呼出气一氧化氮在门诊慢性咳嗽诊治中的意义
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摘要
目的:分析呼出气一氧化氮(FeNO)在门诊慢性咳嗽诊治中的临床意义。方法:回顾性分析2017年10-12月就诊厦门长庚医院呼吸内科门诊的慢性咳嗽患者88例。58例首诊即常规行FeNO在内的相关检查为试验组,其中36例(62%)患者FeNO增高,给予包含吸入糖皮质激素(ICS)在内的综合治疗;另外30例对照组患者根据咳嗽及伴随症状予经验性治疗,如1周后病情缓解不佳,根据病情特点选择做胸片、肺功能、FeNO、24 h双通道食管pH测定、皮肤过敏原点刺试验等相关检查,根据检查结果进一步治疗。计算并对比两组患者1周咳嗽好转率和不同时间点咳嗽严重度评分。结果:本研究中共诊断88例慢性咳嗽患者,58例试验组患者中36例(62%)FeNO增高,最终确诊咳嗽变异型哮喘(CVA)22例(38%),嗜酸性粒细胞支气管炎(EB)16例(28%),胃食管反流性咳嗽(GERC)8例(14%),上气道咳嗽综合征(UACS)6例(10%),其他原因6例(10%);予吸入ICS、支气管扩张剂、抗组胺、制酸、促胃动力等单个或联合治疗方案;D0、D7、D14咳嗽严重度评分分别为(4.19±0.75)、(2.44±0.56)、(1.72±0.45)分,1周好转率81%;对照组最终诊断CVA 10例,EB 7例,GERC 4例,UACS 5例,其他原因咳嗽4例;治疗前后D0、D7、D14咳嗽严重度评分分别为(4.06±0.64)、(3.17±0.75)、(2.13±0.35)分;1周好转率60%,与试验组比较,D7、D14咳嗽严重度评分及1周好转率差异均有统计学意义(P<0.05)。结论:对门诊慢性咳嗽患者行FeNO检查有助于慢性咳嗽的诊断,对FeNO增高患者使用ICS可能带来更快临床缓解。
Objective:To analyze the fractional exhaled nitric oxide(FeNO) detection in the diagnosis and treatment of chronic cough in outpatient clinic.Method:A total of 88 patients with persistent cough lasting who visited our hospital from October to December 2017 were enrolled in this study.Fifty-eight patients in the experimental group received routine examination including FeNO at the first visit.Among them,36 cases(62%) had elevated FeNO and received comprehensive treatment including inhaled corticosteroids(ICS).Thirty patients in the control group were treated empirically,such as poor remission after one week.Chest X-ray,lung function,FeNO,24 hours pH monitoring of esophagus and other related examinations were selected according to the characteristics of the disease,and further treatment based on the results of the examination.1 week's rate of improvement and cough score were analyzed.Result:In this study,88 cases were diagnosed with chronic cough.In the experimental group 36 cases(62%) of FeNO increased,including 22 cases(38%) of CVA,16 cases(28%) of EB,8 cases(14%) of GERC,6 cases(10%) of UACS and 6 cases of other causes(10%).After treatment,the experimental group cough score were(4.19±0.75)at D0,(2.44±0.56) at D7 and(1.72±0.45) at D14,1 week's rate of improvement was 81%.The control group including 4 cases of GERC,5 cases of UACS,10 cases of CVA,7 cases of EB and 4 cases of other causes.The cough score were(4.06±0.64) at D0(vs experimental group,P>0.05),(3.17±0.75) at D7(vs experimental group,P<0.05),(2.13±0.35) at D14(vs experimental group,P<0.05),1 week's rate of improvement was 60%(vs experimental group,P<0.05).Conclusion:Fe NO level detection for outpatients with chronic cough is helpful for diagnosis,and those patients treatment with ICS can bring faster clinical remission.
Objective:To analyze the fractional exhaled nitric oxide(FeNO) detection in the diagnosis and treatment of chronic cough in outpatient clinic.Method:A total of 88 patients with persistent cough lasting who visited our hospital from October to December 2017 were enrolled in this study.Fifty-eight patients in the experimental group received routine examination including FeNO at the first visit.Among them,36 cases(62%) had elevated FeNO and received comprehensive treatment including inhaled corticosteroids(ICS).Thirty patients in the control group were treated empirically,such as poor remission after one week.Chest X-ray,lung function,FeNO,24 hours pH monitoring of esophagus and other related examinations were selected according to the characteristics of the disease,and further treatment based on the results of the examination.1 week's rate of improvement and cough score were analyzed.Result:In this study,88 cases were diagnosed with chronic cough.In the experimental group 36 cases(62%) of FeNO increased,including 22 cases(38%) of CVA,16 cases(28%) of EB,8 cases(14%) of GERC,6 cases(10%) of UACS and 6 cases of other causes(10%).After treatment,the experimental group cough score were(4.19±0.75)at D0,(2.44±0.56) at D7 and(1.72±0.45) at D14,1 week's rate of improvement was 81%.The control group including 4 cases of GERC,5 cases of UACS,10 cases of CVA,7 cases of EB and 4 cases of other causes.The cough score were(4.06±0.64) at D0(vs experimental group,P>0.05),(3.17±0.75) at D7(vs experimental group,P<0.05),(2.13±0.35) at D14(vs experimental group,P<0.05),1 week's rate of improvement was 60%(vs experimental group,P<0.05).Conclusion:Fe NO level detection for outpatients with chronic cough is helpful for diagnosis,and those patients treatment with ICS can bring faster clinical remission.
