咳嗽變異型哮喘76例臨床分析

[摘要] 目的 提高醫務人員對咳嗽變異型哮喘（cough variation asthma， CVA）的認識，減少誤診誤治。 方法 回顧性分析76例CVA的臨床資料，總結其特點。 結果 本病有以下特點：（1）春秋及冬季多發；（2）咳嗽多為陣發性干咳，以夜間及凌晨為著，運動、吸入冷空氣或異味后誘發或加重；（3）多有過敏性鼻炎或蕁麻疹等過敏史；（4）胸部查體及胸片多無明顯異常；（5）支氣管舒張試驗陽性；（6）嗜酸性粒細胞常增高；（7）抗生素及止咳藥治療無效，而糖皮質激素和支氣管擴張劑治療有效。 結論 CVA易被誤診為上呼吸道感染等疾病，但有一定的臨床特點，對臨床上以夜間和清晨為主的反復咳嗽，查體及胸片無明顯異常，止咳藥及抗生素治療無效，有過敏性鼻炎或蕁麻疹等過敏史者，應考慮本病，可用糖皮質激素和支氣管擴張劑進行試驗性治療，有條件的再結合肺功能測定等，大多可做出到早期診斷。

[關鍵詞]哮喘；咳嗽；變異型；診斷；治療

[中圖分類號] R562.2+5 [文獻標識碼] B [文章編號] 2095-0616（2013）13-201-02

Clinical analysis of 76 cases of cough variation asthma

ZHANG Shengquan

Outpatient Clinic，North District of 401 Hospital of PLA，Qingdao 266100，China

[Abstract] Objective To increase the knowledge about cough variation asthma（CVA），and decreasing the mistake in diagnosis and treatment of CVA. Methods The clinical data of 76 cases of CVA were analysed retrospectively， and the features were summarized. Results The features of CVA were as follow：（1）The CVA were often occured in spring， autumn and winter.（2）Cough was often paroxysmal with no sputum. It was serious in the midnight and daybreak.It was caused or becoming more serious when the patient was exercising or inhaling cold air and peculiar smell.（3）The most patients had allergic history of suffering from allergic rhinitis or urticaria. （4）The physical examination and X-ray of chest were normal for most patients.（5）The bronchodilation test result was positive.（6）The amount of esoino was often more.（7）It had no effect to the treatment with antibiotics and drugs for cough.but it was effect to the treatment with glucocorticoid and bronchodilator. Conclusion CVA was often diagnosed as upper respiratory infection and so on.It should be diagnosed as CVA when patient had the features as follow：Cough became serious in the midnight and daybreak.The physical examination and X-ray of chest were normal.It had no effect to the treatment with antibiotics and drugs for cough. The patient had allergic history of suffering from allergic rhinitis or urticaria.After that treatment with glucocorticoid and bronchodilator might be taken，if it was effect and the test result of pulmonary function was positive and so on.If the patient had all of the above，it should be diagnosed as CVA promptly.

[Key words] Asthma；Cough；Variation；Diagnosis；Treatment

咳嗽變異型哮喘（CVA）是一種特殊類型的支氣管哮喘，又稱咳嗽型哮喘或隱匿型哮喘，其主要或唯一臨床表現為反復發作性、陣發性咳嗽，咳嗽多為干咳，或有少許白痰，以夜間及凌晨為著，運動、吸入冷空氣或異味時加重，無明顯喘息等癥狀，胸部查體及胸片多無明顯異常，易被誤診為上呼吸道感染、支氣管炎、慢性咽炎等疾病，是慢性咳嗽中最常見的病因之一，其發病率有逐年上升的趨勢[1]。現將2007年4月～2012年9月我院診治的76例CVA患者進行分析，總結其特點，以提高對本病的認識，減少誤診誤治。……