不同类型支气管扩张症之间的差异性

Heterogeneous profile of different types of bronchiectasis

目的探讨不同类型的支气管扩张症(简称支扩)在痰细菌学、动脉血气、肺功能、CT评分方面的差异。方法纳入经胸部高分辨率CT(HRCT)诊断的支扩稳定期患者50例,根据HRCT表现将患者分为4组:柱状组、囊状组、曲张型组、混合型组,行痰培养、动脉血气分析及肺通气功能检查,根据CT评分系统进行支扩分布范围、扩张程度及管壁厚度评分。比较4种类型支扩在上述指标的差异。结果HRCT检查显示,支扩患者中36%(18/50)表现为柱状扩张,32%(16/50)为囊状,10%(5/50)为曲张型,22%(11/50)为混合型。铜绿假单胞菌感染率:囊状支气管扩张为68·75%(11/16),柱状为27·78%(5/18),曲张型为20%(1/5),混合型为27·27%(3/11),组间比较差异有统计学意义(P<0·05)。4种类型支扩之间动脉血气指标组间比较差异无统计学意义(P>0·05);囊状支扩FEV1%pred为(47·23±21·55)%、FEV1/FVC为(58·58±14·04)%,FVC%pred为(61·75±16·36)%,与其他组比较差异有统计学意义(P<0·05)。囊状组扩张程度CT评分与其他组比较差异有统计学意义(P<0·05)。结论支扩HRCT表现以柱状型多见;囊状支扩比其他类型支扩更易合并细菌感染,肺通气功能受损更明显,CT评分更高,可能是支扩中较为严重的类型。

Objective To investigate the heterogenous clinical features of four different types of bronchiectasis. Methods Clinical assessment, sputum culture, arterial blood gas analysis, spirometry were underwent and CT score including the numbers of bronchiectatic segments, bronchial dilatation and bronchial wall thickening was collected in fifty patients with bronchiectasis diagnosed by high-resolution computed tomography （ HRCT）. The patients were divided into four groups according to four types of HRCT： cylindric, varicose, cystic and mixed type. Results HRCT revealed that cylindric bronchiectasis accounted for 36% （ 18 cases）, cystic bronchiectasis for 32% （16 cases）, mixed for 22% （11 cases）and varicose for 10% （5 cases）. The positive rates of Pseudomonas aeruginosa from sputum in patients with cystic, cylindric, varicose and mixed bronchiectasis were 68.75% （11/16） ,27.78% （5/18） ,20 % （1/5） and 27.27% （ 3/11 ）, respectively. No siganificant difference in PO2 and PCO2 was found among these patients of four types of bronchiectasis（ P 〉 0.05）. The FEV1% pred, FEV1/FVC and FVC%pred of patients with cystic bronchiectasis were （47.23 ± 21.55）%, （58.58 ± 14.04）% and （61.75 ± 16.36）%, respectively, which were significantly lower than those in other types of bronchiectasis （ P 〈 0.05）. Meanwhile, cystic bronchiectasis had highest CT score in four types of bronchiectasis. Conclusions Cylindric bronchiectasis is the most common type in HRCT. Compared to other types of bronchiectasis, cystic bronchiectasis are likely to present with more bacterial clonization and infection, lower ventilation function and higher CT score. So cystic bronchiectasis seems to be the most severe form of bronchiectasis.