Guan W J, Yuan J J, Gao Y H, Li H M, Zhong N S, Chen R C
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Jan 12;40(1):16-23. doi: 10.3760/cma.j.issn.1001-0939.2017.01.005.
To investigate the association between hemoptysis and disease severity and risks of acute exacerbations in patients with bronchiectasis. Between September 2012 and January 2014, we recruited 148 patients (56 males, 92 females, mean age: 44.6 years) with clinically stable bronchiectasis, who were classified into hemoptysis group (36 males, 70 females, mean age: 45.6 years) and non-hemoptysis group (20 males, 22 females, mean age: 41.8 years). We inquired the past history, and evaluated chest imaging characteristics, lung function, cough sensitivity assessed using capsaicin cough challenge tests, and airway inflammation. We also performed a 1-year follow-up to evaluate whether patients with hemoptysis would have greater risk of having acute exacerbations. In the hemoptysis group, median 24-hour sputum volume was 20.0 ml, median Bronchiectasis Severity Index (BSI) was 7.0, median bronchiectatic lobes was 4.0, median chest CT score was 7.0, the geometric mean for eliciting 5 coughs following capsaicin cough sensitivity (C5) was 77 μmol/L, 67 cases (63%) had cystic bronchiectasis and 52 cases (49%) had pulmonary cavity shown on chest CT, and 35 cases (33%) had colonization. In the non-hemoptysis group, median 24-hour sputum volume was 5.0 ml, median BSI was 4.0, median bronchiectatic lobes was 3.0, median chest CT score was 5.0, 15 cases (36%) had cystic bronchiectasis and 10 cases (24%) had pulmonary cavity, the geometric mean for C5 was 212 μmol/L, and 4 cases (10%) had colonization. All the above parameters differed significantly between the hemoptysis and the non-hemoptysis group (<0.05). In the hemoptysis group, 29 patients with pulmonary cavity (27%) had reported the use of intravenous antibiotics, and 44 cases (42%) had at least one hospitalization within the previous 2 years. In the non-hemoptysis group, 8 cases (19.0%) had reported the use of intravenous antibiotics, and 8 cases (19.0%) reported hospitalization within 2 years. A prior history of hemoptysis was associated with a greater risk of experiencing bronchiectasis exacerbations during follow-up, after adjusting for age, sex, smoking status and BSI (62 cases in the hemoptysis group, 18 cases in the non-hemoptysis group, χ(2)=16.06, =0.03). In a multivariate model, cystic bronchiectasis was the sole risk factor for hemoptysis; 67 cases which accounted for 63% of patients in the hemoptysis group and 15 cases which accounted for 36% of patients in the non-hemoptysis group, odds ratio: 2.84, 95% confidence interval: 1.00-8.14, =0.05 . In this study, 72% of bronchiectasis patients had experienced hemoptysis, which was associated with the severity of bronchiectasis. Patients with a prior history of hemoptysis had a greater risk of acute exacerbations during follow-up than those without.
探讨咯血与支气管扩张症患者疾病严重程度及急性加重风险之间的关联。2012年9月至2014年1月期间，我们招募了148例临床稳定的支气管扩张症患者（男性56例，女性92例，平均年龄：44.6岁），将其分为咯血组（男性36例，女性70例，平均年龄：45.6岁）和非咯血组（男性20例，女性22例，平均年龄：41.8岁）。我们询问了既往病史，并评估了胸部影像学特征、肺功能、使用辣椒素咳嗽激发试验评估的咳嗽敏感性以及气道炎症。我们还进行了为期1年的随访，以评估咯血患者是否有更高的急性加重风险。在咯血组中，24小时痰液量中位数为20.0 ml，支气管扩张严重程度指数（BSI）中位数为7.0，支气管扩张肺叶中位数为4.0，胸部CT评分中位数为7.0，辣椒素咳嗽敏感性（C5）诱发5次咳嗽的几何平均值为77 μmol/L，67例（63%）有囊性支气管扩张，52例（49%）胸部CT显示有肺空洞，35例（33%）有定植。在非咯血组中，24小时痰液量中位数为5.0 ml，BSI中位数为4.0，支气管扩张肺叶中位数为3.0，胸部CT评分中位数为5.0，15例（36%）有囊性支气管扩张，10例（24%）有肺空洞，C5的几何平均值为212 μmol/L，4例（10%）有定植。上述所有参数在咯血组和非咯血组之间差异均有统计学意义（<0.05）。在咯血组中，29例有肺空洞的患者（27%）曾使用过静脉抗生素，44例（42%）在过去2年内至少有过1次住院治疗。在非咯血组中，8例（19.0%）曾使用过静脉抗生素，8例（19.0%）在2年内有过住院治疗。在对年龄、性别、吸烟状况和BSI进行校正后，咯血既往史与随访期间支气管扩张症加重的风险更高相关（咯血组62例，非咯血组18例，χ(2)=16.06，P=0.03）。在多变量模型中，囊性支气管扩张是咯血的唯一危险因素；咯血组中占63%的67例患者和非咯血组中占36%的15例患者，比值比：2.84，95%置信区间：1.00 - 8.14，P=0.05 。在本研究中，72%的支气管扩张症患者曾有过咯血，这与支气管扩张症的严重程度相关。有咯血既往史的患者在随访期间急性加重的风险高于无咯血既往史的患者。
