾63.5%、冷空气51.4%、上呼吸道感染47.3%、灰尘37.8%、咽喉发痒36.5%;CVA患者有74.7%诱导痰中嗜酸粒细胞(EOS)比例>2.5%。58例患者平均随访4.2(1～8.5)年,其中8例患者(8/58,13.8%)进展为典型哮喘,单纯CVA组患者使用吸入激素时间显著长于哮喘组[12(20)周vs6(4)周,P<0.05],8例哮喘组患者中仅1例规律吸入激素12周以上,而其他50例单纯CVA患者中有33例规律吸入激素大于12周,两组比较差异有统计学意义(P<0.05)。单纯CVA组各项肺功能指标、痰EOS%、外周血EOS%、皮肤过敏原点刺试验阳性率与哮喘组比较差异均无统计学意义(P>0.05)。结论CVA主要以夜间或清晨咳嗽为临床特征,并有近一半患者合并过敏性鼻炎,长期规范吸入激素治疗可减少CVA患者进展为典型哮喘。【关键词】咳嗽变异性哮喘;哮喘;过敏;诱导痰Clinicalcharacteristicsofcoughvariantasthmaandit′srelasionshipwiththeclassicasthmaXIYin,LAIKe-fang,CHENRu-chong,LUOWei,CHENQiao-li,WANGFa-xia,LINLing,XUDan-yuan,YANGYe.StateKeyLaboratoryofRespiratroyDisease(GuangzhouMedicalCollege),GuangzhouInstituteofRespiratoryDisease,theFirstAffiliatedHospitalofGuangzhouMedicalCollege,Guangzhou510120,ChinaCorrespondingauthor:LAIKe-fang,Email:klai@163.com【Abstract】ObjectiveTostudytheclinicalcharacteristicsofadultcoughvariantasthma(CVA)andinvestigatetheproportionofCVAdevelopedclassicasthma,exploretheriskfactorsforthedevelopmentofasthmainpatientswithCVA.MethodsTheclinicalcharacteristicsandbasicexaminationsof91CVApatientswereretrospectivelyassessed.Moderatedosebudesonideorcompoundsofbronchodilatorandcorticosteroidwereinhaledinallpatientsatleast8weeks.Accordingtowhetherthepatientsdevelopedasthmaticsymptomsofwheezinganddyspneathroughtheclinicortelephonefollow-up,theyweredividedintotwogroups-thepureCVAgroupandtheasthmagroup.Thepulmonaryfunctionparameters,eosinophilproportionofinducedsputumandperipheralblood,skinpricktestpositiverateandICSusageofthesetwogroupswerecompared.ResultsTheincidenceofnocturnalormorningcoughin91CVApatientswas74.7%,theproportionoftheseCVApatientswithallergicrhinitishistorywas46.2%,themajorinducingfactorsofcoughinclude:vaporandsmoke63.5%,coldair51.4%,upper·150·中华哮喘杂志(电子版)2011年6月第5卷第3期ChinJAsthma(ElectronicEdition),June2011,Vol.5,No.3airwayinfection47.3%,dust37.8%,pharynxandlarynxitch36.5%.Theproportionwhoseeosinophilicpercentageinsputumismorethan2.5percentinCVAis74.7%.Duringa4.2(1-8.5)-yearfollow-up,8(13.8%)ofthe58patientswereconsideredtohavedevelopedclassicasthmawithwheezing,comparedwihttheasthmagroup,inhaledcorticost...