慢性咳嗽Irwin诊断程序的临床应用

摘要

Objective To explore the advantages and disadvantages of the diagnostic procedures suggested by the Irwin group, and summarize the experiences in diagnosis and treatment, and to beter understand the etiology, diagnosis, differential diagnosis and treatment of chronic cough. Methods Data of 118 patients, who were finally diagnosed as chronic cough according to the diagnostic procedures suggested by Irwin group in the First Affiliated Hospital of General Hospital of PLA in 2009, were retrospectively analyzed. Results With the Irwin diagnostic procedures of chronic cough, 118 patients were diagnosed definitely. The final diagnostic rate reached 100%. The duration to reach the final diagnosis was 1 day to 30 days. Of the 118 patients with chronic cough, 113 were cured (96%). 32 cases (27. 1%) were caused by asthma and related diseases (allergic rhinitis, allergic pharyngitis, cough variant asthma) and eosinophilic bronchitisj 28 cases (23.7%) were due to upper airway cough syndrome and related diseases (chronic rhinitis, sinusitis, pharyngeal bursitis, postnasal drip syndrome, chronic laryngitis, and vocal cord polyps); 23 cases (19. 5%) due to gastroesophageal reflux disease; 14 cases (11.9%) due to lower respiratory tract infection and related diseases (endobronchial tuberculosis, pulmonary tuberculosis, endotracheal mucosal adenocarcinoma, lung cancer, bronchiectasis, and pulmonary fibrosis) ; 10 cases (8. 5%) due to cardiac insafficiency; 6 cases (5. 1%) due to administration of angiotensin-converting enzyme inhibitor (ACEI)-like antihypertensive agents; 3 cases (2. 5%) were psychogenic cough, and 2 cases (1. 7%) were induced by other causes. Conclusions The Irwin diagnosis of chronic cough is a comprehensive and thorough procedure, and it should be used with deliberation in clinic. The etiology of chronic cough is complicated, mainly including asthma and related diseases, sinusitis and upper airway cough syndrome, and gastroesophageal reflux disease.%目的 探讨慢性咳嗽Irwin诊断程序临床运用中的优缺点,加深对慢性咳嗽的病因、诊断、鉴别诊断及治疗的认识.方法 回顾性分析2009年在解放军总医院第一附属医院门诊按照Irwin小组提出的慢性咳嗽诊断程序确诊的118例慢性咳嗽患者的临床资料.结果 按照Irwin小组提出的慢性咳嗽诊断程序,118例慢性咳嗽患者均得到确诊,确诊率100％;确诊时间1～30d;临床治愈113例,治愈率达96％.慢性咳嗽的病因分布为:哮喘及哮喘相关疾病(过敏性鼻炎、过敏性咽喉炎、咳嗽变异型哮喘等)和嗜酸性粒细胞性支气管炎共32例,占27.1％;上气道咳嗽综合征(慢性鼻炎、鼻窦炎、咽囊炎、鼻后滴漏综合征、慢性咽喉炎、声带息肉等)28例,占23.7％;胃食管反流病23例,占19.5％;下呼吸道疾病(支气管内膜结核、肺结核、气管内黏膜腺癌、肺癌、支气管扩张症、肺间质纤维化等)14例,占11.9％;心功能不全致咳10例,占8.5％;因服用血管紧张素转换酶抑制剂(ACEI)类降压药致咳6例,占5.1％;心因性咳嗽3例,占2.5％;其他2例,占1.7％.结论 慢性咳嗽Irwin诊断程序全面详尽,临床应用中要结合患者实际情况,加以灵活运用.慢性咳嗽的病因复杂,主要有哮喘及相关疾病、鼻窦炎及上气道咳嗽综合征、胃食管反流病三大类.