以肺气肿为主的慢性阻塞性肺疾病患者中支气管扩张的高患病率。
High prevalence of bronchiectasis in emphysema-predominant COPD patients.
作者信息
Dou Shuang, Zheng Chunyan, Cui Liwei, Xie Mengshuang, Wang Wei, Tian Hui, Li Kang, Liu Kaidi, Tian Xinyu, Wang Xin, Zhang Qun, Ai Xin, Che Junchao, Liu Qixiao, Li Haijun, Xiao Wei
机构信息
Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China,
Department of Cadre Health Care, Qilu Hospital, Shandong University, Jinan, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2018 Jun 27;13:2041-2047. doi: 10.2147/COPD.S163243. eCollection 2018.
BACKGROUND
COPD has been identified as an etiology or related disease of bronchiectasis, and bronchiectasis has been classified as a comorbidity of COPD. In this study, we investigated the prevalence of bronchiectasis in different phenotypes of COPD subjects and the correlation between bronchiectasis and different phenotypes, especially emphysema.
METHODS
COPD patients were recruited from April 2012 to December 2015. The presence of bronchiectasis and related information were statistically analyzed. COPD subjects were separated into subgroups in two ways: COPD with and without bronchiectasis groups and emphysema-predominant (emphysema index, EI≥9.9%) and non-emphysema-predominant (EI<9.9%) groups.
RESULTS
In total, 1,739 COPD patients were incorporated into the study, among which 140 cases (8.1%) were accompanied with radiological bronchiectasis. COPD patients with concomitant bronchiectasis presented worse pulmonary function (FEV% predicted, <0.001), higher EI (15.0% vs 13.4%, <0.001), and higher proportion of pulmonary hypertension and cor pulmonale (6.4% vs 2.4%, =0.005 and 23.6% vs 16.1%, =0.022) than patients without bronchiectasis. Of all the COPD patients, 787 with EI data were divided into emphysema-predominant (n=369) and non-emphysema-predominant groups (n=418). The proportion of bronchiectasis was 16.5% and 10.3% (=0.01), respectively. Severity of bronchiectasis increased as the degree of airflow limitation (=-0.371, <0.001) and emphysema increased (=0.226, =0.021). After adjusting confounding factors, FEV% predicted (OR, 1.636; 95% CI, 1.219-2.197; =0.001) and EI (OR, 1.993; 95% CI, 1.199-3.313; =0.008) were significantly related with the presence of bronchiectasis in COPD patients.
CONCLUSION
The proportion of bronchiectasis is higher in emphysema-predominant COPD subjects. Emphysema measured by EI and FEV% predicted are independent predictors for bronchiectasis in COPD subjects, while the underlying mechanism deserves further investigation.
背景
慢性阻塞性肺疾病（COPD）已被确定为支气管扩张的病因或相关疾病，支气管扩张已被归类为COPD的合并症。在本研究中，我们调查了COPD患者不同表型中支气管扩张的患病率，以及支气管扩张与不同表型，尤其是肺气肿之间的相关性。
方法
2012年4月至2015年12月招募COPD患者。对支气管扩张的存在情况及相关信息进行统计分析。COPD患者按两种方式分为亚组：有和无支气管扩张的COPD组，以及以肺气肿为主（肺气肿指数，EI≥9.9%）和非肺气肿为主（EI<9.9%）组。
结果
总共1739例COPD患者纳入研究，其中140例（8.1%）伴有影像学支气管扩张。伴有支气管扩张的COPD患者肺功能更差（预测FEV%，<0.001），EI更高（15.0%对13.4%，<0.001），肺动脉高压和肺心病的比例更高（6.4%对2.4%，=0.005；23.6%对16.1%，=0.022）。在所有COPD患者中，787例有EI数据的患者分为以肺气肿为主组（n=369）和非肺气肿为主组（n=418）。支气管扩张的比例分别为16.5%和10.3%（=0.01）。支气管扩张的严重程度随着气流受限程度（=-0.371，<0.001）和肺气肿程度的增加而增加（=0.226，=0.021）。调整混杂因素后，预测FEV%（OR，1.636；95%CI，1.2（此处原文可能有误，推测应为1.219）-2.197；=0.001）和EI（OR，1.993；95%CI，1.199-3.313；=0.008）与COPD患者支气管扩张的存在显著相关。
结论
以肺气肿为主的COPD患者中支气管扩张的比例更高。通过EI和预测FEV%测量的肺气肿是COPD患者支气管扩张的独立预测因素，但其潜在机制值得进一步研究。
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