影响咳嗽变异型哮喘预后的高危因素分析  

High risk factors affecting the prognosis of cough variant asthma: analysis of 73 cases

作　　者：万敏 张巧 傅银 王长征 马千里 WAN Min;ZHANG Qiao;FU Yin;WANG Changzheng;MA Qianli(Center for Respiratory and Critical Care Medicine,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学第二附属医院呼吸与危重症医学中心

出　　处：《第三军医大学学报》2020年第2期176-180,共5页Journal of Third Military Medical University

基　　金：国家科技支撑计划(2013BAI09B09,2014BAI08B05)~~

摘　　要：目的探讨影响咳嗽变异型哮喘患者预后的高危因素。方法基于慢性咳嗽标准化随访数据库患者数据,筛选随访大于5年,核心医疗信息和预后信息采集完整的,且不合并其他慢性咳嗽病因诊断的咳嗽变异型哮喘患者的数据,按照药物治疗需求情况分为低治疗需求组和高治疗需求组,通过回顾性分析比较两组间不同临床特征的差异,以及各临床特征与结局分组之间的相关性,并进一步采用Logistic回归对各临床特征对结局分组的影响进行分析,采用判别函数分析临床指标对结局的可能预测效果。结果共73例符合标准的患者纳入分析,超过一半患者(38例,52.1%)经过短期治疗后,未来5年(中位随访时间)内未再次经历以吸入糖皮质激素为核心的针对性治疗。在低治疗需求组和高治疗需求组之间存在显著差异(P<0.05)的临床参数包括:PD20、合并咽喉部体征患者比例和咽喉部体征数;PD20、咽后壁淋巴滤泡增生和充血与结局分组存在显著相关性,前两个被作为高危因素纳入到Logistic回归方程中;通过判别函数分析,采用前述两临床指标正确分组比例为74%。结论咳嗽变异型哮喘患者经过短期治疗后,未来无治疗需求患者比例不容低估,咳嗽变异型哮喘患者同时存在过度治疗和治疗不足的风险;而其高危因素是PD20和咽后壁淋巴滤泡增生程度,高PD20,低咽后壁淋巴滤泡增生患者未来治疗需求低。Objective To explore the high risk factors affecting the prognosis of patients with cough variant asthma(CVA). Methods From the standardized follow-up database of patients with chronic cough, we retrieved the data of patients with CVA followed up for more than 5 years with complete clinical and prognostic data. According to the demand of medications, the patients were divided into low-and high-demand treatment groups for comparative analysis of the clinical characteristics and their correlation with the outcomes of the patients. Logistic regression was used to identify the risk factors associated with the prognosis of the patients, and the discriminant function was used to determine the cut-off values of the specific risk factors for predicting the patients’ outcomes. Results We retrieved the data of 73 eligible patients from the database. Thirty-eight(52.1%) of the patients did not experience any treatment with inhaled corticosteroids(ICS) in 5 years(the median follow-up time) following a short-term treatment. The low-and high-demand treatment groups differed significantly in PD20, number of laryngopharyngeal signs and percentage of patients with laryngopharyngeal signs. PD20 and lymphoid follicle hyperplasia and congestion of the posterior pharyngeal wall showed significant correlations with the outcomes of the patients, and the former two factors were identified as risk factors by the logistic regression model. Discriminant function analysis showed that 74% of the patients were grouped correctly for the outcomes based on these two factors. Conclusion A substantial portion of CVA patients do not require further treatment in the next 5 years following a short-term treatment. The CVA patients are exposed to co-existing risks of over-treatment and inadequate treatment, and those with a high PD20 level and a low level of lymphoid follicle hyperplasia in the posterior pharyngeal wall have a low demand of further treatment.

关 键 词：咳嗽变异型哮喘 预后 慢性咳嗽 

分 类 号：R195.4[医药卫生—卫生统计学] R441.5[医药卫生—卫生事业管理]