支气管哮喘支气管扩张表型临床特征研究  

Clinical characteristics of asthmatic patients with bronchiectasis phenotype

作　　者：盛海燕[1] 王玉红[1] 刘晓芳[1] 胥杰[1] 金建敏[1] 刘涌[1] Sheng Haiyan;Wang Yuhong;Liu Xiaofang;Xu Jie;Jin Jianmin;Liu Yong(Department of Respiratory and Critical Care Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,100730

出　　处：《国际呼吸杂志》2020年第18期1361-1366,共6页International Journal of Respiration

摘　　要：目的分析支气管哮喘(简称哮喘)合并支气管扩张患者的临床特征。方法回顾性收集2016年1月至2018年12月北京同仁医院呼吸科165例哮喘患者的临床资料,根据胸部高分辨率CT(HRCT)结果分为单纯哮喘组(87例)和哮喘合并支气管扩张组(78例),对比分析2组患者一般资料、肺功能、胸部HRCT、呼出气一氧化氮(FeNO)、诱导痰嗜酸粒细胞比例等结果差异。结果与单纯哮喘组相比,哮喘合并支气管扩张组男性比例增高(56.4%比40.2%,χ^2=4.315,P=0.038),哮喘病程较长[10(27)年比7(16)年,Z=-2.096,P=0.036],第1秒用力呼气容积/用力肺活量[(66.45±13.76)%比(73.31±14.50)%,t=3.063,P=0.003]、第1秒用力呼气容积占预计值百分比[(64.62±23.75)%比(73.57±23.67)%,t=2.383,P=0.018]及最大呼气中期流量占预计值百分比[24.80%(31.05%)比37.80%(40.00%),Z=-2.404,P=0.016]显著降低。气道炎症指标中,哮喘合并支气管扩张组FeNO≥25 ppb(68.6%比48.1%,χ^2=4.471,P=0.034)及支气管壁增厚(52.6%比10.3%,χ^2=34.710,P<0.001)患者比例高于单纯哮喘组。回归分析显示,哮喘病程长、FeNO≥25 ppb及支气管壁增厚是哮喘患者发生支气管扩张的危险因素。哮喘病程每增加1年,支气管扩张发生的风险增加5.4%;FeNO≥25 ppb的患者支气管扩张发生的风险增加2.923倍;支气管壁增厚患者支气管扩张发生的风险增加6.616倍。结论哮喘支气管扩张表型患者病史较长,气道阻塞程度和嗜酸性气道炎症更显著,临床需重视并加强其管理。Objective To evaluate the clinical features of asthmatic patients with bronchiectasis.Methods The data of 165 asthmatic patients in Department of Respiratory Medicine,Beijing Tongren Hospital from January 2016 to December 2018 were retrospectively analyzed.According to the high resolution computed tomography scanning results,the patients were divided into pure asthmatics group(PA group,n=87)and asthmatics with bronchiectasis group(BE group,n=78).The clinical data,pulmonary function,high resolution computed tomography,fractional exhaled nitric oxide(FeNO),as well as sputum eosinophil proportion were compared between the two groups.Results Compared with PA group,the patients of BE group had a higher male ratio(56.4%vs 40.2%,χ^2=4.315,P=0.038),and had a longer asthma duration[10(27)years vs 7(16)years,Z=-2.096,P=0.036].The BE group had a lower forced expiratory volume in one second/forced vital capacity[(66.45±13.76)%vs(73.31±14.50)%,t=3.063,P=0.003],percentage of forced expiratory volume in one second in the predicted value[(64.62±23.75)%vs(73.57±23.67)%,t=2.383,P=0.018]and percentage of maximum midexpiratory flow in the predicted value[24.80%(31.05%)vs 37.80%(40.00%),Z=-2.404,P=0.016]compared with PA group.The ratios of FeNO≥25 ppb(68.6%vs 48.1%,χ^2=4.471,P=0.034)and bronchial wall thickening(52.6%vs 10.3%,χ^2=34.710,P<0.001)in BE group were higher than those in PA group.The presence of bronchiectasis was associated with a longer duration of asthma(OR=1.054,95%CI:1.012-1.097,P=0.011),FeNO≥25 ppb(OR=3.923,95%CI:1.167-13.190,P=0.027)and greater severity of bronchial wall thickening(OR=7.616,95%CI:2.057-28.203,P=0.002).Conclusions Asthma patients with bronchiectasis tend to have longer duration of asthma,poorer lung function,and more obvious eosinophil airway inflammation.

关 键 词：哮喘 支气管扩张症 表型 气道炎症 

分 类 号：R562.25[医药卫生—呼吸系统] R562.22[医药卫生—内科学]