Xu Jin-Fu, Zheng Hui-Zhen, Lu Hai-Wen, Wang Ling-Wei, Wu Bin, Lv Xiao-Dong, Luo Hong, Feng Jian, Li Yuan-Yuan, Liu Lin, Jia Jin-Guang, Mo Wei-Qiang, Gu Hong-Yan, Jiang Jing-Bo, Wang Dao-Xin, Wang Bin, Li Li, Yuan Zhi, Li Wen, Xie Min, Jie Zhi-Jun, Fan Xiao-Yun, Li Dan, Tian Xinlun, Zhang Min, Guan Wei-Jie, Fan Hong, Song Yuan-Lin, He Jian, Chu De-Jie, Du Chun-Ling, Zhang Jian-Quan, Cao Chao, Qu Jie-Ming, Chalmers James D
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China; Department of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, China.
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, China.
Lancet Respir Med. 2025 Feb;13(2):166-176. doi: 10.1016/S2213-2600(24)00364-3. Epub 2025 Jan 10.
Bronchiectasis is a disease with a global impact, but most published data come from high-income countries. We aimed to describe the clinical characteristics of patients with bronchiectasis in China.
The Chinese Bronchiectasis Registry (BE-China) is a prospective, observational cohort enrolling patients from 111 hospitals in China. Data on demographics, comorbidities, and aetiological testing results were collected from adult patients with bronchiectasis at baseline and annual follow-up. Patients who met the inclusion criteria (age ≥18 years; received chest high-resolution CT in the past year showing bronchiectasis affecting one or more lung lobes; and clinical history consistent with bronchiectasis, including chronic cough, daily sputum production, and history of exacerbations) were included. Patients with known cystic fibrosis were excluded. To investigate variations according to different economic regions, two groups were compared based on whether per capita disposable income of residents was greater than US$5553. Clinical characteristics were compared with the European (EMBARC) registry and other national registries.
Between Jan 10, 2020, and March 31, 2024, 10 324 patients from 97 centres were included in the study. Among 9501 participants with available data, the most common cause of bronchiectasis was post-infective disease (4101 [43·2%] patients), followed by idiopathic (2809 [29·6%] patients). 6676 (70·0%) of 9541 patients with available data had at least one exacerbation in the year before enrolment and 5427 (57·2%) of 9489 patients with available data were hospitalised at least once due to exacerbations. Treatments commonly used in high-income countries, such as inhaled antibiotics and macrolides, were infrequently used in China. Implementation of airway clearance in China was scarce, with only 1177 (12·2%) of 9647 patients having used at least one method of airway clearance. Compared with upper-middle-income regions, patients from lower-middle-income regions were younger (61·0 years [SD 14·0] vs 63·9 years [14·2]) with a higher proportion of pulmonary comorbidities (521 [17·8%] of 2922 patients vs 639 [8·6%] of 7402 with chronic obstructive pulmonary disease and 194 [6·6%] of 2922 patients vs 364 [4·9%] of 7402 patients with asthma), a higher tuberculosis burden (442 [16·0%] of 2768 patients vs 715 [10·6%] of 6733 patients), more severe radiological involvement (1160 [42·4%] of 2736 patients vs 2415 [35·4%] of 6816 patients with cystic bronchiectasis), more exacerbations (median 1·4 [IQR 0-2] in both groups; mean 1·4 [SD 1·6] vs 1·2 [1·4] in the previous year) and hospitalisations (1662 [60·6%] of 2743 patients vs 3765 [55·8%] of 6746 patients hospitalised at least once in the previous year), and poorer quality of life (median 57·4 [IQR 53·5-63·1] vs 58·7 [54·8-64·8] assessed by the Bronchiectasis Health Questionnaire).
The clinical characteristics of patients with bronchiectasis in China show differences compared with cohorts in Europe and India. Bronchiectasis is more severe with a higher burden of exacerbations in lower-income regions. The management of patients with bronchiectasis in China urgently needs standardisation and improvement.
National Natural Science Foundation of China, Innovation Program of the Shanghai Municipal Education Commission, Program of the Shanghai Municipal Science and Technology Commission, and Program of the Shanghai Shenkang Development Center.
For the Chinese translation of the abstract see Supplementary Materials section.
支气管扩张是一种具有全球影响的疾病，但大多数已发表的数据来自高收入国家。我们旨在描述中国支气管扩张患者的临床特征。
中国支气管扩张登记研究（BE-China）是一项前瞻性观察性队列研究，纳入了来自中国111家医院的患者。在基线和年度随访时收集成年支气管扩张患者的人口统计学、合并症和病因学检测结果数据。纳入符合纳入标准的患者（年龄≥18岁；过去一年接受胸部高分辨率CT显示支气管扩张累及一个或多个肺叶；临床病史与支气管扩张一致，包括慢性咳嗽、每日咳痰和加重病史）。排除已知患有囊性纤维化的患者。为了调查不同经济区域的差异，根据居民人均可支配收入是否大于5553美元将两组进行比较。将临床特征与欧洲（EMBARC）登记研究和其他国家登记研究进行比较。
在2020年1月10日至2024年3月31日期间，来自97个中心的10324例患者纳入研究。在9501例有可用数据的参与者中，支气管扩张最常见的病因是感染后疾病（4101例[43.2%]患者），其次是特发性（2809例[29.6%]患者）。在9541例有可用数据的患者中，6676例（70.0%）在入组前一年至少有一次病情加重，在9489例有可用数据的患者中，5427例（57.2%）因病情加重至少住院一次。高收入国家常用的治疗方法，如吸入性抗生素和大环内酯类药物，在中国很少使用。中国气道清理措施的实施很少，在9647例患者中，只有1177例（占12.2%）使用过至少一种气道清理方法。与中高收入地区相比，中低收入地区的患者更年轻（61.0岁[标准差14.0] vs 63.9岁[14.2]），肺部合并症比例更高（2922例患者中有521例[17.8%]患有慢性阻塞性肺疾病，而7402例中有639例[8.6%]；2922例患者中有194例[6.6%]患有哮喘，而7402例中有364例[4.9%]），结核病负担更高（2768例患者中有442例[16.0%]，而6733例中有715例[10.6%]），放射学累及更严重（2736例患者中有1160例[42.4%]患有囊性支气管扩张，而6816例中有2415例[35.4%]），病情加重更多（两组中位数均为1.4[四分位距0-2]；前一年均值为1.4[标准差1.6] vs 1.2[1.4]）以及住院更多（2743例患者中有1662例[60.6%]在前一年至少住院一次，而6746例中有3765例[55.8%]），生活质量更差（通过支气管扩张健康问卷评估，中位数为57.4[四分位距53.5-63.1] vs 58.7[54.8-64.8]）。
中国支气管扩张患者的临床特征与欧洲和印度队列相比存在差异。低收入地区支气管扩张更严重，病情加重负担更高。中国支气管扩张患者的管理迫切需要标准化和改善。
中国国家自然科学基金、上海市教育委员会创新计划、上海市科学技术委员会项目以及上海申康发展中心项目。
摘要的中文翻译见补充材料部分。
