Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medical Center, Chicago, IL.
Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medical Center, Chicago, IL.
Chest. 2012 Jul;142(1):159-167. doi: 10.1378/chest.11-1024.
Previous studies of patients with bronchiectasis have found that the cause is idiopathic in the majority of cases, but these studies were done in homogeneous populations. We hypothesized that the etiology of bronchiectasis can be determined in a higher percentage of patients in a diverse US population and will differ significantly based on ethnicity.
One hundred twelve patients with bronchiectasis confirmed by chest CT scan entered the study. Data from 106 patients were available for full evaluation. Clinical questionnaire, pulmonary function tests, sputum microbiology, laboratory data, and immune function testing were done. Results were analyzed by ethnicity and etiology.
Patients were 61.6% European American (EA), 26.8% African American (AA), 8.9% Hispanic American (HA), and 2.7% Asian American. A cause of bronchiectasis was determined in 93.3% of patients. In 63.2% of patients, bronchiectasis was caused by immune dysregulation, including deficiency (n = 18 [17%]), autoimmune disease (n = 33 [31.1%]), hematologic malignancy (n = 15 [14.2%]), and allergic bronchopulmonary aspergillosis (n = 1 [0.9%]). Rheumatoid arthritis was the cause of bronchiectasis in 28.6% of AA patients vs 6.2% of EA patients (P < .05). Hematologic malignancy was the etiology in 20.0% of the EA patients vs none of the AA patients (P = .02). A significantly higher percentage of HA patients had Pseudomonas aeruginosa in their sputum compared with AA and EA patients (P = .01).
The etiology of bronchiectasis can be determined in the majority of patients in a heterogeneous US population and is most often due to immune dysregulation. Rheumatoid arthritis is more likely in AA patients than EA patients. HA patients are more likely to have P aeruginosa in their sputum.
既往对支气管扩张症患者的研究发现，多数患者的病因是特发性的，但这些研究均在同质性人群中进行。我们推测，在一个多样化的美国人群中，可以确定更高比例的支气管扩张症患者的病因，并且根据种族的不同，病因也会有很大的差异。
112 例经胸部 CT 扫描确诊的支气管扩张症患者入组本研究。106 例患者的资料可用于全面评估。进行了临床问卷、肺功能检查、痰微生物学、实验室数据和免疫功能检测。根据种族和病因进行了结果分析。
患者中 61.6%为欧洲裔美国人（EA），26.8%为非裔美国人（AA），8.9%为西班牙裔美国人（HA），2.7%为亚裔美国人。93.3%的患者确定了支气管扩张症的病因。在 63.2%的患者中，支气管扩张症是由免疫失调引起的，包括缺陷（18 例[17%]）、自身免疫性疾病（33 例[31.1%]）、血液恶性肿瘤（15 例[14.2%]）和变应性支气管肺曲霉病（1 例[0.9%]）。类风湿关节炎是 AA 患者支气管扩张症的病因，占 28.6%，而 EA 患者仅占 6.2%（P <.05）。血液恶性肿瘤是 EA 患者的病因（20.0%），而 AA 患者无此病因（P =.02）。与 AA 和 EA 患者相比，HA 患者的痰中铜绿假单胞菌的比例明显更高（P =.01）。
在一个异质的美国人群中，大多数支气管扩张症患者的病因可以确定，并且最常见的病因是免疫失调。与 EA 患者相比，AA 患者更有可能患有类风湿关节炎。HA 患者的痰中更有可能存在铜绿假单胞菌。
