胃食道反流性咳嗽临床诊断评分系统的建立  

Establishment of gastro-esophageal regurgitation cough scoring system for clinical diagnosis

作　　者：张巧[1] 马千里[1] 黄赞胜[1] 王彬[1] 程晓明[1] 林科雄[1] 王长征[1] 

机构地区：[1]第三军医大学新桥医院全军呼吸内科研究所,重庆400037

出　　处：《第三军医大学学报》2011年第20期2202-2205,共4页Journal of Third Military Medical University

摘　　要：目的综合胃食道反流性咳嗽(gastro-esophageal regurgitation cough,GERC)患者临床特征,建立1个GERC诊断的评分系统,以期为临床GERC经验性诊疗提供简便、快捷的辅助诊断方法。方法我院呼吸内科诊断慢性咳嗽患者,结合患者的临床特征选择拟诊为GERC、咳嗽变异性哮喘(cough variability asthma,CVA)和上气道咳嗽综合征(upperairway cough syndrome,UACS)的患者进行经验性治疗后随访,对随访后确诊病例按本研究建立的GERC评分系统评分比较,确定诊断GERC的判断折点。结果对最终确诊为GERC、UACS和CVA病因的122例患者进行临床特征分析提示:3组患者的年龄、咳嗽严重程度和病程差异无显著性;CVA组患者合并鼻炎/鼻窦炎病史的比例显著高于GERC组(P=0.019);GERC组合并胃病病史的比例显著高于UACS组(P=0.023);3组中GERC组干咳的比例高于其他2组;GERC组和UACS组夜间咳嗽比例显著低于CVA组(P=0.000);GERC组反流症状的比例显著高于UACS组(P=0.002)和CVA组(P=0.007);GERC组胃病症状的比例也均显著高于UACS组(P=0.001)和CVA组(P=0.027);UACS组和CVA组的鼻炎、鼻窦炎相关症状较GERC组高。GERC评分值比较提示GERC、CVA和UACS 3组间差异存在显著性(P<0.001)。以GERC评分≤4为判断折点预测GERC的诊断特异性为83.3%,敏感性为84.0%。结论建立的GERC评分体系可以不依赖食道pH电极监测等检查而获得较好的GERC病因预测。Objective To establish a gastro-esophageal regurgitation cough（GERC） scoring system through analyzing and summarize clinical characteristics of chronic cough patients in order to investigate a quick diagnostic method for GERC.Methods A total of 202 outpatients with chronic cough from our department during June 2010 to February 2011 were rerolled in this study.The inclusion criterions were cough for over 8 weeks and normal chest X-ray film.These patients were firstly diagnosed as 3 common causes of chronic cough,based on their clinical features,that is,GERC,cough variability asthma（CVA）,and upper airway cough syndrome（UACS）.After empiric treatment,all patients were followed up at last 2 to 4 weeks to evaluate the treatment efficiency.The turning point for GERC diagnosis was confirmed according to our scoring system.Results In this study,the analysis for clinical features from 122 patients diagnosed as GERC,UACS or CVA showed that there was no significant difference in age,severity and duration of cough among 3 groups.CVA group had significantly higher incidence of rhinitis/sinusitis than GERC group（P=0.019）,and GERC group had significantly higher rate of history of stomach illness than UACS group（P=0.023）.Percentage of hacking cough was higher in GERC group than other groups,that of night-time cough was higher in CVA group than in the other groups（P=0.000）,and there was no significant difference between the 2 groups（P=0.781）.GERC group had significantly higher proportion of reflux symptoms than UACS group（P=0.002） and CVA group（P=0.007）,and higher proportion of stomach symptoms than UACS group（P=0.001） and CVA group（P=0.027）.But for the symptoms of rhinitis/sinusitis,UACS group and CVA group had higher proportion than GERC group.There were significant difference in GERC scores among the 3 groups（P0.001）.GERC score ≤4 was determined as the turning point for predicting GERC,with a specificity of 83.3% and a sensitivity of 84.0%.Conclusion These results suggest that o

关 键 词：胃食道反流性咳嗽 临床诊断 评分体系 

分 类 号：R441.5[医药卫生—诊断学] R573.9[医药卫生—临床医学]