支气管扩张症患者死亡相关危险因素分析

Risk Factors for Death in Patients with Bronchiectasis

目的探讨支气管扩张症患者死亡相关危险因素。方法收集2011年1月至2013年12月因支气管扩张症住院且有完整资料的283例患者,随访至2015年10月,分析患者年龄、性别、体重指数(body mass index,BMI)、吸烟史、呼吸困难评分、影像学资料,痰培养,血气分析、肺功能等指标,对影响患者预后的危险因素进行COX回归分析。结果 283例患者中好转231例,死亡52例,患者1、2、3、4年累积生存率分别为97%、86%、71%、45%;COX回归分析显示年龄≥70岁(RR=2.222,95%CI 1.145~4.314)、BMI<18.5 kg/m^2(RR=2.328,95%CI 1.205~4.497)、肺HRCT累及肺叶数≥3个(RR=0.382,95%CI 0.188~0.774)、FEV1%pred<70%(RR=1.032,95%CI 0.923~1.180)是影响支气管扩张症患者死亡的独立危险因素(均P<0.05)。结论支气管扩张症患者死亡与多种因素相关,早期识别危险因素有利于支气管扩张症管理。

Objective To explore the risk factors for death in patients with bronchiectasis.Methods Two hundred and eighty-three patients diagnosed with bronchiectasis at Daxing Hospital of Capital Medical University from January 2011 to December 2013 were collected and followed up to October2015 after discharge. Patients＇ age,gender,body mass index（ BMI）,smoking history,dyspnea score,image data,sputum culture,blood gas analysis and the results of spirometry were collected. The risk factors for death were analyzed with COX regression analysis. Results Among 283 cases,52 patients died. The1-,2-,3- and 4-year cumulative survival rates were 97%,86%,71%,45%, respectively. COX regression analysis showed that age≥70 years（ RR = 2. 222,95% CI 1. 145- 4. 314）,BMI 18. 5 kg / m2（ RR = 2. 328,95% CI 1. 205- 4. 497）,bronchiectasis involving ≥ 3 lobes in chest high-resolution computed tomography（ RR = 0. 382,95% CI 0. 188- 0. 774） and FEV1% pred 70%（ RR = 1. 032,95%CI 0. 923- 1. 180） were the independent risk factors for death of patients with bronchiectasis（ all P〈0. 05）. Conclusions There are multiple risk factors contribute to death of patients with bronchiectasis.Early identification of risk factors shall improve the prognosis of patients with bronchiectasis.