氣道過敏反應(yīng)測試系統(tǒng)在慢性咳嗽診斷中的意義
發(fā)布時(shí)間：2018-10-12 10:25
【摘要】：背景隨著空氣污染日益嚴(yán)重,河南省豫北地區(qū)咳嗽患者門診量逐年上升。咳嗽(Cough)是清除氣道內(nèi)分泌物,防止外來異物進(jìn)入機(jī)體的反射性防御動(dòng)作。但是,頻繁咳嗽可引起胸腔壓力增高,加重心臟負(fù)擔(dān),引起嘔吐,胸痛,從而進(jìn)一步影響患者夜間睡眠質(zhì)量,造成白天嗜睡和疲乏,影響生活質(zhì)量。再加上花粉、粉塵過敏原和炎癥因子等刺激,使得咳嗽成為臨床上最常見呼吸系統(tǒng)疾病癥狀。慢性咳嗽的診斷標(biāo)準(zhǔn):以咳嗽為主要或唯一癥狀(持續(xù)時(shí)間8周),而胸部影像學(xué)檢查無明顯異常[2]�；颊邇H表現(xiàn)為咳嗽,而胸部X光及CT檢查均無異常,常被誤診為慢性支氣管炎,無法給予正確有效的治療,延誤病情且嚴(yán)重影響生活質(zhì)量。致使臨床上常應(yīng)用抗生素進(jìn)行對癥治療和進(jìn)行多種非必要的檢查,浪費(fèi)大量醫(yī)療資源。因此,早期明確診斷慢性咳嗽的病因?qū)ζ溥M(jìn)行有效治療具有重要意義�？人宰儺愋韵�(Cough variant asthma,CVA)、嗜酸性粒細(xì)胞性支氣管炎、胃食管反流和鼻后滴漏綜合征、應(yīng)用血管緊張素轉(zhuǎn)換酶抑制劑是引起慢性咳嗽的常見原因。盡管引起慢性咳嗽的病因很多,包括獨(dú)立病因和多發(fā)病因,但是咳嗽變異性哮喘是慢性咳嗽最重要的原因�？人宰儺愋韵且环N臨床上非典型表現(xiàn)的隱匿性哮喘,慢性咳嗽是首發(fā)或唯一表現(xiàn),主要多發(fā)于夜間,吸入糖皮質(zhì)激素或支氣管舒張劑治療有效,因其沒有喘息、發(fā)作性呼吸困難等臨床癥狀且雙肺無哮鳴音,臨床醫(yī)師常診斷為支氣管炎,進(jìn)行大量的無效的治療,引起藥物相關(guān)并發(fā)癥。氣道高反應(yīng)性和炎癥引起的氣道重構(gòu)是支氣管哮喘的主要病理生理特征。當(dāng)前研究顯示支氣管激發(fā)試驗(yàn)是檢測各種類型哮喘的有效手段(包括咳嗽變異性哮喘)。近期研究表明,Th17細(xì)胞產(chǎn)生白介素17(Interleukin-17,IL-17)、IL-22及IL-23等細(xì)胞因子促使中性粒細(xì)胞活化和趨化,從而加重氣道敏感性和炎癥反應(yīng),慢性咳嗽患者氣道中IL-17表達(dá)與中性粒細(xì)胞浸潤數(shù)量和疾病嚴(yán)重程度密切相關(guān)。干擾素調(diào)節(jié)因子4(Interferon regulatory factor 4,IRF4),主要調(diào)控Th17細(xì)胞分化。當(dāng)CD4+T細(xì)胞在轉(zhuǎn)化生長因子β(transforming growth factor beta,TGF-β)和IL-6并存時(shí),如果IRF4缺陷,即使存在TGF-β、IL-6及抗原刺激,Th0細(xì)胞不分化為Th17細(xì)胞,成熟Th17細(xì)胞分泌IL-17、IL-21也受限。IRF4還可控制IL-6誘導(dǎo)CD11b樹突狀細(xì)胞(dendritic cell,DC)的分化發(fā)育來影響Th17細(xì)胞分化。因此在氣道過敏反應(yīng)中,IRF4可以通過調(diào)節(jié)Th17細(xì)胞的分化而參與慢性咳嗽的發(fā)病機(jī)制。慢性咳嗽發(fā)病危險(xiǎn)因素中最重要的是遺傳和環(huán)境因素能通過IRF4對Th17細(xì)胞分化及功能起到重要的調(diào)節(jié)作用。為進(jìn)一步明確氣道過敏反應(yīng)測試系統(tǒng)(支氣管激發(fā)試驗(yàn))在慢性咳嗽診斷中的應(yīng)用價(jià)值及IRF4在慢性咳嗽發(fā)生過程中的作用機(jī)制,以期為慢性咳嗽防治提供新思路和理論依據(jù),分析2016年2月至2017年2月在新鄉(xiāng)市第一人民醫(yī)院呼吸內(nèi)科門診就診的298例慢性咳嗽患者,均進(jìn)行氣道過敏反應(yīng)檢測,現(xiàn)報(bào)告如下。目的探討氣道過敏反應(yīng)測試系統(tǒng)在慢性咳嗽診斷中的意義。方法1.選取新鄉(xiāng)市第一人民醫(yī)院呼吸內(nèi)科2016年2月至2017年2月期間慢性咳嗽患者298例為本研究對象,其中男性患者162例,女性患者136例,并對患者依據(jù)年齡進(jìn)行分組。2.采用全自動(dòng)氣道過敏反應(yīng)檢測儀(ASTOGRAPH J-21)對慢性咳嗽患者進(jìn)行支氣管激發(fā)試驗(yàn)檢查。3.分析慢性咳嗽患者中診斷為咳嗽變異性哮喘與年齡和性別的關(guān)系。4.Real-time PCR檢測受試者炎癥指標(biāo)的表達(dá):ICAM-1,TNF-α,TGF-β、IL-17。5.應(yīng)用SPSS 17.0統(tǒng)計(jì)軟件包,根據(jù)資料類型分別采用χ2檢驗(yàn)和t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)處理,以P0.05為具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.298例慢性咳嗽患者中,氣道過敏反應(yīng)檢測、炎癥指標(biāo)診斷咳嗽變異性哮喘在各年齡組之間差異有統(tǒng)計(jì)學(xué)意義。2.氣道過敏反應(yīng)檢測、炎癥指標(biāo)診斷咳嗽變異性哮喘在性別之間差異無統(tǒng)計(jì)學(xué)意義。3.氣道過敏反應(yīng)檢測陽性157例(52.68%),陰性141例(47.32%),FEV1、FEV1/FVC、PEF及MMEF在激發(fā)陽性、陰性患者間差異均有統(tǒng)計(jì)學(xué)意義(P0.05),FVC在激發(fā)陽性、陰性患者間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.氣道過敏反應(yīng)檢測陽性157例,陰性141例,炎癥指標(biāo)在激發(fā)陽性、陰性患者間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.在298例慢性咳嗽中,支氣管激發(fā)試驗(yàn)陽性在不同年齡組中有顯著差異,而男女兩組陽性率無顯著差異,最終確診CVA患者的支氣管激發(fā)試驗(yàn)陽性率為47.31%。支氣管激發(fā)陽性與過敏相關(guān)因素、年齡、性別、咳嗽癥狀總積分、誘導(dǎo)痰嗜酸性粒細(xì)胞、血清ICAM-1、TNF-α、TGF-β、IL-17和FeNO因素顯著相關(guān)。2.氣道過敏反應(yīng)檢測系統(tǒng)在慢性咳嗽的診斷中有明確意義,應(yīng)用氣道過敏反應(yīng)測試系統(tǒng)在慢性咳嗽患者中篩查CVA患者,早期診斷、正確治療,有助于防止其發(fā)展為典型哮喘。
