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[兰州慢性咳嗽病因的分布特征]

[The distribution characteristics of etiology of chronic cough in Lanzhou].

作者信息

Liu W Y, Yu Q, Yue H M, Zhang J B, Li L, Wang X Y, Hu J M, Feng T, Pu J Y, Bai X

机构信息

Department of Respiratory Medicine of the First Hospital of Lanzhou University, Lanzhou 730000, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2016 May;39(5):362-7. doi: 10.3760/cma.j.issn.1001-0939.2016.05.006.

Abstract

OBJECTIVE

To explore the distribution characteristics of etiology and clinical feature of chronic cough in Lanzhou.

METHODS

Based on the guidelines of the diagnostic process of chronic cough in China, data of medical history and physical examinations were collected, and chest X-ray, pulmonary function plus airway hyperresponsiveness, induced sputum eosinophils, sinus X-ray or CT, 24 h esophageal pH monitoring, chest high-resolution CT and bronchoscopy were performed accordingly for outpatients with chronic cough. The cause of chronic cough was identified by the test results and treatment response. The results were compared with those reported previously in other areas of China.

RESULTS

A total of 173 patients with completed data were collected, including 90 males and 83 females.The causes were as follows: 45 cases (26.01%) of cough variant asthma, 35 (20.23%) upper airway cough syndrome, 20 (11.56%) allergic cough, 17 (9.83%) chronic pharyngitis, 14 (8.09%) gastroesophageal reflux, 14 (8.09%)postinfectious, 13 (7.51%) eosinophilic bronchitis, 8 (4.62%) chronic bronchitis, 4 (2.31%) cough associated with ACEI, 3 (1.73%) bronchial tuberculosis, 2 (1.16%) pulmonary fibrosis and bronchiectasis repectively. The causes of the remaining 14 patients (8.09%)were unknown. The causes of chronic cough were identified in 159 patients (91.91%), of which 141 (88.68%) with a single cause and 18(11.32%)with more than 2 etiological factors.The percentage of cough variant asthma in our series was significantly higher than that reported in Guangzhou (13.6%, χ(2)=5.60, P=0.018, P<0.05), but lower than that reported in Shenyang (39.4%, χ(2)=7.91, P=0, 004, P<0.01). The percentage of allergic cough was higher than that reported in Beijing (3.3%, χ(2)=6.66, P=0.010, P<0.05), and that of eosinophilic bronchitis was lower than those reported in Guangzhou(22.4%, χ(2)=22.38, P=0.000, P<0.01) and Shenyang (12.5%, χ(2)=8.09, P=0.005, P<0.01). The percentage of esophageal reflux cough was lower than that reported in Beijing (20.3%, χ(2)=9.40, P=0.002, P<0.01) but higher than that reported in Shenyang (1.9%, χ(2)=3.98, P=0.036, P<0.05).

CONCLUSION

In Lanzhou, cough variant asthma, upper airway cough syndrome, allergic cough, chronic pharyngitis and gastroesophageal reflux were the main causes of chronic cough, and the etiological distribution was different from Guangzhou, Beijing, Shenyang and other areas.

摘要

目的

探讨兰州地区慢性咳嗽的病因分布特点及临床特征。

方法

按照我国慢性咳嗽诊断流程的指导原则,收集慢性咳嗽门诊患者的病史及体格检查资料,并依次进行胸部X线、肺功能加气道反应性、诱导痰嗜酸性粒细胞、鼻窦X线或CT、24小时食管pH监测、胸部高分辨率CT及支气管镜检查。根据检查结果及治疗反应明确慢性咳嗽病因,并与我国其他地区既往报道的结果进行比较。

结果

共收集到资料完整的患者173例,其中男性90例,女性83例。病因如下:咳嗽变异性哮喘45例(26.01%),上气道咳嗽综合征35例(20.23%),过敏性咳嗽20例(11.56%),慢性咽炎17例(9.83%),胃食管反流14例(8.09%),感染后咳嗽14例(8.09%),嗜酸性粒细胞性支气管炎13例(7.51%),慢性支气管炎8例(4.62%),ACEI相关性咳嗽4例(2.31%),支气管结核3例(1.73%),肺纤维化及支气管扩张各2例(1.16%)。其余14例(8.09%)患者病因不明。159例(91.91%)患者明确了慢性咳嗽病因,其中141例(88.68%)为单一病因,18例(11.32%)有2种以上病因。本研究中咳嗽变异性哮喘的比例显著高于广州报道的比例(13.6%,χ(2)=5.60,P=0.018,P<0.05),但低于沈阳报道的比例(39.4%,χ(2)=7.91,P=0.004,P<0.01)。过敏性咳嗽的比例高于北京报道的比例(3.3%,χ(2)=6.66,P=0.010,P<0.05),嗜酸性粒细胞性支气管炎的比例低于广州报道的比例(22.4%,χ(2)=22.38,P=0.000,P<0.01)及沈阳报道的比例(12.5%,χ(2)=8.09,P=0.005,P<0.01)。食管反流性咳嗽的比例低于北京报道的比例(20.3%,χ(2)=9.40,P=0.002,P<0.01)但高于沈阳报道的比例(1.9%,χ(2)=3.98,P=0.036,P<0.05)。

结论

在兰州地区,咳嗽变异性哮喘、上气道咳嗽综合征、过敏性咳嗽、慢性咽炎及胃食管反流是慢性咳嗽的主要病因,其病因分布与广州、北京、沈阳等地区不同。

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