Fujimori K, Suzuki E, Arakawa M
Department of Medicine (II), Niigata University School of Medicine, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Oct;31(10):1303-7.
A 69-year-old female was admitted for the evaluation of chronic persistent cough of about six week duration which was particularly worse at night and did not respond to antibiotics or cough medicines. She did not smoke and had no history of allergies or abnormal inhalations. Eosinophil counts, serum IgE, CRP, titers of cold hemagglutinin (CHA), and antibody to mycoplasma were all within normal ranges. Chest X-ray films and respiratory function tests showed no abnormalities. Because of her complaint of mild heartburn, gastroesophageal reflux (GER) was thought to be a possible cause of her chronic cough. Upper gastrointestinal X-ray films revealed barium reflux up to the cervical esophagus, and gastrointestinal fiberoscopy showed reflux esophagitis. Bronchial biopsy specimens taken by fiberoptic bronchoscopy showed chronic inflammatory changes of bronchial mucosa with focal squamous metaplasia, mucosal basement membrane thickening, and lymphocytic infiltration in the submucosa. She made favorable progress following treatment with a histamine H2 blocker and cisapride for six weeks. She met Irwin's criteria and we concluded that her cough was caused by GER. We speculate that repeated tracheobronchial microaspirations of refluxed gastric acid may cause chronic inflammatory changes of the bronchial mucosa resulting in persistent cough.
一名69岁女性因持续约六周的慢性持续性咳嗽入院评估，该咳嗽在夜间尤其严重，对抗生素和止咳药均无反应。她不吸烟，无过敏史或异常吸入史。嗜酸性粒细胞计数、血清IgE、CRP、冷凝集素（CHA）滴度及支原体抗体均在正常范围内。胸部X光片和呼吸功能测试均无异常。由于她主诉有轻度烧心，胃食管反流（GER）被认为是其慢性咳嗽的可能原因。上消化道X光片显示钡剂反流至颈段食管，胃肠纤维镜检查显示反流性食管炎。经纤维支气管镜获取的支气管活检标本显示支气管黏膜有慢性炎症改变，伴有局灶性鳞状化生、黏膜基底膜增厚及黏膜下淋巴细胞浸润。经组胺H2受体阻滞剂和西沙必利治疗六周后，她病情好转。她符合欧文标准，我们得出结论，她的咳嗽是由GER引起的。我们推测，反流胃酸反复经气管支气管微吸入可能导致支气管黏膜慢性炎症改变，从而引起持续性咳嗽。
