De Soyza Anthony, McDonnell Melissa J, Goeminne Pieter C, Aliberti Stefano, Lonni Sara, Davison John, Dupont Lieven J, Fardon Thomas C, Rutherford Robert M, Hill Adam T, Chalmers James D
Adult Bronchiectasis Service & Sir William Leech Centre for Lung Research, Freeman Hospital, Heaton, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
Chest. 2017 Jun;151(6):1247-1254. doi: 10.1016/j.chest.2016.12.024. Epub 2017 Jan 16.
This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI).
Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded.
A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%).
Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality.
本研究评估了支气管扩张（BR）与类风湿性关节炎（RA）表现为重叠综合征（BROS）时，与应用支气管扩张严重程度指数（BSI）的其他BR病因相比，是否与更差的预后相关。
从六个中心的1716例成年BR患者的BSI数据库中收集数据：英国爱丁堡（608例患者）；英国邓迪（n = 286）；比利时鲁汶（n = 253）；意大利蒙扎（n = 201）；爱尔兰戈尔韦（n = 242）；以及英国纽卡斯尔（n = 126）。患者被分类为患有BROS（患有RA和BR但无间质性肺病的患者）、特发性BR、支气管扩张-慢性阻塞性肺疾病重叠综合征（BCOS）以及“其他”BR病因。记录死亡率、住院情况和加重频率。
共识别出147例BROS患者（占队列的8.5%）。BROS与死亡率之间存在统计学显著关系，尽管这种关系与BR加重率或BR相关住院率较高无关。特发性BR平均48个月的死亡率为9.3%，其他BR病因患者为8.6%，RA患者为18%，BCOS患者为28.5%。与所有其他病因患者相比，BROS和BCOS患者的死亡率在统计学上更高。与特发性BR患者相比，BROS患者的BSI评分在统计学上更高，但在临床上无显著差异（BSI平均值分别为7.7和7.1；P <.05）。BCOS患者的BSI评分显著更高（平均值为10.4），铜绿假单胞菌定植率（24%）和既往住院率（58%）也更高。
BROS和BCOS组的死亡率均过高。这一发现的机制可能很复杂，但这些数据强调，这些亚组需要进一步研究以了解这种过高的死亡率。
