成人支气管扩张症的临床特点

Clinical evaluation of adult patients with bronchiectasis

目的分析成人支气管扩张症的临床特点,并探索不同影像学类型的差异。方法选取从2011年9月至2014年8月,于山东省2家三甲综合性医院收治、经高分辨率CT确诊为支气管扩张症的成人患者313例。分析其病因、临床表现、影像学、肺功能及痰培养等,并比较不同影像学类型的临床表现的差异。结果特发性(217例,69.3%)是支气管扩张症最常见的病因,其次为结核后(57例,18.2%)。最常见的病变部位为左肺下叶(219例,70.0%)。咳嗽(296例,94.6%)、咯痰(285例,91.1%)、咯血(127例,40.6%)及湿罗音(195例,62.3%)是支气管扩张症的特征表现。218例(69.6%)患者的肺功能异常,最常见的是阻塞性通气功能障碍(136例,62.4%)。144例(46.0%)患者的痰培养阳性,最常见的病原菌为铜绿假单胞菌(106例,73.6%)。囊状支气管扩张症患者更易出现咯痰、呼吸困难、发热及乏力症状(P均<0.001)。结论特发性支气管扩张症最常见,咳嗽、咯痰、咯血及固定湿罗音是支气管扩张症的特征表现,囊状支气管扩张症的临床表现较严重。

Objective To evaluate the clinical manifestations of adult patients with bronchiectasis,and to explore the difference among diverse imaging types on high-resolution chest CT scan. Methods Adult patients diagnosed with bronchiectasis by high-resolution chest CT scan were consecutively recruited from 2 general hospitals in Shandong Province from September 2011 to August 2014. Etiology,clinical presentations,radiographic features,pulmonary function and sputum microbiology were analyzed. The difference among diverse imaging types on high-resolution chest CT scan was determined. Results A total of 313 adult patients with bronchiectasis were included. Idiopathic bronchiectasis（ 217 cases,69. 3%） was the most common reason,followed by post-tuberculosis bronchiectasis（ 57 cases,18. 2%）.The most vulnerable lobe was lower lobe of left lung（ 219 cases,70. 0%）. The characteristic presentations were cough（ 296 cases,94. 6%）,expectoration（ 285 cases,91. 1%）,hemoptysis（ 127 cases,40. 6%）,and moist rales on chest examination（ 195 cases,62. 3%）. Pulmonary function abnormalities were identified in 218 patients（ 69. 6%）,in whom obstructive ventilatory dysfunction was the most common type（ 136 cases,62. 4%）. One hundred and forty-four patients sputum specimens were tested positive（ 144 cases,46. 0%）. The most commonly isolated pathogen was Pseudomonas aeruginosa（ 106 cases,73. 6%）. Patients with cystic bronchiectasis had a higher frequency of expectoration,dyspnea,fever and fatigue（ all P〈0. 001）. Conclusion A large proportion of bronchiectasis patients are idiopathic. The predominant clinical features are cough,expectoration,hemoptysis and fixed moist rales. Patients with cystic bronchiectasis are prone to suffer from more severe clinical manifestations.