[慢性咳嗽临床特征的诊断价值]

[Diagnostic values of the clinical characteristics of chronic cough].

作者信息

Lai Ke-fang, Chen Ru-chong, Lin Ling, Shen Lu, Zheng Yan-bing, Wang Fa-xia, Li Bin-kai, Jiang Hua, Xiao Huan, Liu Chun-li, Zhang Qing-ling, Xie Jia-xing, Luo Wei, Chen Qiao-li, Zeng Yun-xiang, Zhong Shu-qing, Zhong Nan-shan

机构信息

State Key Laboratory of Respiratory Disease, Guangzhou Medical College, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2009 Jun;32(6):418-21.

PMID:19957775

Abstract

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), chi2 = 5.272, P<0.05), UACS (2.2% (1/45), chi2 = 10.657, P<0.01) and GERC (0% (0/46), chi2 = 13.833, P<0.01). The specificity of nocturnal cough for CVA was 95.9%. The sensitivity and specificity of cough associated with meals 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.

摘要

目的

评估慢性咳嗽的临床特征是否有助于确定其具体病因。

方法

采用经过验证的系统诊断方案对慢性咳嗽患者进行评估。将确诊为单一病因的患者相应地分为4组：咳嗽变异性哮喘（CVA）、上气道咳嗽综合征（UACS）或鼻后滴漏综合征（PNDS）、嗜酸性粒细胞性支气管炎（EB）、胃食管反流相关性咳嗽（GERC），并比较不同病因慢性咳嗽的发作时间、性质、起病情况及相关表现的特征。

结果

共有196例患者符合纳入标准，其中EB患者55例，UACS患者45例，CVA患者50例，GERC患者46例。EB、UACS、CVA和GERC患者在年龄、性别和病程方面差异无统计学意义。CVA患者夜间咳嗽发生率为26.0%（13/44），显著高于EB患者（9.1%（5/55），χ2 = 5.272，P<0.05）、UACS患者（2.2%（1/45），χ2 = 10.657，P<0.01）和GERC患者（0%（0/46），χ2 = 13.833，P<0.01）。夜间咳嗽对CVA的特异性为95.9%。GERC患者进餐相关咳嗽的敏感性和特异性分别为52.2%（24/46）和83.3%，GERC患者反流相关症状的敏感性和特异性分别为69.6%（32/46）和80.0%，均显著高于其他组。UACS患者鼻后滴漏、鼻炎相关症状及鼻部疾病病史的发生率分别为66.7%（30/45）、88.9%（40/45）和82.2%（37/45），其特异性分别为89.4%、65.6%和63.6%。