成人支气管扩张症预后影响因素分析  

Prognostic factors analysis in adult patients with bronchiectasis

作　　者：周楚君 李倬哲 王琴 李华茵 ZHOU Chu-jun;LI Zhuo-zhe;WANG Qin;LI Hua-yin(Department of Respiratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院呼吸内科,上海200032

出　　处：《中国临床医学》2023年第4期628-635,共8页Chinese Journal of Clinical Medicine

基　　金：上海市临床重点专科建设项目(shslczdzk02201);上海市肺部炎症与损伤重点实验室(20DZ2261200).

摘　　要：目的探讨成人支气管扩张症患者不良预后的相关因素,并检验支气管扩张严重程度指数(bronchiectasis severity index,BSI)和支气管扩张症严重程度分级(FACED)评分2种评分系统预测此类患者不良预后的能力。方法回顾性选择2017年1月1日至2019年12月31日在复旦大学附属中山医院支气管扩张专病门诊就诊的明确诊断为支气管扩张症且有肺功能资料的患者160例。电话随访12个月,根据预后情况将患者分为预后良好组(n=85)和预后不良组(n=75)。采用多因素logistic回归模型筛选出与其预后相关的危险因素。基线记录为确定BSI和FACED评分提供了数据。采用ROC曲线分析BSI和FACED评分系统对支气管扩张症患者预后的预测价值。结果在多因素logistic回归模型中,病程≥10年(OR=3.142,95%CI 1.325~7.451)、第1秒用力呼气量占预计值的百分比(FEV1%pred)<50%(OR=5.988,95%CI 1.715~20.833)、BMI<18.5 kg/m2(OR=4.762,95%CI 1.247~18.120)、铜绿假单胞菌阳性(OR=3.534,95%CI 1.135~11.007)和咯血(OR=2.551,95%CI 1.070~6.097)是预后不良的独立预测因子(均P<0.05)。在ROC曲线中,BSI(AUC=0.890)较FACED评分系统(AUC=0.753)预测预后不良的能力更强;将CT评分、改良呼吸困难指数(mMRC)和BMI三者结合评价支气管扩张症患者预后不良的准确性较好(AUC=0.842)。结论病程≥10年、FEV1%pred<50%、BMI<18.5 kg/m2、铜绿假单胞菌阳性和咯血是预后不良的独立预测因子。BSI和FACED评分系统对预测支气管扩张症患者预后不良均有较强的能力;CT评分、mMRC和BMI三者结合是一种更简易的预后预测模型。Objective To explore the factors associated with poor prognosis of cohort patients,and to test the ability of bronchiectasis severity index(BSI)and FEV1-Age-Chronic colonization by Pseudomonas aeruginosa-extension-dyspnoea(FACED)scoring systems in predicting poor prognosis of cohort patients.Methods From January 1,2017 to December 31,2019,160 patients diagnosed with bronchiectasis were recruited in Zhongshan Hospital,Fudan University to analyze this retrospective cohort study.All patients were followed up for 12 months by telephone to analyze the prognosis.Patients were divided into a good prognosis group(n=85)and a poor prognosis group(n=75)based on their prognosis.Multivariate logistic regression analysis model was used to identify risk factors related to prognosis.Baseline records provided data for determining BSI and FACED.ROC curve was drawn to analyze the predictive value of BSI and FACED scoring system for prognostic risk of these patients.Results In the multivariate logistic regression analysis model,the disease duration≥10 years(OR=3.142,95%CI 1.325-7.451),FEV1%pred<50%(OR=5.988,95%CI 1.715-20.833),BMI<18.5 kg/m2(OR=4.762,95%CI 1.247-18.120),Pseudomonas aeruginosa positive(OR=3.534,95%CI 1.135-11.007)and hemoptysis(OR=2.551,95%CI 1.070-6.097)were independent predictors for poor prognosis(all P<0.05).In ROC analysis,BSI(AUC=0.890)was more accurate in predicting poor prognosis than FACED(AUC=0.753)in clinical application.CT score,Modified British medical research council(mMRC)and BMI were combined to evaluate poor prognosis in patients with bronchiectasis,which had a good accuracy(AUC=0.842).Conclusions Disease duration≥10 years,FEV1%pred<50%,BMI<18.5 kg/m2,Pseudomonas aeruginosa positivity and hemoptysis are independent predictors of poor prognosis.Both BSI and FACED scoring systems have a strong ability to predict poor prognosis in patients with bronchiectasis.The combination of CT score,mMRC and BMI is a simpler prognosis prediction model.

关 键 词：支气管扩张症 预后 支气管扩张严重度指数 支气管扩张症严重程度分级评分 

分 类 号：R562.2[医药卫生—呼吸系统]