慢性阻塞性肺疾病合并支气管扩张的临床特点分析

Clinical features analysis on chronic obstructive pulmonary disease combined bronchiectasis

目的探讨慢性阻塞性肺疾病(COPD)合并支气管扩张的临床特点。方法收集2012年1月至2013年12月来我院就诊的COPD和支气管扩张患者,选择同时行胸部多层螺旋CT、痰培养及肺功能检查的212例患者作为研究对象,采用回顾性方法分析其中52例被诊断为COPD合并支气管扩张患者的一般临床资料、临床特点及肺功能特点。结果在本组入选的所有COPD和支气管扩张患者中,COPD合并支气管扩张的患者占24.5%(52/212),多见于60岁以上的老年人,秋冬季节好发。既往多有肺结核、百日咳等呼吸道感染疾病及吸烟史,临床上以咳嗽、咳中等量黄脓痰为主要表现,约三分之一以上的患者伴有咯血,肺功能以中重度阻塞性通气功能障碍为主,多伴有呼吸衰竭。结论 COPD和支气管扩张在临床表现上容易混淆,根据既往病史、家族史、肺功能检查可进一步区分。早期、足量、足疗程的使用敏感抗生素,不仅能使临床症状得到迅速缓解,同时也能避免耐药菌株的产生及下呼吸道细菌的定植,延缓肺功能的下降。

Objective To investigate the clinical characteristics of chronic obstructive pulmonary disease（ COPD） combined bronchiectasis（ BE）. Methods To collect all cases of the COPD and BE patients of respiratory department in People’s Hospital of Yuxi from January 2012 to December 2013. Meanwhile,212 cases of them with the integrated clinical data about chest multislice spiral CT,sputum culture and pulmonary function were selected,and according to chest CT and pulmonary function,we have diagnosed 52 cases COPD combined BE,the past history,family history,clinical features and changes in pulmonary function of them were retrospective analyzed. Results These results show the cases of COPD combined bronchiectasis is 24. 5%（ 52 /212） in all patients. The combined group is more common in the aged over 60 years old,especially in autumn and winter. The combined group mostly had the history of respiratory infected disease such as pulmonary tuberculosis,pertussis and smoking history whose clinical features are cough,yellow and viscous sputum.About one-third patients accompany with hemoptysis,moderate to severe obstruction in pulmonary function,and commonly accompany with respiratory failure. Conclusion The differential diagnosis is easily confused between COPD and bronchiectasis. According to past history,family history and pulmonary function of the patient are helpful to discriminate them. In regard to the treatment,we should use susceptible antibiotics in early stage,with sufficient medicine and sufficient course of treatment,which would not only quickly alleviate the clinical symptoms,but also avoid the emerge of resistance bacterial strains and lower airway bacterial colonization,and improve lung function in patients with COPD and bronchiectasis.