92例支气管扩张患者病因学分析及与疾病严重程度的关系

发布时间：2019-05-28 15:36

【摘要】：背景支气管扩张是由不同病因导致的一种持续的肺部炎症及反复感染的共同终末改变,即支气管不可逆性扩张。支气管扩张以往被认为是一种少见的疾病,缺乏大规模的流行病学资料及相关研究,对该病的认识不够充分,其发病率、死亡率和经济影响很可能被低估。高分辨CT(high resolution computed tomography,HRCT)是一种非侵入性、灵敏性高的检查手段,能够直观的显示出扩张的支气管。随着医疗水平的进步,HRCT也逐渐普及,人们对支气管扩张的诊断也越来越明确。英国胸科协会于2010年发布了最新的非囊性纤维化支气管扩张指南,指南中对支气管扩张的病因进行了分类,并建议对支气管扩张患者进行病因学治疗。支气管扩张的病因多种多样,通常包括以下几类:特发性、感染后、支气管粘膜纤毛清除功能障碍、原发性免疫缺陷、继发性免疫缺陷、自身免疫性疾病、变态反应性疾病、大气道先天发育异常、细支气管病及其他。支气管扩张严重程度指数(bronchiectasis severity index,BSI)是目前已被证实的一种支气管扩张严重程度分类系统及预测工具,包含有年龄、BMI、第1秒用力呼气容积占预计值百分比(FEV1pred%)、既往2年住院情况、既往1年急性加重次数、mMRC呼吸困难分级、细菌定植情况、放射学检查严重程度8个变量,可以从多维度综合评估支气管张的疾病严重程度。支气管扩张是一个高发病率、高死亡率的疾病,如果进行早期诊断,明确病因,评估疾病严重程度,予以不同的治疗方案,将有可能提高患者的生活质量,降低死亡率。目的探讨支气管扩张患者的病因谱及与疾病严重程度的关系。方法收集就诊于郑州大学第一附属医院呼吸内科的92例稳定期支气管扩张患者,按照英国非囊性纤维化支气管扩张指南进行综合检查,同时详细询问病史,明确患者病因。根据BSI评分评估患者疾病严重程度。结果1.一般资料:本研究入组的患者男性39例(42.4%),女性53例(57.6%),平均年龄(52.7±14.7)岁,50~69岁组患者有47例(51.0%)。2.病因学分析:92例支气管扩张患者的病因包括感染后(41.3%)、特发性支气管扩张(23.9%)、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)(18.5%)、哮喘(10.8%)、变态反应性支气管肺曲菌病(allergic bronchopulmonary aspergillosis,ABPA)(2.2%)、胃食管反流病(gastroesophageal reflux disease,GERD)(2.2%)和结缔组织疾病(connective tissue disease,CTD)(1.1%);其中,感染后支气管扩张中,结核感染占52.6%。不同性别支气管扩张患者的病因分布无统计学意义(P=0.662)。4.疾病严重程度分析:轻度患者35例(38.0%),中度患者13例(14.1%),重度患者44例(47.8%)。不同疾病严重程度的支气管扩张患者病因差异有统计学意义(P0.05),轻中度支气管扩张患者主要病因为特发性(轻度40.0%;中度38.4%)和感染后(轻度37.1%;中度23.1%);重度支气管扩张患者主要病因为感染后(50.0%)和COPD(27.3%)。随着疾病严重程度的增加,HRCT评分逐渐增高(P0.05)。结论1.感染后支气管扩张、特发性支气管扩张和COPD相关支气管扩张是成人支气管扩张最常见的病因。超过半数的感染后支气管扩张为结核感染。2.轻度和中度患者,均以特发性支气管扩张和感染后支气管扩张多见;重度患者以感染后支气管扩张和COPD相关支气管扩张多见。
[Abstract]:Background Bronchial dilation is a common terminal change of persistent pulmonary inflammation and repeated infections caused by different etiologies, that is, the irreversible expansion of the bronchi. Bronchiectasis is previously thought to be a rare disease, with a lack of large-scale epidemiological data and related studies, and is not sufficiently aware of the disease, and its morbidity, mortality and economic impact are likely to be underestimated. High resolution computed tomography (HRCT) is a non-invasive and high-sensitivity examination method. With the advancement of the medical level, HRCT is also becoming more and more popular, and the diagnosis of the bronchiectasis is also becoming more and more clear. The Association of the Chest of the United Kingdom, in 2010, released the latest guidelines for the non-cystic fibrosis of the bronchi, which classifies the causes of the bronchiectasis and recommends the treatment of patients with bronchiectasis. The causes of bronchiectasis are diverse and usually include the following categories: idiopathic, post-infection, bronchial mucociliary clearance dysfunction, primary immunodeficiency, secondary immune deficiency, autoimmune disease, allergic disease, and congenital development of the atmosphere, Bronchiolitis and others. The severity index (BSI) of the bronchiectasis is a classification system and a prediction tool for the severity of the bronchiectasis, including age, BMI, the percentage of forced expiratory volume in the first second (FEV1ppred%), and the previous 2-year hospitalization. In the past 1 year, the number of acute exacerbations, the grade of mMRC dyspnea, the condition of bacterial colonization, and the severity of radiological examination were 8 variables, and it was possible to comprehensively evaluate the severity of the disease from the multi-dimensional and comprehensive assessment of the severity of the disease. Bronchiectasis is a high-morbidity and high-mortality disease. If early diagnosis is carried out, the cause of the disease is determined, the severity of the disease is assessed, and different treatment schemes are provided, which can improve the quality of life of the patient and reduce the death rate. Objective To study the etiological spectrum of the patients with bronchiectasis and the relationship with the severity of the disease. Methods 92 patients with stable and stable bronchiectasis at the first affiliated hospital of Zhengzhou University were collected, and a comprehensive examination was conducted according to the guidance of the non-cystic fibrosis of the UK, and the medical history was inquired in detail, and the cause of the patient was determined. The severity of the patient's disease was assessed according to the BSI score. Results 1. General data:39 (42.4%) of the patients enrolled in the study,53 (57.6%) of women, mean age (52.7 to 14.7), and 47 (51.0%) in the 50 to 69-year-old group. The etiology of 92 cases of bronchiectasis included infection (41.3%), idiopathic bronchiectasis (23.9%), chronic obstructive pulmonary disease (COPD) (18.5%), asthma (10.8%), allergic bronchopulmonary aspergillosis, ABPA (2.2%), gastroesophageal reflux disease (GERD) (2.2%) and connective tissue disease (CTD) (1.1%), among which, tuberculosis was 52.6% after infection. There was no significant difference in the etiology of the patients with different sexes (P = 0.662). The severity of the disease was analyzed in 35 patients (38.0%), moderate in 13 (14.1%), and severe in 44 (47.8%). There was a significant difference in the cause of the patients with bronchiectasis (P0.05). The main diseases of the patients with mild and moderate bronchiectasis were idiopathic (mild 40.0%; moderate 38.4%) and after infection (mild 37.1%; moderate 23.1%); The major diseases in patients with severe bronchiectasis were due to post-infection (50.0%) and COPD (27.3%). With the increase of the severity of the disease, the HRCT score increased gradually (P0.05). Conclusion 1. Bronchiectasis, idiopathic bronchiectasis and COPD-associated bronchiectasis after infection are the most common cause of the bronchiectasis in adults. More than half of the post-infection bronchi are expanded to a tuberculosis infection. In mild and moderate patients, the bronchiectasis was common in the patients with idiopathic bronchiectasis and infection, and the bronchiectasis and the associated bronchiectasis in the patients with severe COPD were more common.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.22

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