支气管扩张患者急性加重危险因素分析  

Risk factors for acute exacerbation in patients with bronchiectasis

作　　者：杨丽青 杨小东[2] 杨凌婧 卢琪 籍佳琦 YANG Liqing;YANG Xiaodong;YANG Lijing;LU Qing;JI Jiaqi(Department of Respiratory and Critical Care Medicine,Sichuan Academy of Medical Sciences,East Courtyard of Si Chuan Provincial People's Hospital,Chengdu,Sichuan 610100,P.R.China;Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川省医学科学院四川省人民医院东院呼吸与危重症医学科,四川成都610100 [2]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2020年第6期543-547,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探寻支气管扩张(简称支扩)患者1年内发生急性加重的危险因素。方法选取2014年10月至2016年10月期间在四川省人民医院东院呼吸与危重症医学科住院治疗的非囊性纤维化支扩患者422例为研究对象。收集患者的相关临床资料,以患者出院为随访起点,以发生首次急性加重为结局事件,随访至出院后1年。根据是否在1年内发生急性加重分为急性加重组与非急性加重组,采用Logistic回归分析探讨支扩患者1年内发生急性加重的危险因素。结果两组患者的年龄、患病时间、体重指数、体重指数<18.5 kg/m2、吸烟指数、咳痰、咯血、呼吸困难、肺部湿啰音、肺部哮鸣音、影像学类型、支扩CT评分、支扩病变部位、痰培养细菌学培养、是否感染铜绿假单胞菌、血清C反应蛋白(CRP)、血清降钙素原、血清白蛋白、动脉血二氧化碳分压、呼吸衰竭类型、是否合并慢性肺源性心脏病均存在统计学差异(P<0.05)。而性别、既往感染病史、吸烟情况、咳嗽、胸痛、发热、杵状指、外周血白细胞计数、中心粒细胞计数、红细胞沉降率、血清球蛋白、动脉血氧分压无统计学意义(P>0.05)。多因素logistic回归分析显示:感染铜绿假单胞菌、体重指数<18.5 kg/m^2、血清CRP高、动脉血二氧化碳分压高、支扩CT评分高以及合并慢性肺源性心脏病是支扩患者1年内发生急性加重的危险因素(P<0.05)。结论感染铜绿假单胞菌、体重指数<18.5 kg/m^2、高血清CRP、高动脉血二氧化碳分压、支扩CT评分增高和合并慢性肺源性心脏病是支扩患者1年内发生急性加重的危险因素,临床医生可对危险因素进行早期识别及干预,以期减少支扩的急性加重。Objective To explorer the risk factors for acute exacerbation in patients with bronchiectasis within one year.Methods Four hundred and twenty-two patients with non-cystic fibrosis bronchiectasis hospitalized were enrolled in The East Region of the People’s hospital of Sichuan between October 2014 and October 2016.The patients’clinical data were collected,and follow-up began at the time of discharged.The study endpoint was the first acute exacerbation,all patients were followed-up for one year after discharged.The patients were classified into two groups by the occurrence of acute exacerbation or no occurrence.Logistic regression analysis was used to explore the risk factors for acute exacerbation with bronchiectasis.Results The age,sick time,body mass index(BMI)less than 18.5 kg/m^2,smoking index,expectoration,hemoptysis,dyspnea,moist sounds,wheezing sounds,types of imaging,CT scores,lung lesion site,sputum culture,whether infected Pseudomonas aeruginosa,level of serum C-reactive protein(CRP),level of serum PCT,serum albumin,arterial carbon dioxide partial pressure,types of respiratory failure,combined with chronic cor pulmonale differed significantly between the two groups(P<0.05),while gender,history of Infection,smoking,cough,chest pain,fever,clubbed-finger,white blood cell counts,neutrophil counts,erythrocyte sedimentation rate,serum globulins,arterial oxygen partial pressure did not significantly differ(P>0.05).Multivariate Logistic regression analysis found that infection with Pseudomonas aeruginosa,BMI<18.5 kg/m^2,high level of serum CRP,high level of arterial carbon dioxide partial pressure(PaCO2),high CT score with bronchiectasis,combination with chronic cor pulmonale were risk factors for acute exacerbation in patients with bronchiectasis(P<0.05).Conclusions Infection with pseudomonas aeruginosa,BMI<18.5 kg/m2,high serum CRP level,high arterial blood PaCO2 level,high CT score with bronchiectasis and combination of chronic cor pulmonale are risk factors for acute aggravation within 1 year for patient

关 键 词：支气管扩张 急性加重 危险因素 

分 类 号：R562.22[医药卫生—呼吸系统]