支气管扩张合并支气管哮喘临床研究

A Clinical Study of Bronchiectasis Accompany Bronchial Asthma

目的探讨支气管扩张合并支气管哮喘(支扩合并哮喘)此一特殊类型的存在以及该型的临床特点。方法(1)用支气管激发试验和支气管舒张试验对临床确诊的84例支扩患者进行测试,筛选出支扩合并哮喘病例和单纯性支扩病例。(2)对此两类型患者的以往病史详细问卷。(3)对此两类型患者的临床表现进行观察。(4)对支扩合并哮喘类型进行分组用不同方案进行试验性治疗。结果(1)81例支扩患者行支气管激发试验,其16例阳性,(PDFEV1<12.8μmoL)。3例支扩患者行支气管舒张试验,其中2例阳性(FEV1增加幅度>15%)。此18例确诊为支扩合并哮喘。另外66例阴性反应者属单纯性支扩。(2)支扩合并哮喘以往病史的特点是个人过敏病史及家族过敏病史的频率很高,分别为106%和111%。而单纯性支扩的频率很低,仅为9%和6%。(3)支扩合并哮喘的临床表现为发病呈季节性加重;常有上呼吸道过敏症状;痰液多为粘液脓性;除固定部位湿性音外,全部病例有散在性或弥漫性的喘鸣音。(4)支扩合并哮喘类型的分组试验性治疗,用抗支扩+抗哮喘药物的9例,疗效显著,基本完全治愈;而仅单独用抗支扩药物的9例,大部分遗留下症状和体征。结论支扩合并哮喘是一个特殊类型,可通过支气管激发试验和舒张试验测试、以往病史追询、临床特点观察等和单纯性支扩相鉴别。

Objective To explore whether the bronchiectasis accompany bronchial asthma exist and its clinical characteristics. Methods (1) For 84 cases of bronchiectasis of patients which confirmed by clinical diagnosis applied bronchial provocation test and clinical dilatation test. Selected the cases of bronchiectasis accompany asthma and pure bronchiectasis. (2) For this two types performed detailed guestionnaire of former disease history. (3) For this two types performed clinical observation. (4) The type of bronchiectasis accompany asthma was divided into two groups. Group A and group B, performed experiment treatment according different projects. Results (1) 81 cases of patients with bronchiectasis performed bronchial provocation test among 16 cases were positive (PD20 FEV1<12.8u mol), 3 cases of patients with bronchiectasis performed bronchial dilatation test among 2 cases where positive (FEV increase range>15%). These 18 cases were confirmed diagnosis to bronchiectasis accompany asthma, another 66 cases of patients with bronchiectasis were belong to pure bronchiectasis. (2) In bronchiectasis accompany asthma, the frequency of personal allergic disease history and family allergic history was very high, respectively 106% and 111%, but in pure bronchiectasis, the frequency was very low, only 9% and 6%. (3) In bronchiectasis accompany asthma, attack symptoms often were increase heavy seasonly, and frequently there were allergic symptoms in the upper respiratory tract, all of cases of patients contained diffuse wheezing or focal wheezing in the lung. (4) Bronchiectasis accompany asthma divided group experiment treatment. Group A used anti bronchiectasis and anti asthma medicine. The treatment effect showed marked, fundamental completely cure. But group B only used anti bronchiectasis medicine, a large cases leaved symptom and sign. Conclusions Bronchiectasis accompany asthma is a special type, which may be difference from the pure bronchiectasis through the examination of bronchial provocation test and bronchial dilatation test, asking the former disease history and experiment treatment. Project of its treatment different from pure bronchiectasis.