哮喘联盟

    背景：胃食管反流是普通人群中慢性咳嗽最常见的原因之一。囊性纤维化（CF）的患者也往往有反流症状。我们对伴有临床诊断为反流性咳嗽，且对慢性咳嗽常规治疗无效的肺囊性纤维化成人患者进行了腔镜下Nissen胃底折叠术。
    目的：研究伴有难治性反流性咳嗽的CF患者对外科常规手术治疗的反应。
    方法：通过监测24小时 pH和食道测压对难治性咳嗽患者进行评价。比较患者手术前后咳嗽、肺功能和恶化频率。咳嗽采用莱斯特咳嗽问卷（LCQ）评价，肺功能采用肺量测定法进行评价，恶化频率通过比较手术前后相同时间内恶化次数确定。
    结果：所有患者食管功能明显异常。6名患者（平均年龄34.5岁，2名女性）同意手术。他们的平均反流次数为144.4，平均DeMeester 评分为39.2，平均下食管括约肌压力为12.4 mmHg. FEV1有小幅变化，从1.03 L到1.17 (P = 0.04)，FVC得到改善，从11.9到18.3 (P = 0.01)。术后恶化次数减少50％。
    结论：虽然导致CF患者咳嗽的呼吸系统疾病受到关注，但胃食管反流也是一个常见的病因。胃底折叠术能有效的控制CF患者反流性咳嗽。恶化频率的下降，显示反流可能导致的误吸可能是呼吸道疾病一个尚未意识到的原因。

（林江涛 审校）
Fathi H, et al. Cough. 2009 Jan 18;5:1.

Cough in adult cystic fibrosis: diagnosis and response to fundoplication.

ABSTRACT: BACKGROUND: Gastroesophageal reflux is one of the most common causes of chronic cough in the general population. Reflux occurs frequently in patients with cystic fibrosis (CF). We undertook laparoscopic Nissen fundoplication in adult CF patients with a clinical diagnosis of reflux cough who had failed conventional medical therapies.
OBJECTIVE: We determined the response to the surgical route in the treatment of intractable reflux cough in CF.
METHOD: Patients with refractory cough were assessed by 24 h pH monitoring and oesophageal manometry. Pre-and post-operation cough, lung function and exacerbation frequency were compared. Cough was assessed by the Leicester Cough Questionnaire (LCQ), lung function by spirometry and exacerbation frequency was defined by comparing the postoperative epoch with a similar preoperatively.
RESULTS: Significant abnormalities of oesophageal function were seen in all patients studied. 6 patients (2 females), with the mean age of 34.5 years consented to surgery. Their mean number of reflux episodes was 144.4, mean DeMeester score was 39.2, and mean lower oesophageal sphincter pressure 12.4 mmHg. There was a small change in the FEV1 from 1.03 L to 1.17 (P = 0.04), and FVC improved from 2.62 to 2.87 (P = 0.05). Fundoplication lead to a marked fall in cough with the total LCQ score increasing from 11.9 to 18.3 (P = 0.01). Exacerbation events were reduced by 50% post operatively.
CONCLUSION: Whilst there is an obvious attention to respiratory causes of cough in CF, reflux is also a common cause. Fundoplication is highly effective in the control of reflux cough in CF. Significant reduction in exacerbation frequency may indicate that reflux with possible aspiration is a major unrecognised contributor to airway disease.