支气管扩张症不同表型临床特征的单中心回顾性分析

Single center retrospective analysis of clinical characteristics of bronchiectasis with different phenotypes

目的分析支气管扩张症患者不同表型之间临床特征的差异。方法本研究为回顾性研究,选取2016年1月至2018年12月北部战区总医院呼吸内科收治的189例支气管扩张症患者,男61例,女128例,年龄(63.52±13.77)岁,年龄范围为19~89岁。根据患者的病因不同,将患者分为感染后支气管扩张症组(n=46)、非感染后支气管扩张症组(n=32)及特发性支气管扩张症组(n=111)。收集患者的症状、体征、病史、合并疾病、影像学、病原学、肺通气功能等检查结果。根据患者胸部影像学图像,统一区分支气管扩张的分型,明确病变肺叶位置。在病原微生物方面,收集患者的痰普通涂片、抗酸染色涂片镜检结果,痰细菌、真菌培养结果,少见病原体筛查及支气管镜灌洗液检查结果。结果感染后支气管扩张症组患者咯血比例[43.5%(20/46)]高于非感染后支气管扩张症组[15.6%(5/32)],乏力比例[69.6%(32/46)]高于特发性支气管扩张症组[46.8%(52/111)],幼年呼吸道症状病史比例[37.0%(17/46)]高于特发性支气管扩张症组[14.4%(16/111)],差异有统计学意义(P<0.05)。非感染后支气管扩张症组患者干啰音比例[53.1%(17/32)]显著高于感染后支气管扩张症组[23.9%(11/46)]与特发性支气管扩张症组[28.8%(32/111)],差异有统计学意义(P<0.05)。特发性支气管扩张症组呼吸困难比例[82.0%(91/111)]显著低于感染后支气管扩张症组[93.5%(43/46)]与非感染后支气管扩张症组[96.9%(31/32)],差异有统计学意义(P<0.05)。三组患者铜绿假单胞菌的阳性率之间比较,差异无统计学意义(P>0.05)。所有患者均有影像学检查结果,有影像学检查结果图像的患者169例。双肺受累[85.2%(144/169)],柱状支气管扩张[74.6%(126/169)],囊状支气管扩张[61.5%(104/169)],囊柱状支气管扩张[21.9%(37/169)]。三组患者的病变肺叶分布及病变类型比较,差异无统计学意义(P>0.05)。感染后支气管扩张症组患者合并心功能不全比例[56.5%(26/46)]显著高于非感染后支气管扩张症组[34.4%(11/32)]及特发性支气管扩张症组[36.0%(40/111)],差异有统计学意义(P<0.05)。特发性支气管扩张症组患者合并高血压比例[34.2%(38/111)]显著高于感染后支气管扩张症组[17.4%(8/46)]及非感染后支气管扩张症组[15.6%(5/32)],合并冠状动脉粥样硬化性心脏病比例[22.5%(25/111)]显著高于感染后支气管扩张症组[13.0%(6/46)],差异有统计学意义(P<0.05)。结论不同表型支气管扩张症患者在呼吸困难、乏力、咯血、干啰音及合并疾病方面有差异,特发性支气管扩张症是较常见的表型,与心血管疾病联系更密切,应引起临床的更多关注。

Objective The purpose of this study was to analyze the differences of clinical characteristics among different phenotypes in patients with bronchiectasis.Methods This study was a retrospective study,The clinical data of 189 patients with bronchiectasis treated in the General Hospital of Northern Theater Command from January 2016 to December 2018.There were 61 males and 128 females with an age of(63.52±13.77)years old,ranging from 19 to 89 years oid.According to the etiology of the patients,the patients were divided into three groups:post-infectious bronchiectasis group(n=46),non-infection post-infection bronchiectasis group(n=32)and idiopathic bronchiectasis group(n=111).The symptoms,signs,medical history,concomitant diseases,imaging,etiology,pulmonary ventilation function and other examination results were collected.According to the chest images of the patients,the classification of bronchiectasis and the location of the diseased pulmonary lobe were distinguished.In the aspect of pathogenic microorganisms,the results of common sputum smear,acid-fast staining smear,sputum bacterial and fungal culture,rare pathogen screening and bronchoscopic lavage fluid were collected.Results The hemoptysis rate in the post-infection bronchiectasis group was[43.5%(20/46)],which was higher than that in the non-infection bronchiectasis group[15.6%(5/32)],and the fatigue rate[69.6%(32/46)]was higher than that in the idiopathic bronchiectasis group[46.8%(52/111)].The proportion of history of juvenile respiratory symptoms in the idiopathic bronchiectasis group was[37.0%(17/46)],higher than that in the idiopathic bronchiectasis group[14.4%(16/111)],the difference was statistically significant(P<0.05).The dry rale ratio of patients with non-infectious bronchiectasis was[53.1%(17/32)],which was significantly higher than that of[23.9%(11/46)]in post-infective bronchiectasis group and[28.8%(32/111)]in idiopathic bronchiectasis group,and the difference was statistically significant(P<0.05).The proportion of dyspnea in idiopathic bronchiectasis group was[82.0%(91/111)],which was significantly lower than[93.5%(43/46)]in post-infection bronchiectasis group and[96.9%(31/32)]in non-infection post-infection bronchiectasis group,and the difference was statistically significant(P<0.05).There was no significant difference in the positive rate of Pseudomonas aeruginosa among the three groups(P>0.05).All patients had imaging results,and 169 patients had imaging results.The involvement of both lungs was[85.2%(144/169)],the columnar bronchiectasis was[74.6%(126/169)],the cystic bronchiectasis was[61.5%(104/169)],and the cystic columnar bronchiectasis was[21.9%(37/169)].There was no significant difference in the distribution of diseased lobes and the types of bronchiectasis among the three groups.The proportion of patients with cardiac insufficiency in post-infection bronchiectasis group was[56.5%(26/46)],which was significantly higher than that in non-infection bronchiectasis group[34.4%(11/32)]and idiopathic bronchiectasis group[36.0%(40/111)],the difference was statistically significant(P<0.05).The proportion of patients with idiopathic bronchiectasis complicated with hypertension[34.2%(38/111)]was significantly higher than that in post-infective bronchiectasis group[17.4%(8/46)]and non-infective bronchiectasis group[15.6%(5/32)].The proportion of patients with idiopathic bronchiectasis complicated with coronary atherosclerotic heart disease[22.5%(25/111)]was significantly higher than that of post-infection bronchiectasis group[13.0%(6/46)],the difference was statistically significant(P<0.05).Conclusions Patients with different phenotypes of bronchiectasis have their own characteristics in dyspnea,fatigue,hemoptysis,dry rale and concomitant diseases.Idiopathic bronchiectasis is the most common phenotype,which is more closely related to cardiovascular disease and should attract more clinical attention.