摘要目的 探讨慢性咳嗽病因变迁的临床意义.方法 收集2004年1月至2008年12月连续在同济大学附属同济医院呼吸内科就诊并经逐步诊断流程探查病因的940例慢性咳嗽患者,以年为单位分成5组,通过x2检验回顾性分析慢性咳嗽病因分布频率和构成的变化趋势.结果 慢性咳嗽的常见病因依次为咳嗽变异性哮喘(437/940,46%)、上气道咳嗽综合征/鼻后滴流综合征(304/940,32%)、嗜酸粒细胞性支气管炎(87/940,9%)、胃食管反流性咳嗽(83/940,9%)、感染后咳嗽(60/940,6%)和血管紧张素转换酶抑制剂相关咳嗽(46/940,5%).5年间慢性咳嗽病因分布频率存在明昆差异(x2=60.6,P=0.0001),咳嗽变异性哮喘从44%增至51%(x2=12.8,P=0.010),上气道咳嗽综合征/鼻后滴流综合征从49%降至29%(x2=20.1,P=0.001),胃食管反流性咳嗽从2%增至10%(x2=17.6,P=0.002),而嗜酸粒细胞性支气管炎、感染后咳嗽和血管紧张素转换酶抑制剂相关咳嗽分布频率保持不变.结论 慢性咳嗽主要病因随时间发生变迁,可影响相应的诊治策略.

abstractsObjective To investigate the changing patterns of the spectrum and frequency of causes for chronic cough, and to explore its clinical implications. Methods Nine hundred and forty patients consecutively referred to Department of Respiratory Medicine for evaluation of chronic cough between January 2004 and December 2008 were collected and divided into 5 groups by periods of 5 years. The causes of cough had been primarily evaluated according to a step-by-step protocol and confirmed by the specific therapy. The changes in spectrum and frequency of causes were retrospectively analyzed by x2 test. Results The common causes of chronic cough were cough variant asthma (n= 437,46% ), upper airway cough syndrome/postnasal drip syndrome (n=304,32% ), eosinophilic bronchitis (n=87,9% ), gastroesophageal reflux-related chronic cough (n=83,9% ) , postinfectious cough (n=60, 6% ) and angiotensin-converting enzyme inhibitors-induced cough (n=46,5%) in descending order. There were significant differences in the distribution and frequency of etiologies when analyzed by year (x2=60.6, P= 0.0001). During a 5-year period, chronic cough due to cough variant asthma increased from 44% to 51% (x2= 12.8, P=0.010), upper airway cough syndrome/postnasal drip syndrome decreased from 49% to 29% (x2=20.1, P=0.001 ) , and gastroesophageal reflux increased from 2% to 10% ( x2 = 17.6, P = 0.002). However, chronic cough associated with eosinophilic bronchitis, postinfection and angiotensin-converting enzyme inhibitors remained stable. Conclusion The common causes of chronic cough vary with time, which may have an impact on the strategy for the management of chronic cough.