從風(fēng)痰瘀論治咳嗽變異性哮喘

　　摘要：咳嗽變異性哮喘又稱(chēng)咳嗽型哮喘、過(guò)敏性咳嗽，是一種特殊類(lèi)型的哮喘，其臨床表現(xiàn)缺乏特異性，無(wú)明顯的喘息、氣促和呼吸困難等癥狀，故臨床上容易漏診、誤診，且近年來(lái)發(fā)病呈上升的趨勢(shì)。由于其癥狀不典型，不少患者經(jīng)過(guò)很長(zhǎng)時(shí)間或反復(fù)發(fā)作后才被確診，有些患者最終演變成典型哮喘，嚴(yán)重影響著患者身體健康和生活質(zhì)量。因此，加強(qiáng)對(duì)本病的認(rèn)識(shí)及早期治療極為重要。西醫(yī)對(duì)本病的認(rèn)識(shí)有較完整的理論體系，治療亦有一定療效但易反復(fù)，中醫(yī)通過(guò)辨證論治對(duì)本病的治療具有獨(dú)特優(yōu)勢(shì)。中醫(yī)認(rèn)為風(fēng)、痰、瘀是其基本病理特點(diǎn)，根據(jù)其病理特點(diǎn)分為風(fēng)邪侵襲期、痰瘀互結(jié)期、正氣虧損期。通過(guò)從風(fēng)痰瘀三期變化簡(jiǎn)單探討咳嗽變異性哮喘，以期為臨床診治提供更好思路。
　　關(guān)鍵詞：咳嗽變異性哮喘；中醫(yī)病機(jī)；風(fēng)咳
　　中圖分類(lèi)號(hào)：R256.12 文獻(xiàn)標(biāo)志碼：A 文章編號(hào)：1007-2349（2018）02-0005-04
　　On Cough Variant Asthma from Wind Phlegm Stasis
　　LAN Dan-dan1， JIA Xin-hua2△
　　（1. Shandong University of Traditional Chinese Medicine， Jinan 250014， China；
　　2. The Affiliated Hospital of Shandong University of Traditional Chinese Medicine， Jinan 250011， China）
　　【Abstract】Cough variant asthma， also known as cough type asthma or allergic cough， is a special type of asthma. Its clinical manifestations are lack of specificity and have no symptoms of wheezing， shortness of breath and difficult breathing. Therefore， clinically miss diagnosis and misdiagnosis have showed an upward trend in recent years. Because of its atypical symptoms， many patients have been diagnosed definitely after a long period of time or recurrent episodes. Some patients eventually developed into typical asthma and seriously affected their health and quality of life. Therefore， to enhance awareness of this disease and make early treatment are extremely important. Western medicine has a more complete theoretical system and a certain curative effect on the treatment of the disease， but easy to repeat. Traditional Chinese medicine has unique advantages over the disease by treatment based on syndrome differentiation. Chinese medicine believes that the wind， phlegm and stasis are its basic pathological features. According to its pathological features the disease are divided into the epidemic of wind-evil invasion， phlegm and blood stasis and positive qi loss period. Through the three phases of wind phlegm and blood stasis， cough variant asthma is explored in order to provide a better idea for clinical diagnosis and treatment.
　　【Key words】cough variant asthma， TCM pathogenesis， wind cough
　　咳嗽變異性哮喘是以咳嗽為主要或唯一癥狀，無(wú)喘息氣促等癥狀，常在運(yùn)動(dòng)、吸入冷空氣、油煙刺激性氣味、上呼吸道感染后誘發(fā)，在夜間或凌晨加劇，患者多有過(guò)敏性鼻炎或皮膚病病史，發(fā)作大多有一定的季節(jié)性，以春秋為多。GINA（全球哮喘防治倡議）中明確認(rèn)為咳嗽變異性哮喘是哮喘的一種形式，它的病理生理改變與哮喘病一樣，也是持續(xù)氣道炎癥反應(yīng)與氣道高反應(yīng)性。雖然其也有支氣管痙攣，但多發(fā)生在末梢的細(xì)小支氣管或短暫性痙攣，因此體檢時(shí)很少聽(tīng)到哮鳴音。肺功能損害程度亦不如典型哮喘明顯，大部分患者肺通氣功能完全正常，因此對(duì)疑診咳嗽變異性哮喘（CVA）的患者可以行支氣管激發(fā)試驗(yàn)或支氣管舒張?jiān)囼?yàn)進(jìn)一步確診。
　　現(xiàn)代醫(yī)學(xué)認(rèn)為咳嗽變異性哮喘的發(fā)生是自身體質(zhì)與誘因相互作用的結(jié)果，多與遺傳、環(huán)境變換、感染、免疫功能低下等方面有關(guān)，其主要病理變化為：氣道慢性非特異性炎癥引起支氣管平滑肌痙攣，氣道黏膜水腫、肥厚，黏液分泌增多，黏膜纖毛清掃功能障礙和支氣管黏液栓塞等。其發(fā)病機(jī)制多為炎癥細(xì)胞、炎癥介質(zhì)、細(xì)胞因子共同參與相互作用所致的慢性非特異性炎癥，氣道的慢性炎癥加劇了氣道高反應(yīng)和咳嗽的高敏感性。西醫(yī)對(duì)于本病的治療，與治療典型哮喘相似，主要采用糖皮質(zhì)激素、茶堿類(lèi)、抗膽堿藥、β受體激動(dòng)劑緩解病情，短期療效好，但復(fù)發(fā)率高，且易產(chǎn)生副作用。近幾來(lái)年中醫(yī)對(duì)咳嗽變異性哮喘的治療發(fā)展較快，治療時(shí)遵循急則治標(biāo)，緩則治本或標(biāo)本兼治的原則，辨病與辨證相結(jié)合，同時(shí)注重特色藥物的應(yīng)用，取得較好的臨床療效。

相關(guān)熱詞搜索：變異性 哮喘 治咳嗽 風(fēng)痰瘀論