慢性阻塞性肺疾病合并支气管扩张患者的临床特点分析
发布时间：2018-09-06 12:17
【摘要】：目的探讨慢性阻塞性肺疾病(简称慢阻肺)合并支气管扩张患者的临床特征,以提高对该病的诊治水平。方法选取2015年1月~2015年12月入住我科慢阻肺急性加重期130例患者作为研究对象,分为慢阻肺合并支气管扩张组(n=22)和慢阻肺组(n=108),记录患者一般情况及入院后白细胞计数、C反应蛋白、降钙素原、纤维蛋白原、血清白蛋白、痰细菌培养结果、肺功能及动脉血气分析结果,随访6个月记录两组患者的急性加重次数和死亡人数。比较两组患者在临床特征、肺功能及实验室检查方面的差异。结果1、本研究共纳入慢阻肺急性加重期患者130例,其中确诊为慢阻肺合并支气管扩张者22例(占16.9%),其中男性8例,女性14例,年龄43-85岁,平均年龄(64.2±12.2)岁,病程(16.5±5.8)年,吸烟指数(283.2±72.0)包/年;慢阻肺患者108例,男性72例,女性36例,年龄50-91岁,平均年龄(67.5±9)岁,病程(18.2±3.2)年,吸烟指数(250.6±66.8)包/年。两组资料均无统计学意义,具有可比性(P0.05)。2、慢阻肺合并支气管扩张组mMRC评分明显高于慢阻肺组,分别为(2.36±0.7)、(1.93±0.6),两组差异有统计学意义(t=2.87,P0.01);慢阻肺合并支气管扩张组日常咳脓性痰比例为90.9%,合并肺心病比例68.2%,均显著高于慢阻肺组(P0.05);慢阻肺合并支气管扩张组患者平均住院时间明显高于慢阻肺组,分别为(11.9±5.7)天、(9.0±3.2)天,两组差异有统计学意义(t=2.31,P0.05)。3、慢阻肺合并支气管扩张组患者FEV1%pred、FEV 1/FVC、FVC%pred、DLCO%pred降低较单纯慢阻肺组更为显著,差异有统计学意义(t值分别为-4.37、-2.76、-4.24、-3.24,P0.01)。慢阻肺合并支气管扩张组低氧血症的发生率高于慢阻肺组,两组差异有统计学意义(P0.05)。4、慢阻肺合并支气管扩张组C-反应蛋白、降钙素原、纤维蛋白原水平均显著高于慢阻肺组,组间差异有统计学意义(t值分别为2.66、2.25、2.77,P0.05);慢阻肺合并支气管扩张组白蛋白水平明显低于慢阻肺组,分别为(31.2±2.5)g/L、(32.9±2.5)g/L,具有显著差异(t=-2.97,P0.01)。5、慢阻肺合并支气管扩张组患者6个月内急性加重次数显著高于慢阻肺组,分别为(1.68±0.48)次/人、(1.28±0.45)次/人,差异有统计学意义(t=2.97,P0.01)。慢阻肺合并支气管扩张组死亡率为27.3%,明显高于慢阻肺组,结果具有显著差异(P0.05)。结论慢阻肺合并支气管扩张者病情更严重、炎症反应更强、疗程更长、肺功能更差、急性加重更为频繁。故临床上对于确诊为慢阻肺的患者,应常规行胸部高分辨CT检查,以早期明确诊断,早期治疗,改善患者预后。
[Abstract]:Objective to investigate the clinical features of patients with chronic obstructive pulmonary disease (COPD) complicated with bronchiectasis in order to improve the diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Methods from January 2015 to December 2015, 130 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled in this study. The patients were divided into two groups: chronic obstructive pulmonary disease with bronchiectasis group (nm22) and slow obstructive lung group (nnm108). The results of C reactive protein, procalcitonin, fibrinogen, serum albumin and sputum bacterial culture were recorded. The results of pulmonary function and arterial blood gas analysis were followed up for 6 months to record the number of acute exacerbations and the number of deaths in the two groups. The differences in clinical features, pulmonary function and laboratory examination were compared between the two groups. Results 1. A total of 130 patients with acute exacerbation of COPD were included in this study, of whom 22 (16.9%) were diagnosed as COPD complicated with bronchiectasis, including 8 males and 14 females, aged 43-85 years, with an average age of (64.2 卤12.2) years and course of disease (16.5 卤5.8) years. The smoking index was (283.2 卤72.0) bag / year, and the smoking index was (250.6 卤66.8) years in 108 patients with chronic obstructive pulmonary disease (COPD), 72 males and 36 females, aged 50-91 years, mean age (67.5 卤9) years, course of disease (18.2 卤3.23) years. There was no statistical significance between the two groups (P0.05). The mMRC score in COPD with bronchiectasis group was significantly higher than that in COPD group. (2.36 卤0.7), (1.93 卤0. 01), there was significant difference between the two groups (t = 2.87, P0.01), the proportion of daily cough and purulent phlegm was 90.9 and the ratio of cor pulmonale was 68.2 in COPD combined bronchiectasis group, which was significantly higher than that in COPD group (P0.05), and the average residence in COPD combined with bronchiectasis group was higher than that in COPD group (P0.05). Hospital time was significantly longer than that in COPD group. The difference between the two groups was statistically significant (t = 2.31, P 0.05). The decrease of FEV1%pred,FEV 1 / FV C in the COPD group was significantly lower than that in the simple COPD group (t = -4.37 卤2.76 卤4.24 卤3.24 P0.01), and the difference was statistically significant (t = -4.37 ~ (-1) ~ (-2.76) ~ (-2.76) ~ (-4.24) (P ~ (0.01), P ~ (0.01). The difference was significant (t = -4.37 ~ (-2.76) ~ (-2.76) ~ (-4.24) ~ (-1) P ~ (-1) ~ (-1) in chronic obstructive pulmonary disease with bronchiectasis. The incidence of hypoxemia in COPD with bronchiectasis group was higher than that in COPD group, the difference was statistically significant (P0.05). The levels of C-reactive protein, procalcitonin and fibrinogen in COPD with bronchiectasis group were significantly higher than those in COPD group. There was significant difference between the two groups (t = 2.66 卤2.25, P 0.05), and the albumin level in COPD with bronchiectasis group was significantly lower than that in COPD group. It was (31.2 卤2.5) g / L and (32.9 卤2.5) g / L, respectively, with significant difference (tr -2.97 卤P0.01) .5.The times of acute exacerbation in patients with COPD complicated with bronchiectasis within 6 months were significantly higher than those in COPD group (1.68 卤0.48 times / person, 1.28 卤0.45 times / person, respectively) (t = 2.97, P 0.01). The mortality rate of COPD with bronchiectasis group was 27.3%, which was significantly higher than that of COPD group (P0.05). Conclusion the patients with COPD complicated with bronchiectasis are more serious, inflammatory reaction is stronger, the course of treatment is longer, the lung function is worse, and the acute exacerbation is more frequent. Therefore, high resolution CT should be performed clinically in patients with chronic obstructive pulmonary disease (COPD) in order to make early diagnosis, early treatment and improve the prognosis of the patients.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R562.22
