胃食道反流性咳嗽临床诊断的评分系统建立 - 第三军医大学学报.doc

胃食道反流性咳嗽临床诊断的评分系统建立 张 巧,马千里,黄赞胜,王 彬,程晓明,林科雄,王长征(400037 重庆, 第三军医大学新桥医院全军呼吸内科研究所) [摘要] 目的 通过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cough variability asthma，CVA)和上气道咳嗽综合征(upper airway 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 本研究对最终确诊为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它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组间存在差异显著(P0.001)。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 本研究建立的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，为GERC的经验性治疗提供了一种利于临床推广应用的简便的诊断策略。 [关键词] 胃食道反流性咳嗽；临床诊断；评分体系 [中图法分类号] R2332; R378.14; R392.7　　 [文献标志码] A Establishment of gastro-esophageal regurgitation cough scoring system for clinical diagnosis Zhang Qiao, Ma Qianli, Huang Zanshen, Wang Bing, Cheng Xiaoming, Lin Kexiong, Wang Changzheng (Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China) [Abstract] 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 fistly 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 di