摘要目的 验证中文版Hull气道反流问卷(HARQ)评估慢性咳嗽的有效性、可重复性及治疗反应性,探讨其临床应用价值.方法 遵循正反向翻译流程建立HARQ的中文版,并预先在55例未经治疗且症状稳定的慢性咳嗽患者中重复2次评分检验(间隔1周).选择2014年5月至2015年4月在同济大学附属同济医院呼吸内科门诊就诊的132例患者作为慢性咳嗽组,完成HARQ、咳嗽症状积分和辣椒素咳嗽敏感性测定,分析彼此相关性,然后按慢性咳嗽诊治流程确立患者病因后进行针对性治疗,有效治疗2周后再次复查上述问卷,分析治疗反应性,并与104例健康志愿者(对照组)进行HARQ评分差异比较.结果 间隔1周重复性检验HARQ总分值有良好的相关性(组内相关系数r=0.96,95％ CI:0.93～0.98,P=0.00).HARQ评分与咳嗽症状积分无相关性,与辣椒素咳嗽阈值C2存在低度负相关(rlgC2=-0.23,P=0.01),而与C5无职显相关.慢性咳嗽患者HARQ评分明显高于对照组[分别为20.00(14.00,28.00)和4.00(2.00,6.00),Z=-12.89,P=0.00],但评分无性别和年龄差异;不同病因慢性咳嗽患者的HARQ评分均增高,但以胃食管反流相关性咳嗽增高最突出,明显高于其他病因[分别为28.50(25.00,32.25)和18.50(14.00,26.25),Z=4.43,P=0.00].有效治疗2周后,HARQ分值从治疗前的20.00(14.00,28.00)降低至10.00 (4.25,17.75) (Z=-6.06,P=0.00),其积分变化率、效应大小及标准化反应均数分别为52.04％、1.38和1.97.结论 中文版HARQ有良好的重复性和治疗反应性,是有效的慢性咳嗽诊疗评估工具,可能有助于胃食管反流性咳嗽的简易诊断.

abstractsObjective To validate the effectiveness,repeatability and treatment responsiveness of the Chinese version of Hull airway reflux questionnaire (HARQ),and to determine its clinical value.Methods A standard Chinese version of HARQ was developed by an established translation procedure and its repeatability was assessed in a preliminary study involving 55 untreated patients with stable chronic cough.Thereafter,a total of 132 patients with chronic cough referred to our respiratory clinic were recruited into the study between May 2014 and April 2015.After their cough was evaluated with the HARQ,cough symptom score or cough reflex sensitivity to inhaled capsaicin and the correlations among them were analyzed,and the causes of chronic cough in all the patients were presumptively determined according to an established diagnostic protocol and finally confirmed with the subsequent therapy specific to the etiologies.After two weeks of effective treatment,HARQ,cough symptom score and cough reflex sensitivity to inhaled capsaicin were measured once more,and treatment responsiveness was calculated.The score of the HARQ in 132 patients with chronic cough were compared with that in 104 healthy volunteers.Results The repeatability of the Chinese version of the HARQ was validated at a week interval with the intraclass correlation coefficients of 0.96 (95％ CI:0.93-0.98,P =0.00) for total score (n =55).No correlation was found between the HARQ and cough symptom score,and the HARQ showed a weak negative correlation with cough threshold C2(rgC2 =-0.23,P =0.01) but not with C5.The value of HARQ was significantly higher in patients with chronic cough than in healthy volunteers [20.00(14.00,28.00) vs 4.00 (2.00,6.00),Z =-12.89,P =0.00],but no difference of HARQ in gender or age existed in chronic cough.Although all the patients with various etiologies of chronic cough had an increased value of HARQ,cough due to gastroesophageal reflux showed the highest HARQ score among them [28.50 (25.00,32.25) vs 18.50 (14.00,26.25),Z =4.43,P =0.00].After two weeks of effective treatment,the HARQ score decreased from 20.00 (14.00,28.00) pre-treatment to 10.00 (4.25,17.75) post-treatment (Z =-6.06,P =0.00),with 52.04％ of score change ratio,1.38 of effect side and 1.97 of standard response mean respectively.Conclusion HARQ is a reliable and valid tool for the management of chronic cough with good treatment responsiveness,and may be used as an easy way to predict cough due to gastroesophageal reflux.