Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China.
Department of Interventional Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
J Infect Public Health. 2024 Jul;17(7):102446. doi: 10.1016/j.jiph.2024.05.003. Epub 2024 May 9.
Bronchiectasis has high rates of hemoptysis and recurrent hemoptysis, which is inconsistent among various etiologies. Idiopathic bronchiectasis and post-tuberculous bronchiectasis are two important etiologies in China, but the differences in clinical features and risk factors of recurrent hemoptysis have not been elucidated.
Patients hospitalized for idiopathic bronchiectasis or post-tuberculosis bronchiectasis were included. Patients were followed up for at least 24 months post-BAE. Demographic characteristics and clinical data were collected and analyzed between idiopathic bronchiectasis and post-tuberculosis bronchiectasis. Based on the outcomes of recurrent severe hemoptysis in patients with post-tuberculosis bronchiectasis, Cox regression models were used to identify risk factors for recurrence.
Among 417 patients including 352 idiopathic bronchiectasis and 65 post-tuberculous bronchiectasis, 209 (50.1%) were females. Compared with the idiopathic group, the proportion of patients with female (54.5% vs. 26.2%, p < 0.001), with sputum (79.5% vs. 36.9%, p < 0.001), isolation of Pseudomonas aeruginosa (28.7% vs. 7.7%, p < 0.001), and the number of bronchiectatic lobes≥ 3(98.3% vs 50.8%, p < 0.001) were lower, and the proportion of destroyed lung (4.5% vs. 26.6%, p < 0.001) and recurrence of severe hemoptysis (22.4% vs. 41.5%, p = 0.001) were higher in the post-tuberculous group. Among patients with post-tuberculosis bronchiectasis, destroyed lung [HR: 3.2(1.1,9.1), p = 0.026] and abnormal esophageal proper artery [HR: 2.8(1.1,7.0), p = 0.032] were two independent risk factors for the recurrence of hemoptysis.
The recurrence rate of severe hemoptysis in patients with post-tuberculous bronchiectasis receiving BAE is high, and the proper esophageal artery should be actively evaluated and standardized treatment should be given.
支气管扩张症有较高的咯血和复发性咯血发生率，不同病因之间的发生率不一致。特发性支气管扩张症和肺结核后支气管扩张症是中国两个重要的病因，但它们在临床特征和复发性咯血的危险因素方面的差异尚未阐明。
纳入因特发性支气管扩张症或肺结核后支气管扩张症住院的患者。在支气管动脉栓塞术（BAE）后至少对患者进行 24 个月的随访。收集并分析特发性支气管扩张症和肺结核后支气管扩张症患者的人口统计学特征和临床数据。根据肺结核后支气管扩张症患者中严重复发性咯血的结局，使用 Cox 回归模型来确定复发的危险因素。
在包括 352 例特发性支气管扩张症和 65 例肺结核后支气管扩张症在内的 417 例患者中，有 209 例（50.1%）为女性。与特发性组相比，肺结核后支气管扩张症组的女性患者比例（54.5%比 26.2%，p<0.001）、咳痰（79.5%比 36.9%，p<0.001）、分离出铜绿假单胞菌（28.7%比 7.7%，p<0.001）和支气管扩张叶数≥3（98.3%比 50.8%，p<0.001）较低，而肺部破坏（4.5%比 26.6%，p<0.001）和严重咯血复发（22.4%比 41.5%，p=0.001）较高。在肺结核后支气管扩张症患者中，肺部破坏[HR：3.2（1.1，9.1），p=0.026]和异常食管固有动脉[HR：2.8（1.1，7.0），p=0.032]是咯血复发的两个独立危险因素。
肺结核后支气管扩张症患者接受 BAE 后严重咯血的复发率较高，应积极评估食管固有动脉并给予规范治疗。
