纤维支气管镜下肺泡灌洗对支气管扩张合并感染的疗效研究

Efficacy of bronchoalveolar lavage under fiberoptic bronchoscopy on bronchiectasis with infection

目的:探讨纤维支气管镜下肺泡灌洗术(BAL)治疗支气管扩张(BE)合并感染的疗效及对患者血清相关指标的影响。方法:回顾性分析102例BE合并感染患者的临床资料。按治疗方式不同分为观察组和对照组,其中采取纤支镜下BAL治疗的52例患者为观察组;常规治疗的50例患者为对照组,治疗两周后未见显著疗效则采取BAL治疗。比较两组患者临床疗效及治疗前后血气指标[血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、氧合指数(PaO_(2)/FiO_(2))]、炎症指标[降钙素原(PCT)、转化生长因子-β(TGF-β)、可溶性细胞间粘附分子-1(sICAM-1)]、细胞因子[基质金属蛋白酶抑制剂-1(TIMP-1)、基质金属蛋白酶-2(MMP-2)、MMP-9、人中性粒细胞防御素1-3(HNP1-3)、单核细胞趋化蛋白-1(MCP-1)]等变化情况,并比较两组患者并发症发生率。结果:观察组治疗总有效率高于对照组(P<0.05);治疗两周后,两组患者PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)水平较治疗前升高,且高于对照组(P<0.05);PaCO_(2)水平较治疗前降低,且低于对照组(P<0.05);两组患者血清PCT、TGF-β、sICAM-1、MMP-9、MMP-2、HNP1-3、MCP-1水平均较治疗前降低,且观察组低于对照组(P<0.05);血清TIMP-1水平均较治疗前升高,且观察组高于对照组(P<0.05);两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论:纤支镜下BAL治疗BE合并感染可有效改善患者肺功能,减轻炎症反应,促进疾病转归,且不增加并发症,安全可靠。

Objective:To explore the efficacy of bronchoalveolar lavage(BAL)under fiberoptic bronchoscopy in the treatment of bronchiectasis(BE)with infection and its effects on serum related indicators.Methods:The clinical data of patients with BE and infection were retrospectively analyzed,102 patients in total.52 patients who underwent BAL under fiberoptic bronchoscopy were included in observation group and 50 patients who underwent conventional treatment were included in control group,and they were given BAL after 2 weeks of treatment without significant efficacy.The clinical efficacy,the blood gas indexes[partial pressure of blood oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SaO_(2)),oxygenation index(PaO_(2)/FiO_(2))],inflammatory indexes[procalcitonin(PCT),transforming growth factor-β(TGF-β),soluble intercellular adhesion molecule-1(sICAM-1),Leptin]and cytokines[tissue inhibitor of metalloproteinase-1(TIMP-1),matrix metalloproteinase-2(MMP-2),MMP-9,human neutrophil defensin 1-3(HNP1-3),monocyte chemoattractant protein-1(MCP-1)],and the incidence rate of complications were compared between the two groups.Results:The total effective rate of treatment in observation group was higher than that in control group(P<0.05).After 2 weeks of treatment,the levels of PaO_(2),SaO_(2)and PaO_(2)/FiO_(2)in the two groups were increased compared with those before treatment,and the observation group was higher than the control group(P<0.05),and the PaCO_(2)level was decreased compared with that before treatment,and the observation group was lower than the control group(P<0.05).The levels of serum PCT,TGF-β,sICAM-1,MMP-9,MMP-2,HNP1-3,and MCP-1 in the two groups were lower than those before treatment,and the levels in observation group were lower than those in control group(P<0.05),and the serum TIMP-1 level was higher than that before treatment,and the level in observation group was higher than that in control group(P<0.05).There was no significant difference in the incidence rate of complications between the two groups(P>0.05).Conclusion:BAL under fiberoptic bronchoscopy for BE with infection can effectively improve lung function,reduce inflammatory response and promote disease outcomes,and it dose not increase complications,and it is safe and reliable.