The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough.
The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough.
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DOI：
10.5056/jnm16057
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发表时间：
2017-01-30
影响因子：
3.4
通讯作者：
Bor S
中科院分区：
文献类型：
--
作者：
Özdemir P;Erdinç M;Vardar R;Veral A;Akyıldız S;Özdemir Ö;Bor S
胃食管反流病（GERD）是慢性咳嗽的主要病因之一。我们通过测定支气管肺泡灌洗（BAL）标本中载脂巨噬细胞（LLM）的数量来评估微抽吸在反流相关咳嗽发病机制中的作用。共评估了161例慢性咳嗽病例，并招募了36例患者（平均年龄48.2岁）进行这项单中心前瞻性研究。排除有吸烟史、血管紧张素转换酶抑制剂使用史、肺功能检查异常、胸部X线检查异常、职业或环境暴露或上呼吸道咳嗽综合征的患者。通过24小时食管阻抗-pH监测评估GERD。通过柔性支气管镜检查从34例患者中获得用于LLM测定的BAL标本。根据多通道腔内阻抗和pH监测，病理性食管内反流患者的BAL标本中LLM阳性率高于无病理性反流患者（反流阳性组8/14 vs反流阴性组1/22; P = 0.004）。两组之间的BAL细胞分布无差异（巨噬细胞P = 0.574，淋巴细胞P = 0.348，中性粒细胞P = 0.873，嗜酸性粒细胞P = 0.450）。我们的结果证实了反流液的微量吸入在慢性咳嗽的发病机制中的作用。虽然支气管镜检查适用于慢性咳嗽患者，但除了常规气道评估外，还应进行BAL和LLM检测。LLM可用于诊断反流相关慢性咳嗽中的误吸。需要进一步研究来评估LLM阳性患者对抗反流药物或手术的反应。
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 (LLMs) in bronchoalveolar lavage (BAL) specimens. 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-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. Patients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than 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 = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). 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, BAL 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.