[Abstract]:Background As the air pollution becomes more and more serious, the outpatient quantity of cough patients in Henan Province is increasing year by year. Coughing is a reflex defense that removes secretions from the airways and prevents foreign bodies from entering the body. However, frequent cough can cause elevated chest pressure, increase heart burden, cause vomiting, chest pain, and further affect night sleep quality in patients, resulting in daytime sleepiness and fatigue, affecting quality of life. Add pollen, dust allergen and inflammatory factors to make the cough become the most common symptom of respiratory disease in clinic. Diagnostic criteria for chronic cough: major or unique symptoms of cough (8 weeks duration) and no significant abnormalities in chest imaging[2]. The patient only showed cough, while chest Xray and CT examination were not abnormal, often misdiagnosed as chronic bronchitis, unable to give correct and effective treatment, delay the condition and seriously affect the quality of life. so that the clinical application of antibiotics for symptomatic treatment and multiple unnecessary examinations is carried out, and a large amount of medical resources are wasted. Therefore, the early diagnosis of chronic cough is of great significance for effective treatment of chronic cough. Cough variant asthma (CVA), eosinophilic bronchitis, transesophageal reflux and post-nasal drip syndrome, the use of angiotensin converting enzyme inhibitors is a common cause of chronic cough. Cough variant asthma is the most important cause of chronic cough despite the many causes of chronic cough, including independent etiology and multiple morbidity. Cough variant asthma is a clinically atypical allergic asthma, chronic cough is the first or only manifestation, mostly at night, inhaled corticosteroids or bronchodilators are effective because they are not breathing, There are clinical symptoms such as paroxysmal dyspnea, and the double lungs do not have any symptoms, and the clinician is often diagnosed as bronchitis, and a large number of ineffective treatments are carried out, resulting in drug-related complications. Airway remodeling caused by high airway hyperresponsiveness and inflammation is the main pathophysiological feature of bronchial asthma. The current study shows that the bronchial provocation test is an effective means of detecting various types of asthma (including cough variant asthma). Recent studies have shown that Th17 cells produce IL-17 (Interleukin-17, IL-17), IL-22 and IL-23, which promote the activation and chemotaxis of neutrophils, thus increasing airway sensitivity and inflammatory response, and the expression of IL-17 in the airway of chronic cough is closely related to the number of neutrophils and the severity of the disease. An interferon regulatory factor 4 (IRF4) was used to regulate the differentiation of Th17 cells. When CD4 + T cells coexist in transforming growth factor beta (IL-6) and IL-6, if IRF4 is deficient, even if there are IL-6, IL-6 and IL-6, Th0 cells are not differentiated into Th17 cells, and mature Th17 cells secrete IL-17, and IL-21 is also restricted. IRF4 may also control the differentiation development of IL-6-induced CD11b dendritic cells (DC) to affect Th17 cell differentiation. Therefore, IRF4 may be involved in the pathogenesis of chronic cough by modulating the differentiation of Th17 cells in airway allergic reactions. The most important factor in the risk factors of chronic cough is that genetic and environmental factors play an important role in the differentiation and function of Th17 cells by IRF4. To further clarify the application value of airway allergic reaction test system (bronchial provocation test) in the diagnosis of chronic cough and the mechanism of IRF4 in the course of chronic cough, so as to provide new ideas and theoretical basis for the prevention and cure of chronic cough. From February 2016 to February 2017, 298 patients with chronic cough in the respiratory department of the First People's Hospital of Xinxiang City were analyzed, and airway allergic reaction was detected. The report is as follows. Objective To investigate the significance of airway allergy test system in diagnosis of chronic cough. Method 1. 