慢性阻塞性肺病合并支气管扩张的临床研究

Clinical study of chronic obstructive pulmonary disease combine with bronchiectasis

目的探讨慢性阻塞性肺病合并支气管扩张的临床特点及诊断。方法回顾性分析本院5年来诊断的61例慢性阻塞性肺病合并支气管扩张的患者的临床表现、影像学特点、肺功能特点。结果以慢性阻塞性肺病首先表现者(A组)多为高龄患者,吸烟者多、吸烟量大、时间长,高分辨率CT示支气管扩张部位多在肺气肿及肺大泡周围、双上肺多见,肺功能以中重度阻塞性通气障碍多见,弥散功能明显下降;以支气管扩张首先表现者(B组)发病年龄稍小,吸烟者少,咳大量黄脓痰、咯血者多,胸部CT示支气管扩张影像学表现典型,以下肺居多,可见肺气肿和肺大泡,肺功能呈轻中度阻塞性或混合性通气功能障碍。结论慢性阻塞性肺病和支气管扩张在临床上不易鉴别,但确可同时存在,肺功能检查和高分辨率CT检查可协助临床诊断。

Objective To investigate the clinical characteristics and diagnosis of chronic obstructive pulmonary disease（COPD） and bronchiectasis. Methods in the past 5 years, we have diagnosed 61 cases COPD and bronchiectasis, these patients＇clinical manifestations, X -ray and computed tomography of chest, pulmonary spirometry were analysed. Results the patients presenting as COPD first were older,they had higher rate and longer history of smoking. Chest HRCT show that bronchiectasis was around emphysema and pulmonary bulla ,occurred more often in the upper lung, they also had moderate to severe obstructive ventilation impairment in lung function test（ LFF）, diffusing capacity impaired seriously ; in contrast, the patients with bronchiectasis as the first manifestation were younger, smoked less, expectorated more pus sputums, had more hemoptysis, chest X ray and CT showed typical bronchiecta- sis images which was majorly located in lower lung area, HRCT showed emphysema in some lung area. lung function test showed mild to moderate obstructive or mixed ventilation impairment. Conclusion the differential diagnosis is difficult between COPD and bronchiectasis, but both of them exist in same patients surely, pulmonary spirometry and high resolution computed tomography examination are more helpful for the diagnosis.