成人支气管扩张肺功能的特征

发布时间：2018-05-19 17:00

本文选题：急性加重 + 支气管扩张　；参考：《中国实用内科杂志》2014年S1期

【摘要】：目的阐明支气管扩张肺功能受损的风险因素,比较急性加重期与恢复期(14天抗生素治疗后1周内)肺功能的改变。方法纳入142例稳定期支气管扩张成人患者,其中44例出现急性加重而被纳入至亚组分析。基线水平评估包括胸部高分辨率(HRCT)、痰量、脓性、细菌谱分析、用力肺活量、弥散功能测试。急性加重与恢复期仅进行用力肺活量测试(而非弥散功能)。结果确诊支气管扩张3年或以上、24 h痰量30mL或以上、HRCT总分7分或以上、4个或更多受累肺叶、囊状支扩、通气不均以及痰培养铜绿假单胞菌阳性均与FEV1与DLCO下降有关(P0.05)。存在支扩症状10年或以上(OR=4.75,95%CI:1.46-15.43,P=0.01)、痰培养铜绿假单胞菌阳性(OR=4.93,95%CI:1.52-15.94,P0.01)、HRCT总分12分或以上(OR=7.77,95%CI:3.21-18.79,P0.01)为FEV1 50%pred或更低的风险因素。而DLCO下降的唯一风险因素为4个或更多的支扩受累肺叶(OR=5.91,95%CI:2.20-17.23,P0.01)。稳定期至急性加重期和恢复期的用力肺活量改变不甚显著(P0.05),即使按照FEV1与DLCO下降程度划分也不改变以上结论。结论支气管扩张患者若肺功能下降则需考虑是否存在显著的胸部HRCT病变及痰培养是否分离出铜绿假单胞菌。急性加重对用力肺活量的影响不甚显著。
[Abstract]:Objective to elucidate the risk factors of bronchiectasis and compare the changes of pulmonary function between acute exacerbation and convalescence within 14 days after antibiotic therapy. Methods 142 adult patients with stable bronchiectasis were included in the subgroup analysis. Baseline assessment included HRCTV, sputum volume, purulent, bacterial spectrum analysis, forced vital capacity, and diffusion function tests. Only forced vital capacity tests (not diffusive function) were performed in acute exacerbation and convalescence. Results the total score of sputum volume 30mL or above in bronchiectasis for 3 years or more 24 hours was 7 or more, 4 or more involved lobes, cystic bronchiectasis, uneven ventilation and positive sputum culture of Pseudomonas aeruginosa were all related to the decrease of FEV1 and DLCO. The risk factors of FEV1 50%pred were 4.75% 95% CI 1.46-15.43% P0.01, and 4.9395% CI 1.52 -15.94% P0.01 or more in sputum culture. The total score of FEV1 50%pred was 7.795 CI: 3.21-18.79 P0.01). The only risk factor for the decrease of DLCO was 5. 91% CI: 2. 20-17. 23 and P 0. 01% for 4 or more bronchiectasis involved lobes. The change of forced vital capacity from stable stage to acute exacerbation stage and convalescence stage was not significant (P 0.05), even according to the degree of FEV1 and DLCO decrease, it did not change the above conclusion. Conclusion in patients with bronchiectasis, it is necessary to consider the existence of significant chest HRCT lesions and the isolation of Pseudomonas aeruginosa in sputum culture. The effect of acute exacerbation on forced vital capacity was not significant.
【作者单位】：广州医科大学附属第一医院广州呼吸疾病研究所(呼吸疾病国家重点实验室呼吸疾病国家临床研究中心);
【分类号】：R562.22

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