113例支气管色素沉着纤维化患者的临床特征分析

Bronchial ultrasound imaging features of bronchial anthracofibrosis in 113 patients

目的:观察支气管色素沉着纤维化(BAF)患者临床特征,为BAF的防治提供临床参考。方法:回顾性分析2018年4月—2019年10月遵义市红花岗区人民呼吸与危重症医学科行气管镜检查及治疗的113例BAF患者资料,所有患者均行胸部CT,55例患者行肺功能检查,分析其炎症指标(白细胞计数、红细胞沉降率、降钙素原、C反应蛋白)、氧合指标(氧分压及氧合指数)以及常规生化指标(如脑钠肽、肌钙蛋白、D-二聚体、血钠、血清蛋白)。结果:113例BAF患者,平均年龄(66.2±9.3)岁,男性占46.9%;有结核病史者13例(11.5%),有生物燃料暴露者57例(50.4%),平均暴露时间(17.4±6.2)年;合并症情况:113例患者中合并糖尿病4例4(3.5%)、缺血性心脏病22例(19.4%)、慢性肝脏和肾脏疾病各1例(0.9%)、高脂血症26例(23.0%)。BAF主要临床表现为咳嗽113例(100.0%)、喘息65例(57.5%);急性加重的原因:支气管炎34例(30.0%)、肺炎79例(69.9%);预后情况:BAF死亡7例(6.2%)、改善94例(83.2%)、进展9例(8.0%);实验室检查结果显示,BAF患者白细胞计数多在正常范围内,氧分压平均(81.5±16.9)mmHg;氧合指数为(246.8±51.4);胸部CT检查结果显示,有肺气肿征象46例(41.1%)、支气管扩张40例(36.0%)、支气管壁增厚34例(30.6%)、细支气管炎79例(69.9%)、支气管壁钙化71例(62.8%)、肺不张53例(46.9%);影像学表现以细支气管炎症常见。通过肺功能检测,55例BAF患者中多为轻度阻塞且支气管扩张剂后反应不明显。结论:BAF在老年人中有较高发病率,其胸部CT及肺功能表现均有一定的临床特点,对BAF防治具有重大临床价值。

Objective To observe the clinical characteristics of patients with bronchial anthracofibrosis(BAF)and provide clinical reference for the prevention and treatment of BAF.Methods The data of 113 patients with BAF who underwent tracheoscopy and treatment in the Department of Respiratory and Critical Care Medicine of Honghuagang District People’s Hospital of Zunyi City from April 2018 to October 2019 were retrospectively analyzed.All patients underwent chest CT and 55 patients underwent pulmonary function examination.Inflammatory markers(white blood cell count,erythrocyte deposition rate,procalcitonin,C-reactive protein),oxygenation markers(oxygen partial pressure and oxygenation index)and routine biochemical markers(such as brain natriuretic peptide,troponin,D-dimer,blood sodium,serum protein)were analyzed.Results The average age of 113 patients with BAF was(66.2±9.3)years,and 46.9%were males.There were 13 cases(11.5%)with a history of tuberculosis and 57 cases(50.4%)with a mean exposure time of(17.4±6.2)years.Complications:Among the 113 patients,there were 4 cases of diabetes mellitus(3.5%),22 cases(19.4%),of ischemic heart disease 1 case(0.9%)of chronic liver and kidney disease,and 26 cases of hyperlipidemia(23.0%).The main clinical manifestations of BAF were cough in 113 cases(100.0%)and wheezing in 65 cases(57.5%).The causes of acute exacerbation were bronchitis in 34 cases(30.0%)and pneumonia in 79 cases(69.9%).Prognosis:BAF died in 7 cases(6.2%),improved in 94 cases(83.2%),and progressed in 9 cases(8.0%).Laboratory examination results showed that the white blood cell count of BAF patients was mostly within the normal range,and the average oxygen partial pressure was(81.5±16.9)mmHg.Oxygenation index was(246.8±51.4);Chest CT showed signs of emphysema in 46 cases(41.1%),bronchiectasis in 40 cases(36.0%),bronchial wall thickening in 34 cases(30.6%),bronchiolitis in 79 cases(69.9%),bronchial wall calcification in 71 cases(62.8%),atelectasis in 53 cases(46.9%).The imaging manifestations were bronchiolar inflammation.According to the pulmonary function test,most of the 55 patients with BAF had mild obstruction and no obvious response to bronchodilators.Conclusions There is a high incidence of BAF in the elderly,and its chest CT and lung function manifestations have certain clinical characteristics,which is of great clinical value for the prevention and treatment of BAF.