住院支气管哮喘患者合并支气管扩张症的十年单中心调查结果分析

Analysis of bronchiectasis in hospitalized asthmatic patients: 10-year experience of a single center

目的 分析住院支气管哮喘(简称哮喘)患者合并支气管扩张症(简称支扩)的十年单中心调查结果 .方法 回顾2008年1月1日至2017年12月31日北部战区总医院呼吸内科与变态反应疾病诊治中心住院的所有哮喘患者的临床资料,分析连续10年哮喘住院、哮喘合并支扩住院和哮喘因支扩加重住院情况和10年变化趋势.哮喘患者按照是否合并支扩分为合并支扩组和不合并支扩组,分析两组患者一般情况、症状、特征和合并疾病,分析合并支扩组危险因素.合并支扩组按住院次数分为住院≥2次和住院1次者,按住院原因分为因支扩加重住院、因哮喘加重住院和因其他合并疾病加重住院,分析不同住院次数的住院原因和因支扩加重住院的临床特点、合并疾病和危险因素.结果 共纳入住院哮喘患者2 207例,其中合并支扩组434例(19.7%);合并率2008年最低,为8.2%(17/207),2011至2017年均显著高于2008年(均P<0.05).合并支扩组危险因素从高到低依次为咯血、查体湿啰音、咳痰、咳嗽、活动后气短、体温>37℃、合并肺气肿、住院时间≥14 d (0R=13.75、2,638、2.156、1,957、1.828、1.351、1.383、1.351).合并支扩组住院≥2次者181例(41.7%),住院1次者253例(58.3%);因哮喘加重住院≥2次者83例(45.9%)、住院1次者117例(46.2%)(P>0.05);因支扩加重住院≥2次者85例(47.0%),住院1次者102例(40.3%)(P>0.05);因其他合并疾病加重住院≥2次者比例显著低于住院1次者[13例(7.2%)比34例(13.4%),P<0.05].因支扩加重住院者发热、咳嗽、咳痰、咯血、活动后气短、查体有湿啰音、住院时间≥14d、行无创机械通气、合并肺气肿、心功能不全和肺心病比例均显著高于因哮喘加重住院者(均P<0.05);合并支扩组住院费用显著高于不合并支扩组[11 264(8 035,17 161)比9 337(5 916,15 151)元人民币)],因支扩加重住院者的费用显著高于因哮喘加重住院者[13 101(8 931,20 118)比10 076(7 136,14 659)元人民币](均P<0.05).结论 哮喘合并支扩住院率有增加的趋势,相比于因哮喘加重住院者,因支扩加重住院者发热、咯血、咳痰更明显,病情较重,住院时间更长,费用更高。

Objective To analyze bronchiectasis in hospitalized asthmatic patients in the past 10 years in a single center. Methods The clinical data of all asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. The data of hospitalized asthmatic patients, hospitalized asthmatic patients with bronchiectasis and hospitalized asthmatic patients with acute exacerbation of bronchiectasis in the past 10 years and the trends of 10 consecutive years were analyzed. According to whether or not co-existing with bronchiectasis, asthmatic patients were divided into asthmatic patients with bronchiectasis group and asthmatic patients without bronchiectasis group, then the general condition, symptoms, characteristics and comorbidities of the two groups were analyzed and the risk factors of bronchiectasis in asthmatic patients were also analyzed. According to the number of hospitalizations, asthmatic patients with bronchiectasis group was divided into hospitalization ≥ 2 times group and single-time group;according to the causes of hospitalization, asthmatic patients with bronchiectasis group was divided into asthmatic patients hospitalized for acute exacerbation of bronchiectasis group, hospitalized for acute asthmatic attack group and hospitalized for acute exacerbation of other comorbidities group. Then the reasons for different hospitalization times and the clinical characteristics, comorbidities and risk factors of asthmatic patients hospitalized for acute exacerbation of bronchiectasis group were analyzed. Results A total of 2 207 cases of hospitalized asthmatic patients were included, of which 434 cases (19.7%) were classified into asthmatic patients with bronchiectasis group over the 10-year study period. The lowest percentage of asthmatic patients with bronchiectasis group over the total hospitalized asthmatic patients was observed in the year 2008 (8.2%, 17/207), and there was significant difference in the comparison of the 2008 and 2011 through 2017 (all P<0.05). The most common risk factor of asthmatic patients with bronchiectasis group was hemoptysis, followed by wet rales on physical examination, phlegm, cough, shortness of breath after activity, T>37 ℃, co-existing with emphysema, hospitalization≥ 14 d (OR=13.75, 2.638, 2.156, 1.957, 1.828, 1.351, 1.383, 1.351). In asthmatic patients with bronchiectasis group, there were 181 cases (41.7%) in ≥2 times group, 253 cases (58.3%) in single-time group;when the reason for hospitalization was analyzed by grouping single-time versus ≥2 times, the reason of acute asthmatic attack: the number of cases in ≥2 times group (45.9%, 83/181) was similar to the single-time group (46.2%, 117/253);the reason of acute exacerbation of bronchiectasis: the number of cases in ≥2 time groups (47.0%, 85/181) was higher than the single-time group (40.3%, 102/253);but there was no significant difference between the two groups (P>0.05). The reason of acute exacerbation of other comorbidities: the number of cases in ≥2 times group was significantly lower than single-time group [13 cases (7.2%) vs 34 cases (13.4%), P<0.05]. The frequencies of symptoms of fever, cough, phlegm, hemoptysis, shortness of breath after activity, wet rales on physical examination, hospitalization ≥ 14 d, non-invasive mechanical ventilation, co-existing with emphysema, heart function insufficiency and cor pulmonale in asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group (all P<0.05). Hospital costs in asthmatic patients with bronchiectasis group was higher than asthmatic patients without bronchiectasis group [RMB 11 264 (8 035, 17 161) vs 9 337 (5 916, 15 151) yuan];asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group [RMB 13 101 (8 931, 20 118) vs 10 076 (7 136, 14 659) yuan](both P<0.05). Conclusions Asthmatic patients with bronchiectasis have an increased trend of hospitalization. In asthmatic patients hospitalized for acute exacerbation of bronchiectasis, the symptoms of fever, hemoptysis, cough and sputum were more frequently seen than those in asthmatic patients hospitalized for acute asthmatic attack, and the former have more serious condition, longer hospitalization and increased costs.