咽喉反流诱导慢性咳嗽发病机制的研究进展

Research Progress on the Pathogenesis of Chronic Cough Induced by Laryngeal Reflux

摘要: 咳嗽是呼吸道反射性防御反应，通过迷走神经的感觉传入纤维介导，旨在清除气道分泌物与刺激物，其发生与气道炎症、外界刺激密切相关。慢性咳嗽受多种因素的影响，涉及呼吸系统、消化系统等。目前认为胃食管反流性咳嗽是慢性咳嗽中常见病因之一，但近期多项研究表明部分有反酸症状的患者无咳嗽症状，反流诱发咳嗽患者无典型反酸症状；且食管下段性反流的病人咳嗽并不多见；非酸性的反流也能引起慢性咳嗽，与胃食管反流性咳嗽相比，咽喉反流诱导慢性咳嗽的几率更大。目前咽喉反流在慢性咳嗽疾病中的发病机制尚未明确，文章梳理归纳了近年来咽喉反流在慢性咳嗽中的作用机制，为治疗难治性咳嗽提供临床思路及治疗方案。

Abstract: Coughing is a reflexive defensive response of the respiratory tract, mediated by sensory afferent fibers of the vagus nerve, aimed at clearing airway secretions and irritants. Its occurrence is closely related to airway inflammation and external stimuli. Chronic cough is influenced by multiple factors, including those affecting the respiratory and digestive systems, among others. Gastroesophageal reflux cough is currently recognized as a common cause of chronic cough. However, recent studies indicate that some patients with acid reflux symptoms do not experience coughing, while those with reflux-induced cough often lack typical acid reflux symptoms. Furthermore, coughing is not commonly observed in patients with lower esophageal reflux. Non-acidic reflux can also induce chronic cough, and compared to gastroesophageal reflux cough, laryngopharyngeal reflux is more likely to trigger chronic cough. The exact mechanism of laryngopharyngeal reflux in chronic cough remains unclear. This paper reviews and summarizes the current understanding of the role of laryngopharyngeal reflux in chronic cough, providing clinical insights and treatment strategies for refractory cough.