本文编号：2226326
[Abstract]:Objective to investigate the clinical features of patients with chronic obstructive pulmonary disease (COPD) complicated with bronchiectasis in order to improve the diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Methods from January 2015 to December 2015, 130 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled in this study. The patients were divided into two groups: chronic obstructive pulmonary disease with bronchiectasis group (nm22) and slow obstructive lung group (nnm108). The results of C reactive protein, procalcitonin, fibrinogen, serum albumin and sputum bacterial culture were recorded. The results of pulmonary function and arterial blood gas analysis were followed up for 6 months to record the number of acute exacerbations and the number of deaths in the two groups. The differences in clinical features, pulmonary function and laboratory examination were compared between the two groups. Results 1. A total of 130 patients with acute exacerbation of COPD were included in this study, of whom 22 (16.9%) were diagnosed as COPD complicated with bronchiectasis, including 8 males and 14 females, aged 43-85 years, with an average age of (64.2 卤12.2) years and course of disease (16.5 卤5.8) years. The smoking index was (283.2 卤72.0) bag / year, and the smoking index was (250.6 卤66.8) years in 108 patients with chronic obstructive pulmonary disease (COPD), 72 males and 36 females, aged 50-91 years, mean age (67.5 卤9) years, course of disease (18.2 卤3.23) years. There was no statistical significance between the two groups (P0.05). The mMRC score in COPD with bronchiectasis group was significantly higher than that in COPD group. (2.36 卤0.7), (1.93 卤0. 01), there was significant difference between the two groups (t = 2.87, P0.01), the proportion of daily cough and purulent phlegm was 90.9 and the ratio of cor pulmonale was 68.2 in COPD combined bronchiectasis group, which was significantly higher than that in COPD group (P0.05), and the average residence in COPD combined with bronchiectasis group was higher than that in COPD group (P0.05). Hospital time was significantly longer than that in COPD group. The difference between the two groups was statistically significant (t = 2.31, P 0.05). The decrease of FEV1%pred,FEV 1 / FV C in the COPD group was significantly lower than that in the simple COPD group (t = -4.37 卤2.76 卤4.24 卤3.24 P0.01), and the difference was statistically significant (t = -4.37 ~ (-1) ~ (-2.76) ~ (-2.76) ~ (-4.24) (P ~ (0.01), P ~ (0.01). The difference was significant (t = -4.37 ~ (-2.76) ~ (-2.76) ~ (-4.24) ~ (-1) P ~ (-1) ~ (-1) in chronic obstructive pulmonary disease with bronchiectasis. The incidence of hypoxemia in COPD with bronchiectasis group was higher than that in COPD group, the difference was statistically significant (P0.05). The levels of C-reactive protein, procalcitonin and fibrinogen in COPD with bronchiectasis group were significantly higher than those in COPD group. There was significant difference between the two groups (t = 2.66 卤2.25, P 0.05), and the albumin level in COPD with bronchiectasis group was significantly lower than that in COPD group. It was (31.2 卤2.5) g / L and (32.9 卤2.5) g / L, respectively, with significant difference (tr -2.97 卤P0.01) .5.The times of acute exacerbation in patients with COPD complicated with bronchiectasis within 6 months were significantly higher than those in COPD group (1.68 卤0.48 times / person, 1.28 卤0.45 times / person, respectively) (t = 2.97, P 0.01). The mortality rate of COPD with bronchiectasis group was 27.3%, which was significantly higher than that of COPD group (P0.05). Conclusion the patients with COPD complicated with bronchiectasis are more serious, inflammatory reaction is stronger, the course of treatment is longer, the lung function is worse, and the acute exacerbation is more frequent. Therefore, high resolution CT should be performed clinically in patients with chronic obstructive pulmonary disease (COPD) in order to make early diagnosis, early treatment and improve the prognosis of the patients.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R562.22
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