慢性咳嗽中客观咳嗽频度的性别差异和预测因子
2009/03/27
背景：在咳嗽专科医疗中心，女性就诊患者一直过多，并且已知女性比男性咳嗽反射更敏感。女性性别和其他病人特征是否与咳嗽率较高有关还不清楚。我们的研究目的是检测在三级医疗中心就诊的慢性咳嗽患者中客观的咳嗽次数的预测因子。
方法：100名原因不明的慢性咳嗽患者[平均年龄55.8岁（SD±11.0），女性65人，平均咳嗽持续时间4年(四分位数间距2.0～10.0年)]完成流速—容量环[FEV1为103%预计值(SD±15.2), FEF50; 为68.8%预计值, SD±24.1]、乙酰甲胆碱激发试验（42 %阳性）、枸橼酸咳嗽反射敏感性试验[C5; 0.12M (四分位数间距0.06-0.50M)]和莱斯特咳嗽调查表。对86名研究对象进行了24小时动态咳嗽监测，人工计数咳嗽次数，用每小时猛烈咳嗽次数表示。
结果：女性咳嗽次数明显高于男性[几何均数16.6次/小时(95%CI，13.1-21.0) vs 9.4次/小时(95% CI，6.4-13.9), p=0.01]。女性的咳嗽反射也比男性更敏感（中位数logC5 -0.9M vs -0.6M, p=0.002），但是与咳嗽有关的生活质量女性和男性相似[女性12.0 (±3.6) vs 男性12.2 (±3.2), p=0.76]。线性回归分析表明性别（p=0.01）、logC5（p= <0.001）和年龄（p=0.003）预计了41%的咳嗽率的变异，但是肺功能或支气管高反应性不能预计咳嗽率的变异。
结论：动态的客观咳嗽监测为我们研究调节慢性咳嗽的因素提供了新视点。这些结果提示在研究咳嗽及设计检测新型止咳药的临床试验时必须考虑性别和年龄的影响。
（张永明 审校）
Kelsall A, et al. Thorax. 2009 Jan 8.
Kelsall A, et al. Thorax. 2009 Jan 8. [Epub ahead of print] Links
Sex differences and predictors of objective cough frequency in chronic cough.
BACKGROUND: Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. We aimed to determine the predictors of objective cough frequency in chronic cough patients presenting to a tertiary referral clinic.
METHODS: 100 subjects [mean age 55.8yrs (SD+/-11.0), 65 female, median cough duration 4yrs (IQR 2.0-10.0yrs)] with unexplained chronic cough, completed flow-volume loops (FEV1 103% predicted (SD+/-15.2), FEF50; 68.8% predicted, SD+/-24.1), methacholine challenge (42 % positive), citric acid cough reflex sensitivity [C5; 0.12M (IQR 0.06-0.50M)] and the Leicester Cough Questionnaire. 24-hour ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour.
RESULTS: Females coughed significantly more than males [geometric mean 16.6 coughs/hr (95%CI 13.1-21.0) versus 9.4coughs/hr (95% CI 6.4-13.9), p=0.01)]. The cough reflex was also more sensitive in females than males (median logC5 -0.9M versus -0.6M, p=0.002) but cough related quality of life was similar (females 12.0 (+/-3.6) versus males 12.2 (+/-3.2), p=0.76). Linear regression analysis showed 41% of the variation in cough rate was predicted by sex (p=0.01), logC5 (p= <0.001) and age (p=0.003) but not lung function or bronchial hyper-reactivity.
CONCLUSIONS: Ambulatory objective cough monitoring provides novel insights into factors modulating chronic cough. These findings suggest that effects of sex and age must be taken into account in the study of cough and when designing clinical trials testing novel anti-tussive agents.
方法：100名原因不明的慢性咳嗽患者[平均年龄55.8岁（SD±11.0），女性65人，平均咳嗽持续时间4年(四分位数间距2.0～10.0年)]完成流速—容量环[FEV1为103%预计值(SD±15.2), FEF50; 为68.8%预计值, SD±24.1]、乙酰甲胆碱激发试验（42 %阳性）、枸橼酸咳嗽反射敏感性试验[C5; 0.12M (四分位数间距0.06-0.50M)]和莱斯特咳嗽调查表。对86名研究对象进行了24小时动态咳嗽监测，人工计数咳嗽次数，用每小时猛烈咳嗽次数表示。
结果：女性咳嗽次数明显高于男性[几何均数16.6次/小时(95%CI，13.1-21.0) vs 9.4次/小时(95% CI，6.4-13.9), p=0.01]。女性的咳嗽反射也比男性更敏感（中位数logC5 -0.9M vs -0.6M, p=0.002），但是与咳嗽有关的生活质量女性和男性相似[女性12.0 (±3.6) vs 男性12.2 (±3.2), p=0.76]。线性回归分析表明性别（p=0.01）、logC5（p= <0.001）和年龄（p=0.003）预计了41%的咳嗽率的变异，但是肺功能或支气管高反应性不能预计咳嗽率的变异。
结论：动态的客观咳嗽监测为我们研究调节慢性咳嗽的因素提供了新视点。这些结果提示在研究咳嗽及设计检测新型止咳药的临床试验时必须考虑性别和年龄的影响。
（张永明 审校）
Kelsall A, et al. Thorax. 2009 Jan 8.
Kelsall A, et al. Thorax. 2009 Jan 8. [Epub ahead of print] Links
Sex differences and predictors of objective cough frequency in chronic cough.
BACKGROUND: Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. We aimed to determine the predictors of objective cough frequency in chronic cough patients presenting to a tertiary referral clinic.
METHODS: 100 subjects [mean age 55.8yrs (SD+/-11.0), 65 female, median cough duration 4yrs (IQR 2.0-10.0yrs)] with unexplained chronic cough, completed flow-volume loops (FEV1 103% predicted (SD+/-15.2), FEF50; 68.8% predicted, SD+/-24.1), methacholine challenge (42 % positive), citric acid cough reflex sensitivity [C5; 0.12M (IQR 0.06-0.50M)] and the Leicester Cough Questionnaire. 24-hour ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour.
RESULTS: Females coughed significantly more than males [geometric mean 16.6 coughs/hr (95%CI 13.1-21.0) versus 9.4coughs/hr (95% CI 6.4-13.9), p=0.01)]. The cough reflex was also more sensitive in females than males (median logC5 -0.9M versus -0.6M, p=0.002) but cough related quality of life was similar (females 12.0 (+/-3.6) versus males 12.2 (+/-3.2), p=0.76). Linear regression analysis showed 41% of the variation in cough rate was predicted by sex (p=0.01), logC5 (p= <0.001) and age (p=0.003) but not lung function or bronchial hyper-reactivity.
CONCLUSIONS: Ambulatory objective cough monitoring provides novel insights into factors modulating chronic cough. These findings suggest that effects of sex and age must be taken into account in the study of cough and when designing clinical trials testing novel anti-tussive agents.
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伴有和不伴有呼吸道阻塞的吸烟者中辣椒素咳嗽敏感性试验
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缺血性中风患者误吸的预测：临床表现和自主咳嗽空气动力学检测的比较
