误吸在胃食管反流性的慢性咳嗽发病机制中的作用
2016/11/09
摘要
背景/目的：胃食管反流病（GERD）是慢性咳嗽的主要原因之一。我们通过测定支气管肺泡灌洗液标本中的脂质巨噬细胞的量评估了误吸在反流性咳嗽发病机制中的作用。
方法:总共对161例慢性咳嗽进行了评价，从中招募36例（平均年龄48.2岁）患者参与这一单中心前瞻性研究。吸烟史、血管紧张素转换酶抑制剂的使用、肺功能检查的任何异常、胸部X线检查异常、职业或环境暴露，或上气道咳嗽综合征的患者被排除在外。胃食管反流病（GERD）通过24小时食管阻抗-PH监测。通过纤维支气管镜检查34例患者支气管肺泡灌洗液（BAL）标本中的脂质巨噬细胞（LLM）。
结果:根据MII/ PH监测的结果，病理性食管内反流患者比没有病理性反流的病人在支气管肺泡灌洗液（BAL）标本中脂质巨噬细胞（LLM）含量更高（病理性反流组8 / 14 VS 非病理性反流组1 / 22；P = 0.004）。支气管肺泡灌洗液（BAL）的细胞分布在两组间无明显差异（巨噬细胞P = 0.57，淋巴细胞P = 0.35，中性粒细胞P = 0.87，嗜酸性粒细胞P = 0.45）。
结论:我们的研究结果证实反流误吸在慢性咳嗽的发病机制中的作用。支气管镜检查显示：慢性咳嗽患者，除了常规的气道评估，也应评估支气管肺泡灌洗液和脂质巨噬细胞。脂质巨噬细胞可以用于诊断反流相关慢性咳嗽的误吸。未来需要研究脂质巨噬细胞阳性患者对抗反流药物或手术的反应。
（苏欣 审校）
J Neurogastroenterol Motil. 2016 Sep 8. doi: 10.5056/jnm16057. [Epub ahead of print]
The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough.
Özdemir P1,2, Erdinç M3,2, Vardar R4,2, Veral A5, Akyıldız S6,2, Özdemir Ö7, Bor S4,2.
Author information
Abstract
BACKGROUND/AIMS:Gastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages in bronchoalveolar lavage specimens.
METHODS:A total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-ray, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. Bronchoalveolar lavage (BAL) specimens for lipid-laden macrophage (LLM) determination were obtained from 34 patients by flexible bronchoscopy.
RESULTS:Patients with pathological intra-oesophageal reflux according to MII/pH monitoring had higher LLM positivity in BAL specimens than did patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.57 for macrophages, P = 0.35 for lymphocytes, P = 0.87 for neutrophils and P = 0.45 for eosinophils).
CONCLUSIONS:Our results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, bronchoalveolar lavage and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to anti-reflux medications or surgery in patients with LLM positivity.
KEYWORDS:Alveolar macrophages; Cough; Gastroesophageal reflux
J Neurogastroenterol Motil. 2016 Sep 8. doi: 10.5056/jnm16057. [Epub ahead of print]
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