目的 探討下氣道炎癥在上氣道咳嗽綜合征( UACS) 發(fā)生機制中的作用。方法 選擇UACS 患者10 例, 并與無咳嗽的10 例慢性鼻炎或鼻竇炎患者和10 例健康志愿者比較。分析各組吸入辣椒素誘發(fā)≥2 次或≥5 次咳嗽的C2 和C5 咳嗽閾值, 誘導(dǎo)痰中細胞數(shù)量和成分, 以及上清液中組胺和前列腺素E2( PGE2 ) 含量的變化。結(jié)果 UACS 患者咳嗽閾值明顯低于無咳嗽的慢性鼻炎或鼻竇炎患者[ C2 : ( 0. 65 ±0. 08) μmol / L 比( 3.90 ±1. 37) μmol / L; C5 : ( 1. 59 ±0. 28) μmol /L 比( 33. 46 ±23. 71) μmol / L, P 均 lt;0. 05] , 但后者與健康志愿者比較無顯著差異( P 均 gt;0. 05) 。UACS患者誘導(dǎo)痰中炎性細胞總數(shù)較健康志愿者升高, 單核細胞比例明顯降低, 中性粒細胞比例增高( P lt;0. 05) , 但與無咳嗽的慢性鼻炎或鼻竇炎患者比較無明顯差異( P gt; 0. 05) 。UACS 患者誘導(dǎo)痰上清液中組胺和PGE2 均高于無咳嗽的慢性鼻炎或鼻竇炎患者[ 組胺: ( 9.55 ±1. 89) ng/mL 比( 2. 37 ±0. 25) ng/mL; PGE2 : ( 361. 71 ±39. 38) pg /mL 比( 144. 34 ±15. 69) pg/mL; P 均 lt; 0. 05] , 而后者與健康志愿者無明顯差異( P 均 gt;0. 05) 。結(jié)論 氣道炎癥引起的咳嗽高敏感性可能在UACS 的發(fā)生中起重要作用, 下氣道黏膜肥大細胞激活可能是重要因素。
引用本文： 時翠芹,余莉,魏為利,黃漾,呂寒靜,邱忠民. 氣道炎癥在鼻后滴流綜合癥慢性咳嗽發(fā)生中的作用. 中國呼吸與危重監(jiān)護雜志, 2009, 09(3): 256-258. doi: 復(fù)制
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- 1. Pratter MR. American College of Chest Physicians( ACCP) . Chronic upper airway cough syndrome secondary to rhinosinus diseases ( previously referred to as postnasal drip syndrome) : ACCP evidencebased clinical practice guidelines. Chest, 2006, 129:63S-71S.
- 2. Hsu JY, Stone RA, Logan-Sinclair RB, et al. Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Eur Respir J, 1994, 7: 1246-1253.
- 3. 時翠芹, 邱忠民, 呂寒靜, 等. 辣椒素咳嗽敏感性試驗在慢性咳嗽中的應(yīng)用價值. 中華結(jié)核和呼吸雜志, 2007, 30: 954-966.
- 4. Brightling CE, Ward R, Woltmann G, et al. Induced sputum inflammatory mediator concentrations in eosinophilic bronchitis and asthma. Am J Respir Crit Care Med, 2000, 162: 878-882.
- 5. Tanaka S, Hirata K, Kurihara N, et al. Effect of loratadine, an H1 antihistamine, on induced cough in non-asthmatic patients with chronic cough. Thorax, 1996, 51: 810-814.
- 6. Bonay M, Neukirch C, Grandsaigne M, et al. Changes in airway inflammation following nasal allergic challenge in patients with seasonal rhinitis. Allergy, 2006, 61: 111-118.
- 7. Irwin RS, Ownbey R, Cagle PT, et al. Interpreting the histopathology of chronic cough: a prospective, controlled, comparative study.Chest, 2006, 130: 362-370.
- 8. Nightingale JA, Rogers DF, Barnes PJ. Effect of repeated sputum induction on cell counts in normal volunteers. Thorax,1998, 53: 87-90.
- 9. McGarvey LP, Forsythe P, Heaney LG, et al. Bronchoalveolar lavage findings in patients with chronic nonproductive cough. Eur Respir J,1999, 13: 59-65.
- 10. Marshall JS. Mast-cell responses to pathogens. Nat Rev Immunol,2004, 4: 787-799.
- 11. Niimi A, Chung KF. Airway inflammation and remodeling changes in patients with chronic cough: do they tell us about the cause of cough? Pulm Pharmacol Ther, 2004, 17: 441-446.