支气管扩张症急性加重的危险因素及意义

Risk factors for acute exacerbation in patients with bronchiectasis

目的 探讨支气管扩张症急性加重的危险因素及意义.方法 回顾性分析2008年1月至2012年12月首都医科大学附属北京安贞医院因支气管扩张症急性加重住院且有完整随访资料的228例患者的临床资料.根据出院后1年内是否再次发生支气管扩张症急性加重分成2组,分析患者入院时的一般资料、临床症状及体征、血常规、痰培养、呼吸困难评分（mMRC）、影像学资料等.结果 228例患者中男110例,女118例;年龄24- 93岁,平均（64.5±14.5）岁;出院后1年内发生急性加重者127例（55.7％）.多元Logistic回归分析显示年龄≥60岁（OR=2.583,95％ CI：1.188 -5.613）、体质指数（BMI）＜ 18.5 kg/m2（OR=2.991,95％ CI：1.112-8.042）、呼吸困难评分高（OR=7.905;95％CI：2.288 - 27.309）、痰培养检出铜绿假单胞菌（OR=3.227;95％ CI：1.041- 10.004）、胸部高分辨CT提示支气管扩张累及≥3个肺叶（OR=3.179;95％ CI：1.449-6.976）、入住监护室（OR =2.499;95％ CI：1.301 -4.801）与支气管扩张症急性加重相关（均P＜0.05）.结论 支气管扩张症患者急性加重与多种危险因素相关,识别危险因素对优化管理支气管扩张症患者有益.

Objective To evaluate the risk factors for patients with an acute exacerbation of bronchiectasis.Methods Retrospective analyses were conducted for 228 patients diagnosed with acute exacerbation of bronchiectasis at Affiliated Beijing Anzhen Hospital,Capital Medical University from January 2008 to December 2012.Depending on whether there were recurrences with exacerbation within one year after discharge,they were divided into two groups.Their basic profiles,clinical symptoms and signs,blood tests,sputum culture,dyspnea score （mMRC） and imaging data were analyzed.Results There were 110 males and 118 females with an average age of （64.5 ＋ 14.5） years.The incidence of the recurrence of acute exacerbation was 55.7% （127/228） within one year after discharge.Multivariate Logistic regression analysis showed that age ≥60 years （OR =2.583,95% CI：1.188-5.613）,body mass index （BMI） 〈 18.5 kg/m2 （OR =2.991,95% CI：1.112-8.042）,high dyspnea score （OR =7.905,95% CI：2.288-27.309）,Pseudomonas aeruginosa in sputum culture （OR =3.227,95% CI：1.041-10.004）,chest high-resolution computed tomography （CT） displayed bronchiectasis involving ≥3 lobes （OR =3.179,95% CI：1.449-6.976） and staying in intensive care unit （ICU） （OR =2.499,95% CI：1.301-4.801） were associated with the acute exacerbation of bronchiectasis （all P 〈 0.05）.Conclusions There are multiple risk factors of acute exacerbation in patients with bronchiectasis.And their proper identification and management shall improve the prognosis of bronchiectasis patients.