慢性阻塞性肺疾病合并支气管扩张危险因素分析

Risk factors associated with bronchiectasis in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)合并支气管扩张患者的临床特点及危险因素。方法收集河南省人民医院呼吸内科2016年1月至2018年5月住院诊断为中度以上COPD患者173例,其中69例患者行胸部高分辨率CT(HRCT)检查诊断合并支气管扩张,作为病例组;另104例患者行HRCT检查未合并支气管扩张(对照组)。整理两组患者首诊时病例资料,如性别、年龄、吸烟史、吸烟年限、慢阻肺评估测试问卷(CAT)评分、GOLD分级、慢性呼吸道症状(咳嗽、咳痰、呼吸困难)出现时间、既往肺结核史、既往糖尿病史、血糖、血红蛋白(Hb)、总蛋白(TP)、痰培养细菌学结果等。分析慢性阻塞性肺疾病合并支气管扩张患者的临床特点,评估易合并支气管扩张的相关因素。结果慢性阻塞性肺疾病合并支气管扩张占39.9%,大多为男性(P=0.017),有吸烟史(P=0.037),吸烟年限更长(P=0.035),CAT评分更高(P=0.002),GOLD分级更重(P=0.031),慢性呼吸道症状时间更长(P=0.001),既往有结核病史(P=0.044),既往有糖尿病史(P=0.003),血糖更高(P=0.003);多因素logistic回归分析显示与COPD合并支气管扩张的危险因素有男性(OR 2.427,95%CI 1.126~5.231,P=0.024)、CAT分(OR 1.476,95%CI 1.031~2.113,P=0.034)、慢性呼吸道症状时间(OR 3.502,95%CI 1.619~7.575,P=0.001)、既往糖尿病史(OR 4.182,95%CI 1.407~12.427,P=0.010)。结论慢性阻塞性肺疾病患者为男性、CAT评分越高、慢性呼吸道症状时间持续越长、既往有结核病史和糖尿病史时易合并支气管扩张,应得到重视,尽早明确诊断给予治疗。

Objective To analyze the clinical features and risk factors of patients with chronic obstructive pulmonary disease(COPD)complicated with bronchiectasis.Methods 173 patients diagnosed moderate or above COPD were collected from respiratory department of Henan provincial people’s hospital.Among them,69 cases were diagnosed with bronchiectasis by HRCT.Analyzed the clinical characteristics of COPD patients with bronchiectasis,and evaluated the related factors.Results Bronchiectasis was observed in 39.9%of patients with COPD.The patients with bronchiectasis of COPD are almost male(P=0.017),with a history of smoking(P=0.037)and long history of smoking(P=0.035),high CAT score(P=0.002),poor lung function(P=0.031),long history of chronic respiratory symptoms(P=0.001),previous TB history(P=0.044),previous diabetes history(P=0.003)and high blood glucose(P=0.003).Multivariate Logistic analysis showed that risk factors for bronchiectasis of COPD included male(OR:2.427,P=0.024),high CAT score(OR:1.476,P=0.034),history of chronic respiratory symptoms(OR:3.502,P=0.001),and previous diabetes history(OR:4.182,P=0.010).Conclusions The patients with COPD were male,with the higher CAT score,the longer the duration of chronic respiratory symptoms,and the patients with previous history of tuberculosis and diabetes were prone to bronchiectasis.