慢性咳嗽的成人和儿童患者阿诺德神经反射的患病率
2017/12/20
摘要
背景：咳嗽源于迷走神经支配的结构（包括气道和食管远端）受到刺激。阿诺德神经反射描述的是迷走神经支配外耳道的耳支经受刺激而诱发咳嗽。从历史上看，这种反射的患病率在门诊耳鼻喉科的研究中已经报道了2%至3%，但在健康志愿者或慢性咳嗽患者中没有被调查过。
方法：研究对200名成人慢性咳嗽患者和100名儿童慢性咳嗽患者，以及100名成人和100名儿科志愿者，进行了一项评估：用棉签敷贴刺激双侧外耳道。在刺激后10秒内发生咳嗽，被认为是由刺激引起的。
结果：阿诺德神经反射存在于25.5%的成人和3%的慢性咳嗽患儿中。健康成人和儿童的反射发生率为2%。在慢性咳嗽患者中，阿诺德的神经反射更常见于女性（31.6%），多于男性（12.5%），在大多数患者中是单侧的（90.2%）。
结论：成年慢性咳嗽患者阿诺德神经反射的患病率较健康志愿者高12倍，支持咳嗽过敏综合征的概念（CHS）——以迷走神经超敏反应为基础的慢性难治性咳嗽。在儿童慢性咳嗽患者与对组之间并没有观察到阿诺德神经反射的患病率存在差异，提示CHS是一种获得性状态，可能是由病毒性呼吸道感染或其他环境因素引发。
Prevalence of Arnold's Nerve Reflex in Adults and Children with Chronic Cough
Dicpinigaitis PV, Kantar A, Enilari O, Paravati F
Abstract
BACKGROUND:Cough originates from stimulation of structures innervated by the vagus nerve, including the airways and distal esophagus. Arnold's nerve reflex describes the induction of cough by stimulation of the external auditory canal, which is innervated by the auricular branch of the vagus. Historically, the prevalence of this reflex has been reported in the range of 2-3%, based on studies of outpatients in otolaryngology practices, but has not been investigated in healthy volunteers or in patients with chronic cough.
METHODS:Two hundred adults and 100 children with chronic cough, as well as 100 adult and 100 pediatric volunteers, underwent evaluation consisting of stimulation of the external auditory canal of each ear with a cotton-tipped applicator. Cough occurring within 10 seconds of stimulation was considered induced by the intervention.
RESULTS:Arnold's nerve reflex was present in 25.5% of adults and 3% of children with chronic cough. The prevalence of the reflex was 2% among healthy adults and children. In adults with chronic cough, Arnold's nerve reflex was observed more commonly in women (31.6%) than men (12.5%), and was unilateral in the majority of patients (90.2%).
CONCLUSIONS:The greater than 12-fold prevalence of Arnold's nerve reflex in adults with chronic cough compared with healthy volunteers supports the concept of the Cough Hypersensitivity Syndrome (CHS), in which vagal hypersensitivity is proposed to underlie chronic refractory cough. The absence of increased prevalence among children with chronic cough suggests that CHS is an acquired condition, perhaps triggered by viral respiratory infection or other environmental factor.
背景：咳嗽源于迷走神经支配的结构（包括气道和食管远端）受到刺激。阿诺德神经反射描述的是迷走神经支配外耳道的耳支经受刺激而诱发咳嗽。从历史上看，这种反射的患病率在门诊耳鼻喉科的研究中已经报道了2%至3%，但在健康志愿者或慢性咳嗽患者中没有被调查过。
方法：研究对200名成人慢性咳嗽患者和100名儿童慢性咳嗽患者，以及100名成人和100名儿科志愿者，进行了一项评估：用棉签敷贴刺激双侧外耳道。在刺激后10秒内发生咳嗽，被认为是由刺激引起的。
结果：阿诺德神经反射存在于25.5%的成人和3%的慢性咳嗽患儿中。健康成人和儿童的反射发生率为2%。在慢性咳嗽患者中，阿诺德的神经反射更常见于女性（31.6%），多于男性（12.5%），在大多数患者中是单侧的（90.2%）。
结论：成年慢性咳嗽患者阿诺德神经反射的患病率较健康志愿者高12倍，支持咳嗽过敏综合征的概念（CHS）——以迷走神经超敏反应为基础的慢性难治性咳嗽。在儿童慢性咳嗽患者与对组之间并没有观察到阿诺德神经反射的患病率存在差异，提示CHS是一种获得性状态，可能是由病毒性呼吸道感染或其他环境因素引发。
(中日友好医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(Chest.2017 Nov 29.)
(Chest.2017 Nov 29.)
Prevalence of Arnold's Nerve Reflex in Adults and Children with Chronic Cough
Dicpinigaitis PV, Kantar A, Enilari O, Paravati F
Abstract
BACKGROUND:Cough originates from stimulation of structures innervated by the vagus nerve, including the airways and distal esophagus. Arnold's nerve reflex describes the induction of cough by stimulation of the external auditory canal, which is innervated by the auricular branch of the vagus. Historically, the prevalence of this reflex has been reported in the range of 2-3%, based on studies of outpatients in otolaryngology practices, but has not been investigated in healthy volunteers or in patients with chronic cough.
METHODS:Two hundred adults and 100 children with chronic cough, as well as 100 adult and 100 pediatric volunteers, underwent evaluation consisting of stimulation of the external auditory canal of each ear with a cotton-tipped applicator. Cough occurring within 10 seconds of stimulation was considered induced by the intervention.
RESULTS:Arnold's nerve reflex was present in 25.5% of adults and 3% of children with chronic cough. The prevalence of the reflex was 2% among healthy adults and children. In adults with chronic cough, Arnold's nerve reflex was observed more commonly in women (31.6%) than men (12.5%), and was unilateral in the majority of patients (90.2%).
CONCLUSIONS:The greater than 12-fold prevalence of Arnold's nerve reflex in adults with chronic cough compared with healthy volunteers supports the concept of the Cough Hypersensitivity Syndrome (CHS), in which vagal hypersensitivity is proposed to underlie chronic refractory cough. The absence of increased prevalence among children with chronic cough suggests that CHS is an acquired condition, perhaps triggered by viral respiratory infection or other environmental factor.
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