引文
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[9]余莉,魏为利,吕寒静,等.慢性咳嗽病因变迁的回顾性分析[J].中华结核和呼吸杂志,2009,32(6):414-417.
[10]刘国梁,林江涛.“不明原因”慢性咳嗽的病因构成和临床特征分析[J].中华结核和呼吸杂志,2009,32(6):422-425.
[11]司淑一,彭秋风,时旭,等.沈阳及周边地区慢性咳嗽的病因构成和临床特征分析[J].中华结核和呼吸杂志,2010,33(11):862-863.
[12]曹国强,程晓明,戴晓天,等.重庆地区慢性咳嗽病因的多中心研究[J].中国呼吸与危重监护杂志,2009,8(6):565-568.
[13]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2009版)[J].中华结核和呼吸杂志,2009,32(6):407-413.
[14]Dicpinigaitis P V,Tso R,Banauch G.Prevalence of depressive symptoms among patients with chronic cough[J].Chest,2006,130:1839-1843.
[15]Polley L,Yaman N,Heaney L,et al.Impact of cough across different chronic respiratory diseases:comparison of two cough-specific healthrelated quality of life questionnaires[J].Chest,2008,134:295-302.
[16]Donohue,James F,Herje,et al.Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels:a pilot study[J].International Journal of Chronic Obstructive Pulmonary Disease Jan,2014,9:745-751.
[17]刘春涛,林江涛.凝聚共识推进气道炎症无创检测技术迈上新台阶[J].中华结核和呼吸杂志,2015,38(5):321-323.
[18]Song W J,Kim H J,Shim J S,et al.Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough:A systematic review and meta-analysis[J].J Allergy Clin Immunol,2017,140:701.
[2]Iyer V N,Lim K G.Chronic cough:an update[J].Mayo Clin Proc,2013,88(10):1115-1126.
[3]Damask Cecelia.The use of fractional exhaled nitric oxide is valuable in select asthmatic patients[J].Otolaryngology&Head And Neck Surgery Jun,2016,24(3):256-260.
[4]Dweik R A,Boggs P B,Erzurum S C,et al.An oficial ATS clinical practice guideline:interpretation of exhaled nitric oxide levels(FeNO)for clinical applications[J].Am J Respir Crit Care Med,2011,184(5):602-615.
[5]Babu K S,Kastelik J A,Morjaria J B.Inhaled corticosteroids in chronic obstructive pulmonary disease:a pro-con perspective[J].Br J Clin Pharmacol,2014,78(2):282-300.
[6]Johnson L F,DeMeester T R.Development of the 24-hour intraesophgeal pH monitoring composite scoring system[J].J Clin Gastroenterol,1986,8(Supp1):52-58.
[7]陈如冲,赖克方,刘春丽,等.辣椒素咳嗽激发试验方法的建立及其安全性评价[J].中华结核和呼吸杂志,2005,28(11):751-754.
[8]赖克方,陈如冲,刘春丽,等.不明原因慢性咳嗽的病因分布及诊断程序的建立[J].中华结核和呼吸杂志,2006,29(2):96-99.
[9]余莉,魏为利,吕寒静,等.慢性咳嗽病因变迁的回顾性分析[J].中华结核和呼吸杂志,2009,32(6):414-417.
[10]刘国梁,林江涛.“不明原因”慢性咳嗽的病因构成和临床特征分析[J].中华结核和呼吸杂志,2009,32(6):422-425.
[11]司淑一,彭秋风,时旭,等.沈阳及周边地区慢性咳嗽的病因构成和临床特征分析[J].中华结核和呼吸杂志,2010,33(11):862-863.
[12]曹国强,程晓明,戴晓天,等.重庆地区慢性咳嗽病因的多中心研究[J].中国呼吸与危重监护杂志,2009,8(6):565-568.
[13]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2009版)[J].中华结核和呼吸杂志,2009,32(6):407-413.
[14]Dicpinigaitis P V,Tso R,Banauch G.Prevalence of depressive symptoms among patients with chronic cough[J].Chest,2006,130:1839-1843.
[15]Polley L,Yaman N,Heaney L,et al.Impact of cough across different chronic respiratory diseases:comparison of two cough-specific healthrelated quality of life questionnaires[J].Chest,2008,134:295-302.
[16]Donohue,James F,Herje,et al.Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels:a pilot study[J].International Journal of Chronic Obstructive Pulmonary Disease Jan,2014,9:745-751.
[17]刘春涛,林江涛.凝聚共识推进气道炎症无创检测技术迈上新台阶[J].中华结核和呼吸杂志,2015,38(5):321-323.
[18]Song W J,Kim H J,Shim J S,et al.Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough:A systematic review and meta-analysis[J].J Allergy Clin Immunol,2017,140:701.