摘要
目的探讨支气管扩张症患者的肺功能损害与临床特点之间的相关性,分析肺功能损害相关因素。方法选择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症专病门诊诊断为支气管扩张症,且有肺功能资料的患者。收集患者的人口学特征、病史、临床表现、实验室指标、肺功能指标、影像学表现、治疗信息等。将患者按肺功能指标第1秒用力呼气量占预计值的百分比(FEV1%pred)和肺一氧化碳弥散量占预计值的百分比(DLCO%pred)分组,比较各组临床特征、实验室指标等。通过logistic回归分析筛选影响肺功能的相关因素。结果共纳入160例患者,不同FEV1%pred和DLCO%pred组间患者过去1年内急性加重次数、CT图像上累及的肺叶数、Reiff评分、临床症状、痰培养铜绿假单胞菌阳性比例、24 h痰量、白细胞计数差异有统计学意义(P<0.05)。多因素logistic回归分析显示,慢性阻塞性肺疾病评估测试(CAT评分;OR=1.170,95%CI 1.059~1.293,P<0.01)升高、Reiff评分升高(OR=1.541,95%CI1.236~1.920,P<0.01)、铜绿假单胞菌阳性(OR=8.166,95%CI 1.727~38.623,P<0.01)和病程≥10年(OR=4.933,95%CI 1.371~17.753,P<0.05)为FEV1%pred<50%的独立危险因素;CAT评分升高(OR=1.083,95%CI 1.003~1.169,P<0.05)和CT图像上累及的肺叶数≥3叶(OR=3.914,95%CI 1.316~11.646,P<0.05)为DLCO%pred<80%的独立危险因素。结论病程越长、Reiff评分越高,影像学上累及的肺叶数目越多,支气管扩张症患者肺功能受损越严重。
Objective To explore the relevant factors affecting pulmonary function in patients with bronchiectasis.Methods The patients diagnosed with bronchiectasis in Zhongshan Hospital,Fudan University from January 1,2017 to December 31,2019 were selected.Baseline data including demographic information,medical history,clinical manifestations,laboratory indicators,pulmonary function(spirometry and diffusing capacity),chest high-resolution computed tomography(HRCT),and treatment information.Patients were divided into different groups according to different grades of the percentage of predicted value of forced expiratory volume in one second(FEV1%pred)and the percentage of predicted value of diffusion capacity for carbon monoxide of lung(DLCO%pred),and the clinical characteristics,laboratory indicators were compared among the different groups.Logistic regression analysis was used to analyze the related factors affecting pulmonary function.Results 160 patients were included.There were statistically significant differences in the number of acute exacerbations past 1 year,number of involved lung lobes on CT images,Reiff score,clinical symptoms,positive proportion of Pseudomonas aeruginosa in sputum culture,24-hour sputum volume,and white blood cell count in patients with different FEV1%pred or DLCO%pred grades(P<0.05).Multivariate logistic regression analysis showed that higher COPD assessment test(CAT score;OR=1.170,95%CI 1.059-1.293,P<0.01),higher Reiff score(OR=1.541,95%CI 1.236-1.920,P<0.01),Pseudomonas aeruginosa positive(OR=8.166,95%CI 1.727-38.623,P<0.01)and disease duration≥10 years(OR=4.933,95%CI 1.371-17.753,P<0.05)were independent risk factors of FEV1%pred<50%;higher CAT score(OR=1.083,95%CI 1.003-1.169,P<0.05)and the number of lobe involved on CT images≥3(OR=3.914,95%CI 1.316-11.646,P<0.05)were independent risk factors of DLCO%pred<80%.Conclusion The longer disease duration,higher Reiff score,more lobes involved,the more severe the pulmonary function damage in bronchiectasis patients.
作者
周楚君
李华茵
ZHOU Chujun;LI Huayin(Department of Respiratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中国临床医学》
2024年第3期477-483,共7页
Chinese Journal of Clinical Medicine
基金
上海市肺部炎症与损伤重点实验室(20DZ2261200)
上海市临床重点专科建设项目(shslczdzk02201)
