北京协和医院136例支气管扩张症住院患者临床特征分析

Clinical Evaluation of 136 Inpatients with Bronchiectasis in Peking Union Medical College Hospital

目的总结住院支气管扩张症患者的临床特征,增进对支气管扩张症的认识。方法回顾性分析了2010年1月至2012年12月在北京协和医院住院经高分辨CT确诊的136例支气管扩张症患者的临床资料。结果 136例患者中,男61例(44.9%),女75例(55.1%),平均年龄(57.7±16.3)岁,平均病程(17.2±15.8)年。77.2%(105/136)的患者未能明确病因;既往感染为最主要病因,占14.7%(20/136),其中多为结核感染。主要症状为咳嗽、咳痰。支气管扩张类型为柱状37.8%(37/98)、囊柱状40.8%(40/98)、囊状21.4%(21/98)。多为多肺叶受累,占77.2%(105/136);以左肺下叶受累最多,为76.5%(104/136)。77例住院期间行肺功能检查,其中61.0%(47/77)有阻塞性通气功能障碍。各类型支气管扩张症间1秒用力呼气容积(FEV1)(P=0.918)、用力肺活量(FVC)(P=0.982)及FEV1/FVC(P=0.211)占预计值百分比的差异均无统计学意义。痰培养中以铜绿假单胞菌阳性最多,药敏提示对多数广谱抗生素均敏感。囊状支气管扩张症患者现症感染比例高,易闻及湿罗音。结论本组支气管扩张症患者以中老年女性为多。既往感染,特别是结核感染可能是主要病因。临床症状主要表现为咳嗽、咳痰,肺功能常示阻塞性通气功能障碍,支气管扩张分布多为双肺弥漫性,双下肺为著,特别是左下肺受累最多。囊状支气管扩张可能为病情较重类型,影像学发现此类支气管扩张需引起重视。

Objective To summarize the clinical features of bronchiectasis. Methods We retrospec- tively analyzed the clinical data of 136 patients who had been admitted to Peking Union Medical College Hospital from January 2010 to December 2012 due to bronchiectasis, which was confirmed by high-resolution computed tomography. Results The average age of these 136 patients （61 men and 75 women） was （ 57.7 ±16. 3 ） years. The average clinical history was （ 17.2 ±15.8 ） years. The exact etiology was unidentified in 77.2% （105/136） of the patients. The most commonly identified cause was previous infections （14. 7%, 20/136）, particularly tuberculosis. The main symptoms of bronchiectasis were cough and sputum production. The types of bronchiectasis were cylindrical in 37.7% （37/98）, varicose in 40. 8% （40/98）, cystic in 21.4% （21/98） of these patients. Multilober involvement was most common （77.2%, 105/136）, The most commonly involved lobes were left lower lobe （76. 5%, 104/136）. Of 77 patients who had undergone pulmonary fuction test,47 （61.0%） showed obstructive. For each bronchiectasis type, the values （percentages of predicted） of forced expiratory volume in one second （ FEVI ） （ P = 0. 918 ）, forced vital capacity （ FVC ） （ P = 0. 982 ）, and FEV1/FVC（P = 0. 211 ） showed no statistical significance. The most commonly identified pathogen in sputum culture was Pseudomonas aeruginosa, which was sensitive to most broad-spectrum antibiotics. Current infections were most common in patients with cystic bronchiectasis, among whom tales were frequently heard. Conclusions Most bronchiectasis patients are old women. The main etiology is previous infection, especially tuberculo- sis. The main symptom of bronchiectasis is productive cough. Many patients can have obstructive pulmonary func- tion. The distribution of lesions is diffuse, and the lesions are often seen in both lungs, particularly in the left lower lobe. Cystic bronchiectasis may be a more severe type, and should be carefully managed once identified by radiology.