Department of Internal Medicine, Geriatrics and Allergology, Wroclaw Medical University,Wroclaw, Poland.
Respir Med. 2011 Aug;105(8):1257-61. doi: 10.1016/j.rmed.2011.04.015. Epub 2011 May 17.
One of the theories which explain, why gastroesophageal reflux disease (GORD) may provoke cough, is the occurrence of aspiration of gastric content into the airways. The aim of the study was to assess the presence of aspiration markers: pepsin and bile acids (BA) in induced sputum in gastroesophageal reflux-related (GOR-related) chronic cough (CC) patients. Forty-one CC patients and 20 healthy controls were enrolled in the study. GORD as cause of CC was diagnosed by presence of GORD-related symptoms, gastroscopy and/or improvement of cough upon treatment with proton pump inhibitors (PPI). Patients were divided into two groups based on the response to PPI treatment. In all patients and healthy controls induced sputum was obtained and differential cell counts were calculated. Levels of pepsin and BA were measured in sputum supernatants. Pepsin was detectable in 48.8% samples in CC patients and in 60% healthy controls (p = NS). In pepsin positive samples no significant difference in pepsin concentration could be found between CC patients and control subjects. Pepsin levels in pepsin positive samples were significantly decreased in patients treated with PPI compared to non-treated patients. BA were detectable in 56% samples of CC patients and in 70% healthy controls (p = NS). BA concentration in BA positive samples in CC group was not different from healthy controls. There was also no difference when comparing patients who took PPI and those who did not. Patients characterized as PPI-responders and PPI-non-responders had similar pepsin and BA concentrations. Airway cellularity was not significantly different between groups of patients with or without pepsin or BA in induced sputum. Our results demonstrated the lack of differences in gastric content aspiration between patients with probable GOR-related CC and healthy control subjects. This might imply that the reflex cough theory may be more relevant than the reflux-associated aspiration theory in the pathophysiology of GORinduced chronic cough.
有一种理论解释了为什么胃食管反流病（GORD）可能会引起咳嗽，即胃内容物被吸入气道。本研究旨在评估胃食管反流相关（GOR 相关）慢性咳嗽（CC）患者诱导痰中的吸入标志物：胃蛋白酶和胆汁酸（BA）的存在。纳入了 41 名 CC 患者和 20 名健康对照者。CC 患者的 GORD 病因通过 GORD 相关症状、胃镜检查和/或质子泵抑制剂（PPI）治疗后咳嗽改善来诊断。根据 PPI 治疗的反应，将患者分为两组。所有患者和健康对照者均获得诱导痰，并计算了差异细胞计数。测量痰上清液中的胃蛋白酶和 BA 水平。在 CC 患者中，48.8%的样本中可检测到胃蛋白酶，在健康对照者中为 60%（p=NS）。在胃蛋白酶阳性样本中，CC 患者和对照者之间的胃蛋白酶浓度无显著差异。与未治疗的患者相比，接受 PPI 治疗的患者胃蛋白酶阳性样本中的胃蛋白酶水平显著降低。BA 在 CC 患者中 56%的样本中可检测到，在健康对照者中为 70%（p=NS）。CC 组 BA 阳性样本中的 BA 浓度与健康对照者无差异。比较接受 PPI 和未接受 PPI 的患者时也无差异。PPI 反应者和 PPI 非反应者的胃蛋白酶和 BA 浓度相似。诱导痰中存在胃蛋白酶或 BA 的患者组之间的气道细胞数无显著差异。我们的结果表明，可能与 GOR 相关的 CC 患者与健康对照者之间的胃内容物吸入无差异。这可能意味着，在 GOR 引起的慢性咳嗽的病理生理学中，反射性咳嗽理论可能比反流相关的吸入理论更为重要。
