支气管扩张合并哮喘的临床特点及其治疗的探讨

To Explore the Clinical Characteristics and Treatment Methods of Bronchiectasis Accompany with Bronchial Asthma

目的探讨支气管扩张合并哮喘(支扩合并哮喘)此一特殊类型临床特点和治疗方法。方法①用支气管激发试验和支气管舒张试验对临床诊断为支气管扩张的102例患者进行测试,筛选出支扩合并哮喘的病例。②对单纯性支扩和支扩合并哮喘此两类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对支扩合并哮喘此一类型的病例进行分组试验性治疗。A组按抗支扩加抗哮喘治疗。B组按常规抗支扩治疗,均治疗2个月。结果①102例临床诊断支扩患者,其中98例进行支气管激发试验,其中18例阳性(PD20FEV1<12.8μmol)4例进行支气管舒张试验,其中2例阳性(FEV1增加幅度>15%)。即102例临床诊断支扩患者,发现20例为支扩合并哮喘。另外82例为单纯性支扩。②支扩合并哮喘以往病史的特点是个人过敏病史和家族过敏史的频率很高,分别为120%和110%。而单纯性支扩的发生频率很低,仅为7.3%和3.6%。③支扩合并哮喘的临床特点是发病呈季节性加重(20例);常有上呼吸道过敏症状;痰液多为黏液脓性;除固定部位湿性音外,全部病例有散在性或弥漫性喘鸣音。④支扩合并哮喘类型的分组试验性治疗,用抗支扩+抗哮喘药物治疗的10例,疗效显著,基本属完全治愈,而单独用抗支扩药物的10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支气管舒张试验和以往病史追询、临床特点观察,而与单纯性支扩相鉴别,其治疗方法也和单纯性支扩不同。对支扩合并哮喘应当应用抗支扩+抗哮喘的治疗方案。在抗哮喘方面应用表面糖皮质激素吸入,疗效确实而且安全。

Objective To explore whether the bronchiectasis accompany with bronchial asthma exist and its clinical characteristics and treatment methods. Methods ①For 102 cases of bronchietasis of patients which confi rmed by clinical diagnosis applied bronchial provocation test and bronchial dilatation test,Selected the cases of bronchiectasis accompany asthma and pure bronchiectasis.②For this tow types performed detailed guestionnaire of former disease history.③For this tow types performed clinical observation. ④The type of bronchiectasis accompany with athma was divided into tow groups. Group A and Group B,performed experiment treatment according different project. Results ①98 cases of patients with bronchiectsis performed bronchial provocation test among 18 cases were positive（PD20FEV112.8mol） .4 cases of patients with bronchiectasis performed bronchial dilatation test among 2 cases were positive（FEV increase range15%） .these 20 cases were confi rmed diagnosis to bronchiectasis accompany with asthma,another 82 cases of patients with bronchiectasis were belong to pure bronchiectasis. ②In bronchiectasis accompany asthma,the frequency of personal allergic disease history and family allergic history was very high,respectively 120% and 111%,but in pure bronchiectasis,the frequency was very low,only 7.3% and 3.6%. ③In 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. ④Bronchiectasis 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.