298 cases of chronic cough were selected from February 2016 to February 2017 for the first People's Hospital of Xinxiang City from February 2016 to February 2017. Among them, 162 were male, 136 were female, and the patient was grouped according to age. Bronchial provocation test was performed in patients with chronic cough with a full-automatic airway allergy tester (ASTM OGRAPH J-21). To analyze the relationship between cough variant asthma and age and sex in patients with chronic cough. Statistical processing was carried out using SPSS 17. 0 statistical software package according to the type of data, respectively. The statistical significance was found in P0.05. Results One hundred and twenty-eight patients with chronic cough, airway allergic reaction, inflammation index and cough variant asthma had statistical significance between age groups. There was no significant difference in gender between the diagnosis of airway hypersensitivity and the diagnosis of cough variant asthma. There were 157 cases (52. 68%) positive airway allergy test, 141 cases negative (47. 32%), FEV1, FEV1/ FVC, FEV1 and MMEF were statistically significant (P0.05), and there was no significant difference in FVC between positive and negative patients (P0.05). There were 157 cases of positive airway allergy test, 141 cases were negative, and there was statistical difference between the positive and negative patients (P0.05). Conclusion 1. In 298 cases of chronic cough, the positive rate of bronchial provocation test was significantly different in different age groups, while there was no significant difference between the two groups. The positive rate of bronchial provocation test in the patients with CVA was 47. 31%. The positive and allergy-related factors, age, sex, cough symptom and total score of bronchial provocation, induced sputum eosinophil, serum ICAM-1, TNF-CoV, IL-17, IL-17 and FeNO were significantly correlated. The airway allergy test system has definite meaning in the diagnosis of chronic cough, and the application of the airway allergic reaction test system to screen CVA patients in chronic cough patients, early diagnosis, correct treatment, and help prevent it from developing into typical asthma.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R56
本文編號：2265771
[Abstract]:Background As the air pollution becomes more and more serious, the outpatient quantity of cough patients in Henan Province is increasing year by year. Coughing is a reflex defense that removes secretions from the airways and prevents foreign bodies from entering the body. However, frequent cough can cause elevated chest pressure, increase heart burden, cause vomiting, chest pain, and further affect night sleep quality in patients, resulting in daytime sleepiness and fatigue, affecting quality of life. Add pollen, dust allergen and inflammatory factors to make the cough become the most common symptom of respiratory disease