58例咳嗽变异型哮喘的临床分析  

Analysis of Fifty-eight Cases with Cough Variant Asthma

作　　者：侯会玲[1] 赵洪芬[1] 聂秀红[1] 

机构地区：[1]首都医科大学宣武医院呼吸科

出　　处：《首都医科大学学报》2009年第6期841-844,共4页Journal of Capital Medical University

摘　　要：目的鉴别诊断咳嗽变异型哮喘(cough variant asthma,CVA)与慢性咳嗽。方法对112例慢性咳嗽患者经询问病史,摄X线胸片,做肺功能检查(支气管激发试验)和过敏原筛查。检查结果做卡方检验。结果112例慢性咳嗽患者中有58例确诊为CVA,其X线胸片无异常改变,支气管激发试验均阳性,过敏原皮试阳性率为86.2%(50/58);42例存在诱因,其过敏原皮试阳性率为74.5%(38/42),其中79%(30/38)能检测到与诱因相关的过敏原;无诱因者的皮试阳性率为75%(12/16)。其他54例慢性咳嗽患者中X线胸片正常者34例,肺纹理增重者17例、有肺气肿征3例;支气管激发试验全部阴性,其中3例用力呼气1秒率(FEV1/FVC)<70%及用力呼气1秒量(FEV1)<80%;非CVA组过敏原皮试阳性率为16.7%(9/54);41例有诱因,其过敏原检测阳性率为12.2%(5/41),无诱因者皮试阳性率为30.8%(4/13)。经卡方检验,2组患者发病诱因(χ2=0.180,P=0.672)差异无统计学意义;而X线胸片无异常者(χ2=26.151,P=0.000)、支气管激发试验阳性率(χ2=112,P=0.000)、过敏原皮试阳性率(χ2=54.248,P=0.000)和无诱因病例中过敏原皮试阳性率(χ2=5.673,P=0.017)2组差异均有统计学意义。结论本组CVA患者的过敏原与诱因有一定的因果关系,无诱因的病例中大多数能检测出过敏原。支气管激发试验及过敏原筛查是诊断CVA的重要方法。Objective To identify patients with cough variant asthma（CVA） among those with chronic cough. Methods Data of the patients＇ history,chest X-ray,pulmonary function（bronchial provocation test）,screening allergen for 112 cases with chronic cough were collected and analyzed. Chi-square test was used for differences in rates. Results Fifty-eight cases were diagnosed as having CVA. Chest X-ray had no abnormalities,bronchial provocation test was positive in all these cases and allergen skin test was positive in 86.2%（50/58）. Forty-two cases had predisposing factors. Allergen skin test was positive in 74.5%（38/42）,and in 79% of them（30/38） allergens related to the predisposition were identified. Allergen skin test was positive in 75%（12/16） of the cases who had no predisposing factors. Among 54 non-CVA cases chest X-ray had no abnormalities in 34 cases,lung marking increased in 17 cases,and emphysema in 3 cases. Bronchial provocation test was negative in all these cases and among 3 cases FEV1/FVC〈70% and FEV1〈80%. Allergen skin test was positive in 16.7%（9/54） cases. Forty-one cases had predisposing factors,and allergen skin test was positive in 12.2%（5/41） of the cases. Allergen skin test positive rate of the cases without predisposing factors was 30.8%（4/13）. There was no significant difference in the positive rates of predisposing factors between the two group（χ2=0.180,P=0.672）. However,chest X-ray findings（χ2=26.151,P=0.000）,bronchial provocation test positive rate（χ2=112,P=0.000）,allergen skin test positive rate（χ2=54.248,P=0.000）,and allergen skin test positive rate of those without predisposing factors（χ2=5.673,P=0.017） had significant differences. Conclusion Allergen and predisposing factors were causally associated with CVA cases. In majority of cases who had no predisposing factors allergens could be detected. Bronchial provocation test and screening for allergen are important method to diagnose CVA.

关 键 词：慢性咳嗽 咳嗽变异型哮喘 X线胸片 支气管激发试验 过敏原皮试 

分 类 号：R562.25[医药卫生—呼吸系统]