胃食管反流(GER)是指胃酸和其他胃内容物反流进入食管，正常人存在一定程度的反流，称为生理性反流。GER 可以引起临床症状，甚至组织病理学的改变。当出现胃烧灼、反酸、胸骨后疼痛等临床症状和(或)组织病理学的改变时，也被称为胃食管反流病(GERD)。以慢性咳嗽为主要临床表现的GERD称为胃食管反流性咳嗽(GERC)。2006年蒙特利尔会议提出了反流性咳嗽综合征的定义 。GERC 是慢性咳嗽的常见原因，发生率为5％~41％ ，存在一定的地区差异。欧美报道极为常见，而日本极为少见，国内 GERC占慢性咳嗽病因的12％。
临床上通常将以咳嗽为唯一症状或主要症状、时间超过 8周、胸部x检查无明显异常者称为不明原因慢性咳嗽，简称慢性咳嗽 。慢性咳嗽是内科门诊患者最常见的病症，与典型支气管哮喘、肺部感染、肺纤维化和支气管肺癌等疾病不同，由于缺乏典型的相关症状，胸片检查无异常，一些临床医生习惯性地给病人戴上“支气管炎或慢性支气管炎”(简称“慢支”)的帽子，给予止咳祛痰或反复使用多种抗生素治疗，当然临床疗效并不理想。我们进行的流行病学调查结果显示，72％的慢性咳嗽患者被诊断为“支气管炎、慢支或慢性咽喉炎”，而病因诊断显示其中慢性支气管炎仅占4％(该资料尚未发表)。 慢性咳嗽的病因非常复杂，但并非毫无规律可循。只要掌握正确的诊断方法，按照慢性咳嗽病因诊断程序，大部分患者实际上可以获得明确的病因诊断，根据病因进行特异性治疗能够取得良好的治疗效果。在诊断慢性咳嗽时主要应注意以下几个问题。
Objective To explore the association between cough patterns and cerebrovascular disease risk, and to provide epidemiological evidence for the early diagnosis and prevention of cerebrovascular disease. Methods During the period from 2010 to 2012 in Guizhou Province, a multi-stage proportional stratified cluster sampling method was used to recruit people with the inclusion criteria of the study into a cohort and a baseline questionnaire for demographic information, lifestyle, and disease history was administered. The incidence of cerebrovascular disease was followed up from 2016 to 2020. Results A total of 4804 subjects were followed up, and 4589 (53.5% were female) subjects were enrolled in final investigation. Compared with non-chronic cough group, there was no statistical significance in the risk of cerebrovascular diseases (P>0.05), however, chronic cough (the risk ratio was 2.00 and the 95% confidence interval ranged from 1.08 to 3.69) was twice as likely to develop cerebrovascular disease as non-cough. Conclusions People with chronic cough are more likely to develop cerebrovascular disease than people without cough. More attention to the management and control of cough should be paid to avoid chronic cough, so as to reduce the risk of cerebrovascular diseases.
Objective To reveal the differences in gene expression levels between Th2-driven classical asthma (CA) and Th2-driven cough variant asthma (CVA) in order to investigate the pathogenesis of asthma further. Methods Clinical data were collected from asthmatic patients in the Department of Respiratory and Critical Care of Sichuan Provincial People's Hospital from June 1, 2018, to December 31, 2019. The healthy control (HC) group was healthy adults from the physical examination center. Gene expression of peripheral blood mononuclear cells (PBMCs) in the CA group, CVA group, and HC group was determined by full-length transcriptome sequencing. Differential genes were screened by GO, KEGG analysis, and protein-protein interaction (PPI) network analysis. The results of interaction network analysis were visualized by Cytoscape. Finally, the candidate genes were verified by real-time quantitative polymerase chain reaction (RT-PCR). ResultsA total of 31 patients with asthma were included in the study, including 20 patients in the CA group and 11 patients in the CVA group. According to serum total IgE > 60 IU/mL and fractional exhaled nitric oxide (FeNO) > 40 ppb as the screening condition, 9 cases of Th2-driven CA and 5 cases of Th2-driven CVA were screened for analysis. Gene expression analysis showed 300 differentially expressed genes between the Th2-driven CA group and the Th2-driven CVA group, among which 155 genes were up-regulated, and 145 were down-regulated. GO enrichment analysis showed that differential genes were mainly enriched in drug response, nitrogen compound biosynthesis, cytoplasmic matrix, protein binding, ATP binding, etc. KEGG pathway analysis showed that differential genes were mainly concentrated in 2-oxy-carboxylic acid metabolism and cytotoxic signaling pathways mediated by natural killer cells. PPI analysis revealed extensive protein interactions between different genes. Ten candidate genes were screened for RT-PCR verification and finally found that CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X were significantly differentially expressed between the Th2-driven CA group and the Th2-driven CVA group. Conclusions Asthma's occurrence results from the interaction of many genes and pathways. CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X genes may be essential in developing Th2-driven CVA to Th2-driven CA.
ObjectiveTo explore the predictive factors for extubation in mechanically ventilated patients with moderate to severe traumatic brain injury (TBI). MethodsMechanically ventilated adult patients with moderate to severe brain injuries admitted to the People’s Hospital of Hunan province were selected between April 2020 and March 2022. The general data, neurological function and airway protective ability of the patients were collected. The patients were divided into successful extubation and failed extubation groups based on extubation outcomes. The differences in various indicators between the two groups were compared. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors for tracheal tube extubation in patients with moderate to severe TBI. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of each indicator for extubation in TBI patients. ResultsA total of 263 patients with moderate to severe TBI were included in the analysis, with 183 patients in the successful extubation group and 80 patients in the failed extubation group. The successful extubation group had higher Glasgow coma scale (GCS) and cough peak flow (CPF) compared to the failed extubation group. The incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, length of ICU stay, and length of hospital stay were all lower in the successful extubation group. Univariate and multivariate logistic regression analyses showed that the predictive factors for tracheal tube extubation in patients with moderate to severe TBI were CPF and GCS at the time of extubation. Adjusting for confounding factors, every 1 L/min increase in CPF at the time of extubation reduced the risk of extubation failure by 2% [odds ratio (OR) = 0.98, 95% confidence interval (CI) 0.97 - 0.99], and every 1-point increase in GCS reduced the risk of extubation failure by 12% (OR = 0.88, 95%CI 0.79 - 0.98). ROC curve analysis showed that CPF, GCS, GCS eye, and GCS motor had predictive value for tracheal tube extubation in patients with moderate to severe TBI. When patients simultaneously met the criteria of GCS≥8 (GCS motor≥5, GCS eye≥3) and CPF ≥68.5 L/min, the diagnostic value for predicting successful extubation was highest, with an area under the ROC curve of 0.946 (95%CI 0.917 - 0.975), sensitivity of 0.850, and specificity of 0.907. ConclusionCPF ≥ 68.5 L/min and GCS ≥ 8 have clinical guiding value for successful extubation in mechanically ventilated patients with moderate to severe traumatic brain injury.