in clinic. Diagnostic criteria for chronic cough: major or unique symptoms of cough (8 weeks duration) and no significant abnormalities in chest imaging[2]. The patient only showed cough, while chest Xray and CT examination were not abnormal, often misdiagnosed as chronic bronchitis, unable to give correct and effective treatment, delay the condition and seriously affect the quality of life. so that the clinical application of antibiotics for symptomatic treatment and multiple unnecessary examinations is carried out, and a large amount of medical resources are wasted. Therefore, the early diagnosis of chronic cough is of great significance for effective treatment of chronic cough. Cough variant asthma (CVA), eosinophilic bronchitis, transesophageal reflux and post-nasal drip syndrome, the use of angiotensin converting enzyme inhibitors is a common cause of chronic cough. Cough variant asthma is the most important cause of chronic cough despite the many causes of chronic cough, including independent etiology and multiple morbidity. Cough variant asthma is a clinically atypical allergic asthma, chronic cough is the first or only manifestation, mostly at night, inhaled corticosteroids or bronchodilators are effective because they are not breathing, There are clinical symptoms such as paroxysmal dyspnea, and the double lungs do not have any symptoms, and the clinician is often diagnosed as bronchitis, and a large number of ineffective treatments are carried out, resulting in drug-related complications. Airway remodeling caused by high airway hyperresponsiveness and inflammation is the main pathophysiological feature of bronchial asthma. The current study shows that the bronchial provocation test is an effective means of detecting various types of asthma (including cough variant asthma). Recent studies have shown that Th17 cells produce IL-17 (Interleukin-17, IL-17), IL-22 and IL-23, which promote the activation and chemotaxis of neutrophils, thus increasing airway sensitivity and inflammatory response, and the expression of IL-17 in the airway of chronic cough is closely related to the number of neutrophils and the severity of the disease. An interferon regulatory factor 4 (IRF4) was used to regulate the differentiation of Th17 cells. When CD4 + T cells coexist in transforming growth factor beta (IL-6) and IL-6, if IRF4 is deficient, even if there are IL-6, IL-6 and IL-6, Th0 cells are not differentiated into Th17 cells, and mature Th17 cells secrete IL-17, and IL-21 is also restricted. IRF4 may also control the differentiation development of IL-6-induced CD11b dendritic cells (DC) to affect Th17 cell differentiation. Therefore, IRF4 may be involved in the pathogenesis of chronic cough by modulating the differentiation of Th17 cells in airway allergic reactions. The most important factor in the risk factors of chronic cough is that genetic and environmental factors play an important role in the differentiation and function of Th17 cells by IRF4. To further clarify the application value of airway allergic reaction test system (bronchial provocation test) in the diagnosis of chronic cough and the mechanism of IRF4 in the course of chronic cough, so as to provide new ideas and theoretical basis for the prevention and cure of chronic cough. From February 2016 to February 2017, 298 patients with chronic cough in the respiratory department of the First People's Hospital of Xinxiang City were analyzed, and airway allergic reaction was detected. The report is as follows. Objective To investigate the significance of airway allergy test system in diagnosis of chronic cough. Method 1. 