支气管扩张症患者肺通气功能障碍及肺气肿的高危因素分析

High risk factors of pulmonary ventilation dysfunction and emphysema in patients with bronchiectasis

目的分析支气管扩张症患者肺通气功能障碍及肺气肿的高危因素。方法回顾性分析118例住院支气管扩张症患者,分析病程、咳痰、吸烟、CT树芽征、支气管扩张病变范围、铜绿假单胞菌感染对患者肺通气功能的影响,分析肺通气功能障碍的高危因素;按照CT肺气肿表现将支气管扩张症患者分为肺气肿阳性组和肺气肿阴性组,对比两组年龄、性别基线数据及肺通气功能的差异,分析CT肺气肿阳性的高危因素。结果住院支气管扩张症患者中,长病程、咳痰、非吸烟、CT树芽征阳性、支气管扩张病变范围广泛、铜绿假单胞菌感染阳性与患者肺通气功能障碍有相关性。但logistic回归分析未发现第一秒用力呼气容积(FEV1)/预计值<80%、第一秒用力呼气容积占用力肺活量比值(FEV1/FVC)<70%的危险因素。肺气肿阳性组的用力肺活量(FVC)、FEV1/FVC、FEV1/预计值、用力呼气中期流速(FEF)25%~75%/预计值均明显低于肺气肿阴性组(t分别=-3.72、-4.57、-3.81、-3.32,P均<0.05)。logistic回归分析显示咳痰是支气管扩张症患者CT肺气肿阳性的危险因素(OR=22.77,P<0.05),CT树芽征阳性是保护因素(OR=0.25,P<0.05)。结论与慢性阻塞性肺病(COPD)患者不同,住院支气管扩张患者中,吸烟不是造成肺通气功能障碍和肺气肿的危险因素,咳痰是肺气肿的危险因素。

Objective To analyze the high-risk factors of pulmonary ventilation dysfunction and emphysema in patients with bronchiectasis.Methods Totally 118 hospitalized patients with bronchiectasis were retrospectively analyzed.The influences of course of disease,expectoration,smoking,CT tree-in-bud sign,bronchiectasis lesion range and Pseudomonas aeruginosa infection on pulmonary ventilation function were analyzed to screening the high risk factors of pulmonary ventilation dysfunction.According to the CT manifestations of emphysema,patients with bronchiectasis were divided into emphysema positive group and emphysema negative group.The differences in age,gender and pulmonary ventilation function between the two groups were compared,and the high-risk factors of emphysema were analyzed.Results In the hospitalized patients with bronchiectasis,long course of disease,expectoration,non-smoking,CT tree-in-bud sign positive,extensive bronchiectasis lesions,Pseudomonas aeruginosa infection were associated with decreased pulmonary ventilation function.Logistic regression analysis showed that there was no independent risk factors for FEV1/predicted value<80%and FEV1/FVC<70%.The FVC,FEV1/FVC,FEV1/predicted value and FEF25%~75%/predicted value of emphysema positive group were significantly lower than those of emphysema negative group(t=-3.72,-4.57,-3.81,-3.32,P<0.05).Logistic regression analysis showed that the expectoration was the risk factor of positive emphysema in patients with bronchiectasis(OR=22.77,P<0.05),while positive CT tree-in-bud sign was the protective factor(OR=0.25,P<0.05).Conclusion In hospitalized patients with bronchiectasis,smoking is not an independent risk factor for pulmonary ventilation dysfunction and emphysema,but sputum is an independent risk factor for emphysema,which is different from COPD patients.