糖尿病对支气管扩张症的影响

The impact of diabetes on bronchiectasis

目的探讨糖尿病对支气管扩张症的影响。方法回顾性收集2017年1月1日至2021年12月31日在同济大学附属肺科医院呼吸与危重症医学科住院患者1310例,支气管扩张症合并糖尿病患者78例(支扩糖尿病组),不合并糖尿病患者1232例(单纯支扩组)。为控制混杂因素,使用倾向性评分方法按1∶4从单纯支扩组匹配出269例作为支扩非糖尿病组。比较支扩糖尿病组和支扩非糖尿病组临床特征、检验指标、病原菌感染以及严重程度等。计量资料采用t检验或非参检验,计数资料采用卡方检验。结果支扩糖尿病组年龄[(62.99±8.09)岁]高于单纯支扩组[(57.05±13.07)岁](t=-6.012,P<0.001)。倾向性评分匹配后,支扩糖尿病组前白蛋白水平[(188.44±71.65)g/L]低于支扩非糖尿病组[(208.17±62.50)]g/L(t=2.023,P=0.044),而支扩糖尿病组住院费用[1.39(1.23,1.62)万元]高于支扩非糖尿病组[1.59(1.34,2.15)万元](U=-3.744,P<0.001)。支扩糖尿病组mMRC严重程度高于支扩非糖尿病组(χ2=25.392,P<0.001),既往因加重住院以及既往1年内急性加重的频次均高于支扩非糖尿病组(χ2分别为34.031和40.841,均P<0.001)。此外,支扩糖尿病组患者BSI评分(8.07±4.07)明显高于支扩非糖尿病组(10.44±3.82),差异有统计学意义(t=-3.765,P<0.001)。空腹血糖浓度、尿糖等级与BSI评分呈正相关,前白蛋白浓度与BSI评分呈负相关(均P<0.05)。结论合并糖尿病支气管扩张症患者营养差,症状严重且急性加重风险高,病情更严重,医疗负担重。

ObjectiveTo study the impact of diabetes on bronchiectasis.MethodsFrom January 12017 to December 312021,data of 1310 inpatients with bronchiectasis were retrospectively collected from Shanghai Pulmonary Hospital,Tongji University.This cohort inclueded 78 patients with bronchiectasis and diabetes(bronchiectasis-diabetes group)and 1232 patients of bronchiectasis without diabetes(simple bronchiectasis group).To mitigate confounding variables,269 patients with bronchiectasis but without diabetes(bronchiectasis non-diabetes group)were matched with 78 patients of bronchiectasis with diabetes(bronchiectasis-diabetes group)using the propensity score method in a 1∶4 ratio.A comparative analysis of clinical characteristics,laboratory test results,pathogenic infections,and disease severity was performed between the two groups.Analysis of continuous variables was performed using either a t-test or non-parametric test,while categorical data was assessed using the chi-square test.ResultsThe mean age of individuals in the bronchiectasis-diabetes group(62.99±8.09 years)was significantly higher than that of subjects in the simple bronchiectasis group(57.05±13.07 years)(t=-6.012,P<0.001).After propensity score matching,the pre-albumin level in the bronchiectasis-diabetes group(188.44±71.65 g/L)was found to be lower than in the bronchiectasis non-diabetes group(208.17±62.50 g/L)(t=2.023,P=0.044).In addition,the hospitalization cost for the bronchiectasis-diabetes group[1.59(1.34,2.15)Ten thousand yuan]was higher than that in the bronchiectasis non-diabetes group[1.39(1.23,1.62)Ten thousand yuan](U=-3.744,P<0.001).The severity of mMRC in the bronchiectasis-diabetes group was significantly higher than that in the bronchiectasis non-diabetes group(χ2=25.392,P<0.001),and the frequency of previous hospitalization due to aggravation and acute exacerbation within the previous year were higher than in bronchiectasis non-diabetes group(χ2=34.031,40.841,respectively,P<0.001).In additional,the BSI score was significantly increased in patients with bronchiectasis-diabetes compared to those with bronchiectasis non-diabetes(8.07±4.07 vs.10.44±3.82)(P<0.001).Furthermore,fasting blood glucose concentration,urine glucose level,and BSI score exhibited positive correlations,whereas pre-albumin concentration showed a negative correlation with the BSI score(all P<0.05).ConclusionCompared to those without diabetes,patients of bronchiectasis with diabetes have poorer nutritional status,more severe symptoms,increased risk of acute exacerbation,higher BSI score severity,and greater financial burden.