胃食管反流相关性咳嗽患者以中性粒细胞升高气道炎症的临床分析  

Clincal analysis of neutrophilic airway inflammation exists in patient with gastroesophageal refluxassociated cough

作　　者：刘湘[1] 刘禹[1] 高瞻[1] 陈华萍[1] 程晓明[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：《中华肺部疾病杂志（电子版）》2015年第2期32-36,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然基金面上项目(81070018);卫生部行业专项基金资助(201002008)

摘　　要：目的探讨胃食管反流相关性咳嗽（GERC）气道炎症的特点及临床意义。方法选取2013年10月至2014年6月就诊于第三军医大学新桥医院呼吸内科门诊的慢性咳嗽患者76例,按照咳嗽指南推荐的方法进行病因诊断并随访,全部患者均进行诱导痰细胞学分类检查,并选取同期的健康志愿者11例作为对照。对诊断为GERC的患者进行抗反流治疗后复查诱导痰。结果 76例患者中,最终共有60例患者明确诊断,其中GERC 28例（46.6%）,嗜酸性支气管炎（EB）12例（20.0%）,上气道咳嗽综合征（UACS）10例（16.6%）,咳嗽变异性哮喘（CVA）10例（16.6%）;将确诊的60例患者纳入数据统计,GERC组诱导痰中性粒细胞比例[（74.79±8.05）%]显著高于健康对照、CVA及EB组[（41.62±8.21）%,（56.67±15.15）%,（58.22±12.92）%,P〈0.01],GERC组诱导痰嗜酸细胞比例（0.35±0.67）%与健康对照组无差异[（0.11±0.05）%,P〉0.05],显著低于CVA和EB组[（10.88±11.29）%,（7.85±6.77）%,P〈0.01]。13例GERC患者经抑酸剂和胃动力药联合治疗2~4周后,咳嗽积分显著下降（日间：1.69±0.98 vs.0.92±0.24;夜间：0.62±0.51 vs.0.15±0.38,P〈0.05）,中性粒细胞比例显著降低[（70.62±6.13）%vs.（60.80±15.76）%,P〈0.05],咳嗽症状改善显著。结论GERC患者诱导痰中性粒细胞比例显著高于其它慢性咳嗽患者,通过针对性治疗后GERC患者气道诱导痰中性粒细胞减少,咳嗽症状改善。表明GERC患者存在气道中性粒细胞性炎症,可能与GERC有关。Objective To investigate the feature and clinical signification of airway inflammation in patient with gastroesophageal reflux-associated cough（ GERC）. Methods 76 patients with chronic cough which consult doctor in outpatient department of Xin Qiao hospital from October 2013 to June 2014 was enrolled in,all of them are diagnosed in accordance with the method recommend by cough guidelines. The induce sputum cell counts was performed in each patient,of couse the blank control of 11 health volunteers. The patients diagnosed of GERC need to be reviewed the induced sputum after treating with anti-acid treatment.Results 60 patients were clearly diagnosed among the 76 patients,including 28 cases of GERC（ 46. 6%）,12cases（ 16. 6%） of eosinophilic bronchitis（ EB）,10 cases（ 20. 0%） of upper airway cough syndrome（ UACS）,10 cases（ 20. 0%） of cough variant asthma（ CVA）. Finally,the 60 cases clearly diagnosed are fit into the statistical data. They show that the GERC induced sputum neutral granulocyte ratio [（ 74. 79 ± 8. 05） %] was significantly higher than that in healthy comparison. The percentages of CVA and EB groups [（ 41. 62 ±8. 21） %,（ 56. 67 ± 15. 15） %,（ 58. 22 ± 12. 92） %,P 〈 0. 01 ],in GERC group induced sputum eosinophil[（ 0. 35 ± 0. 67） %] have no difference compared with the group of healthy comparison [（ 0. 11 ± 0. 05） %,P 〉 0. 05],significantly lower than that in CVA and EB group[（ 10. 88 ± 11. 29） %,（ 7. 85 ± 6. 77） %,P 〈0. 01]. The cough integral was significantly decreased（ daytime： 1. 69 ± 0. 98 vs. 0. 92 ± 0. 24; night： 0. 62 ±0. 51 vs. 0. 15 ± 0. 38,P 〈 0. 05）,and the proportion of neutrophils in 13 GERC patients was significantly decreased[（ 70. 62 ± 6. 13） % vs.（ 60. 80 ± 15. 76） %,P 〈 0. 05],after antacids and gastric motility drug treatment for 2-4 weeks,at the same time,cough symptoms are also significantly improved. Conclusions In the patients with GERC,the induced sputum neutrophil ratio was sign

关 键 词：相关性咳嗽 胃食管反流 诱导痰 气道炎症 中性粒细胞 

分 类 号：R571[医药卫生—消化系统] R446.19[医药卫生—内科学]