298 cases of chronic cough were selected from February 2016 to February 2017 for the first People's Hospital of Xinxiang City from February 2016 to February 2017. Among them, 162 were male, 136 were female, and the patient was grouped according to age. Bronchial provocation test was performed in patients with chronic cough with a full-automatic airway allergy tester (ASTM OGRAPH J-21). To analyze the relationship between cough variant asthma and age and sex in patients with chronic cough. Statistical processing was carried out using SPSS 17. 0 statistical software package according to the type of data, respectively. The statistical significance was found in P0.05. Results One hundred and twenty-eight patients with chronic cough, airway allergic reaction, inflammation index and cough variant asthma had statistical significance between age groups. There was no significant difference in gender between the diagnosis of airway hypersensitivity and the diagnosis of cough variant asthma. There were 157 cases (52. 68%) positive airway allergy test, 141 cases negative (47. 32%), FEV1, FEV1/ FVC, FEV1 and MMEF were statistically significant (P0.05), and there was no significant difference in FVC between positive and negative patients (P0.05). There were 157 cases of positive airway allergy test, 141 cases were negative, and there was statistical difference between the positive and negative patients (P0.05). Conclusion 1. In 298 cases of chronic cough, the positive rate of bronchial provocation test was significantly different in different age groups, while there was no significant difference between the two groups. The positive rate of bronchial provocation test in the patients with CVA was 47. 31%. The positive and allergy-related factors, age, sex, cough symptom and total score of bronchial provocation, induced sputum eosinophil, serum ICAM-1, TNF-CoV, IL-17, IL-17 and FeNO were significantly correlated. The airway allergy test system has definite meaning in the diagnosis of chronic cough, and the application of the airway allergic reaction test system to screen CVA patients in chronic cough patients, early diagnosis, correct treatment, and help prevent it from developing into typical asthma.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R56
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 門翔;尚喜雨;黨強(qiáng);;咳嗽變異性哮喘和典型支氣管哮喘患者DCs、mDC、pDC比例和數(shù)量的變化及意義[J];廣東醫(yī)學(xué);2017年03期
2 李寧;吳明明;張寶林;;FENO在不同病因慢性咳嗽中的反應(yīng)水平及臨床意義[J];國際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2016年22期
3 郭華;周紅;尚東;楊嵐;任徽;;西安地區(qū)成人慢性咳嗽流行病學(xué)調(diào)查[J];陜西醫(yī)學(xué)雜志;2016年08期
4 劉維英;余勤;岳紅梅;張佳賓;李龍;汪小亞;胡建明;馮濤;濮家源;白雪;;蘭州地區(qū)不明原因慢性咳嗽的病因[J];中華結(jié)核和呼吸雜志;2016年05期
5 楊偉;;兒童咳嗽變異性哮喘患兒氣道高反應(yīng)的動(dòng)態(tài)觀察[J];海南醫(yī)學(xué);2016年05期
6 張輝;于倩倩;劉穎;張連蓮;于振香;;慢性咳嗽患者病因分析及診斷思路[J];中國老年學(xué)雜志;2015年21期
7 劉賢兵;李芳;陳曉萍;田明慶;吳倩;張偉;;中青年慢性咳嗽患者病因分布及生活質(zhì)量差異性研究[J];中國全科醫(yī)學(xué);2015年28期
8 季俊峰;許莉;張勇;王志頤;陳偉;薛飛;王秋萍;;氣道神經(jīng)源性炎癥在上氣道咳嗽綜合征中的作用[J];實(shí)用醫(yī)學(xué)雜志;2015年09期
9 翟鵬勇;李雪琴;梁淑霞;王燕;;晉城地區(qū)慢性咳嗽病因構(gòu)成及治療探討[J];山西醫(yī)科大學(xué)學(xué)報(bào);2015年02期
10 何雪梅;盧育明;;感染后咳嗽氣道神經(jīng)源性炎癥水平與肺功能相關(guān)性研究[J];中國醫(yī)學(xué)創(chuàng)新;2014年19期
，本文編號：2265771
本文鏈接：http://sikaile.net/yixuelunwen/huxijib/2265771.html
最近更新
教材專著
