慢性阻塞性肺疾病合并支气管扩张患者临床特点分析  

Characteristics of clinical feature in the patients with chronic obstructive pulmonary disease withbronchiectasis

作　　者：赵京梅 阎锡新[1] 李国翔[2] 王永红[2] 夏远舰[2] Zhao Jingmei;Yan Xixin;Li Guoxiang;Wang Yonghong;Xia Yuanjian(Department of Pulmonary and Critical Care Medicine,the Second Hospital of Hebei MedicalUniversity,Hebei Institute of Respiratory Diseases,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院呼吸与危重症学科河北省呼吸病研究所,石家庄050000 [2]邯郸市中心医院呼吸内科,056001

出　　处：《国际呼吸杂志》2018年第19期1460-1464,共5页International Journal of Respiration

基　　金：河北省政府雾霾专项资金资助（2014,2016年度）（冀卫财务函[2014]129号）

摘　　要：目的分析中重度慢性阻塞性肺疾病（COPD）合并支气管扩张患者的临床特点。方法收集2015至2016年河北医科大学第二医院和邯郸市中心医院慢性阻塞性肺疾病急性加重期住院患者200例，其中男173例，女27例，年龄56-78岁，平均年龄（68．53±9．62）岁。对所有人选患者进行痰培养，胸部高分辨率CT（HRCT）扫描，出院后稳定期行肺功能随访。从HRCT电脑图像中截取肺尖部、隆突水平及右膈顶上各两个层面，层厚〈2mm，以便判定肺气肿特征与支气管表现。结果200例COPD患者中，86例合并支气管扩张，114例无支气管扩张。86例合并支气管扩张患者中，23例为中度COPD，63例为重度COPD。COPD合并支气管扩张患者临床症状更多，长期咳黄痰或黄白黏痰患者63例，1年内至少一次急性加重人院患者74例，痰培养阳性患者34例。中重度COPD患者中43％合并支气管扩张，其中柱型支气管扩张占72.09％（62例），支气管扩张下叶分布者占67．44％（58例）。结论HRCT是诊断COPD合并支气管扩张的重要手段。COPD合并支气管扩张者气流阻塞更趋严重，急性加重与下呼吸道细菌感染频繁。Objective To analyse the clinical characteristics of moderate and severe chronic obstructive pulmonary disease （COPD） patients with bronchiectasis. Methods We examined 200 patients with acute exacerbation of COPD hospitalized in the Second Hospital of Hebei Medical University and Handan Central Hospital from 2015 to 2016 included 173 males and 27 females, 56-78 years old, mean age （68.53 ± 9.62） years old. Pulmonary function tests, sputum culture, and high-resolution chest CT （HRCT） scans were performed on all selected patients. Pulmonary function test was carried out during stable phase. We selected six levels from every patientrs HRCT, which include each two level images from lung apex, tracheal carina and above the right diaphragm. These images were taken with 〈2 mm collimation at end expiration following a forced vital. The characteristics of emphysema and bronchial performance were judged. Results There were 86 cases of COPD patients with bronchiectasis and 114 cases without it. These 86 cases of patients （43% in total） included 23 cases of patients with moderate COPD and 63 cases of patients with severe COPD. The COPD patients complicating with bronchiectasis exhibited more severe symptoms. They have chronic expectoration （cough yellow sputum or yellow white phlegm） in 63 cases, acute exacerbations admitted to hospital at least once a year in 74 cases, sputum culture positive in 34 cases. The moderate and severe COPD patient with bronchiectasis was 43%,including 62 cases of cylindrical bronchiectasis and 58 cases of bronchiectasis in the lower lobe distribution. Conclusions HRCT plays an important role in diagnosis of COPD complicated with bronchiectasis. COPD complicated with bronchiectasis have more severe airflow obstruction, acute exacerbation and lower respiratory tract bacterial infections frequent compare with COPD alone.

关 键 词：慢性阻塞性肺疾病 急性加重期 支气管扩张症 表型 预后 

分 类 号：R563.9[医药卫生—呼吸系统] R562.22[医药卫生—内科学]