Airway Allergic Reaction Test System Significance In Diagnosis Of Chronic Cough

BackgroundWith the increase in air pollution in northern regions of Henan province,outpatients with the complaint of cough have been increased during these years.Cough is a protective reflex,and a common clinical symptom,which can clear the airway secretions,and prevent particles and microbes in the air from breathing into the airway.Cough can increase the pressure in the chest and the posterior cardiac load.Frequent cough can lead to vomit,chest pain,consuming strength,which can significantly influence the quality of sleep and the quality of patients' life.At the same time,with the stimulation of allergen and inflammatory factors,cough becomes one of the most common symptoms of respiratory diseases in clinical practice.When cough as the main or only symptoms last more than 8 weeks,without abnormal chest imaging,it is called chronic cough.Because the patient only has cough symptoms,chest X-ray and chest computerized tomographic scanning examination is normal,most patients are often misdiagnosed as chronic bronchitis,which seriously affect the quality of life of the patients.Because the patients are often treated with antibiotics and a variety of tests with no clear diagnosis need to be done,a large number of medical resources are wasted.Therefore,the early diagnosis is important for the treatment of chronic cough.The chronic cough is usually caused by cough variant asthma,eosinophilic bronchitis and postnasal drip syndrome.Cough variant asthma(CVA)is the most important cause of chronic cough.Cough variant asthma(CVA)is a kind of clinical atypical asthma.The patients have no clinical symptoms,and are not treated with antibiotics,corticosteroids or bronchodilator,which was easy to be misdiagnosed as bronchitis.Airway hyperresponsiveness is the main pathophysiological feature of bronchial asthma.Bronchial provocation test is an important means to diagnose asthma.Recent studies have shown that Th17 cells mainly produce Interleukin 17(IL-17),IL-22 and 23 cytokines,such as IL-prompting neutrophil activation and chemotaxis to increase airway inflammation.Patients with chronic cough can get a high IL-17 expression and neutrophils infiltrating,which was related to the severity of disease.Interferon regulatory factor 4(IRF4),as one of the important regulatory factors of Th17 cell differentiation,involved in many autoimmune diseases.When CD4 + T cells in the transforming growth factor ?(TGF-?)and IL-6,when IRF4 defects,even TGF-?,IL-6 and antigenic stimulation,it differentiates into both Th0 cells andTh17 cells.Mature Th17 cells can secrete with limited IL-17 and IL-21.IRF4 can also control the induce of CD11 b dendritic cells(DC),which can influence the differentiation and development of Th17 cell.In airway allergic reaction,IRF4 can adjust the differentiation of Th17 cells and participate in the pathogenesis of chronic cough.The influence of gene and environmental factors for IRF4 and Th17 play an important role in regulating cell differentiation and function.In order to clear the function of the bronchial provocation test in diagnosis of chronic cough,298 cases of patients took airway allergic reaction with chronic cough were analyzed in Xinxiang First People's Hospital from December 2015 to November 2016.The report is showed as follows.ObjectiveExplore the influence of airway allergy test system in chronic cough diagnosis.Methods1.In total,298 patients with chronic cough were selected from the Department of respiratory medicine of Xinxiang First People's Hospital from December 2015 to November 2016.Among them,there were 162 cases of male patients,and 136 female patients.2.Bronchial provocation test was performed using a fully automated J-21(ASTOGRAPH).3.To analyze the relationship between age and gender in the diagnosis of cough variant asthma in patients with chronic cough.4.Real-time PCR Monitoring the expression of inflammatory biomarkers:ICAM-1,TNF-?,TGF-??IL-17;5.SPSS 17.0 software was used to analyze.According to the material type,chi-square and spearman's correlation analysis were used in statistical processing.The significant difference was considered when the P value was less than 0.05.Results1.In 298 patients with chronic cough,there are significant differences in the detection of airway allergic reaction and inflammatory markers in the diagnosis of cough variant asthma in all age groups(P<0.05).2.There is no significant difference in the detection of airway allergic reaction and inflammatory marks between male and female in the diagnosis of cough variant asthma(P>0.05).3.Airway allergic reaction is positive in 157 cases(52.68%),negative in 141 cases(47.32%),there are significant statistical significance of FEV1,FEV1/FVC,PEF and MMEF between airway allergic reaction patients and negative patients(P<0.05),there is no significant statistical significance of FVC between airway allergic reaction patients and negative patients(P>0.05).4.Inflammation markers test was positive for 157 cases,negative for 141 cases,a difference was detected between the positive and negative patients(P < 0.05).Conclusions1.In 298 cases of chronic cough,the rate of bronchial provocation test positive in different age groups were significantly different,while the male and female positive rate was no significant difference.The final diagnosis of CVA patients with bronchial provocation test positive rate was 47.31%.There were significant correlations between the rate of bronchial positive and allergic factors,age,sex,total cough symptom,sputum eosinophils,serum ICAM-1,TNF-?,TGF-?,IL-17 and FeNO.2.Airway allergic reaction system in the diagnosis of chronic cough has a significant meaning.The application of airway allergic reaction test system in patients with chronic cough screening CVA patients can make early diagnosis,get correct treatment,help to prevent the development of a typical asthma.