非哮喘性嗜酸性粒细胞支气管炎:慢性咳嗽的重要病因

发布时间：2018-09-09 08:19

【摘要】：非哮喘性嗜酸性粒细胞支气管炎(NAEB)占我国慢性咳嗽常见病因的第三位,可与上气道咳嗽综合征、胃食管反流性咳嗽合并存在。慢性咳嗽是NAEB患者最主要、甚至常常是唯一的就诊症状。NAEB的诊断依据包括:慢性(亚急性)咳嗽症状,肺通气功能正常,支气管激发试验阴性,气道黏膜嗜酸性粒细胞增高以及吸入性糖皮质激素治疗有效(极少数患者需要口服糖皮质激素治疗)。在治疗上,通常推荐吸入性糖皮质激素,但具体剂量和疗程尚无循证医学证据可供参考,经验性参考剂量为吸入性布地奈德400μg,2次/d,疗程至少4周,必要时可给予短期(3~5d)口服糖皮质激素,给予孟鲁斯特协同治疗能有效控制咳嗽症状、逆转嗜酸性粒细胞气道炎症,有助于降低激素剂量。低剂量吸入性变应原暴露可能是NAEB的重要发病机制,而肥大细胞炎性浸润部位的差异可能是导致NAEB与哮喘气道炎症相似,但病理生理和临床症状不同的病理基础。
[Abstract]:Non-asthmatic eosinophil bronchitis (NAEB) is the third most common cause of chronic cough in China. It can be associated with upper airway cough syndrome and gastroesophageal reflux cough. Chronic cough is the most common, and often the only, symptom of NAEB. The diagnostic criteria include chronic (subacute) cough, normal pulmonary ventilation, and negative bronchial provocation test. Airway mucosal eosinophilic granulocytes and inhaled glucocorticoids are effective (few patients need oral glucocorticoid therapy). Inhaled glucocorticoids are usually recommended for treatment, but there is no evidence-based medical evidence for specific doses and courses of treatment. The empirical reference dose is 400 渭 g / d of inhaled budesonide for at least 4 weeks. If necessary, oral glucocorticoids can be given for a short time (3 ~ 5 days). The synergistic therapy of Montrusz can effectively control cough symptoms, reverse airway inflammation of eosinophils, and help to reduce the dose of hormone. Low dose inhaled allergen exposure may be an important pathogenesis of NAEB, and the difference of inflammatory infiltration sites of mast cells may be the pathophysiological basis for the difference of airway inflammation between NAEB and asthma, but the pathophysiology and clinical symptoms are different.
【作者单位】：杭州市红十字会医院呼吸内科;
【基金】：国家自然科学基金(30971316/C140403) MISP(Merck investigator-initiated study program)基金(39758)~~
【分类号】：R562.25

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