慢性阻塞性肺疾病合并支气管扩张患者的肺功能评价

摘要

目的：探讨慢性阻塞性肺疾病(COPD)合并支气管扩张的临床特点及肺功能变化。方法整群收集2013年1月—2015年12月就诊莆田学院附属医院的COPD患者,分为慢阻肺合并支气管扩张组(n=96)、单纯慢阻肺组(n=112)。比较两组患者的临床特征、胸部高分辨率CT( HRCT)、吸烟指数、肺功能表现,随访2年记录两组患者的急性加重次数、每次急性加重的住院时间。结果在入选的所有COPD患者中,COPD 合并支气管扩张的患者占46.2%(96/208)。与单纯慢阻肺组患者相比,慢阻肺合并支气管扩张组患者FVC%pred、FEV1% pred、、DLCO%pred、 FEV1/FVC降低幅度更为显著(P<0.01)。慢阻肺合并支气管扩张组2年内平均每人发生急性加重次数(2.4±1.4)次；高于单纯慢阻肺组患者(1.5±1.6)次,两者比较差异有统计学意义(P<0.01)；慢阻肺合并支气管扩张组每次住院时间(12.9±8.6)d；高于慢阻肺组患者(8.3±7.4)d,两者比较差异有统计学意义(P<0.01)。结论慢阻肺合并支气管扩张的患者较为常见,在临床表现上容易混淆,根据既往病史、家族史、肺功能检查可进一步区分。合并支气管扩张的慢阻肺患者肺功能下降更为明显,发生急性加重的风险增加,住院时间延长。%Objective To investigate the clinical characteristics and pulmonary function of chronic obstructive pulmonary disease ( COPD) combined bronchiectasis (BE). Methods Group selection to collect all cases of the COPD and BE patients of respiratory department in The Affiliated Hospital Of Putian University from January 2013 to December,2015.The study selected 208 patients to compare their clinical characteristics,HRCT,smoking index and pulmonary function,which includ-ed 112 cases of COPD patients ( the COPD group) and 96 cases of COPD patients complicated with bronchiectasis ( the study group). The times of acute exacerbation and hospital stays in the two years follow-up were also observed. Results These Results show the cases of COPD combined bronchiectasis is 46.2%(96/208) in all patients. The decline of FEV1%pred,FEV1 /FVC,FVC% pred and DLCO%pred was more pronounced in the study group than in the COPD group (P<0.01). The times of exacerbation during the two years follow-up was (2.4±1.4) times in the study group,which was higher than that of the COPD group (1.5±1.6) times.Meanwhile,The hospital stays was (12.9±8.6)d in the study group,which was also higher than that of the COPD group (8.3±7.4) d. the difference was statistically significant. Conclusion The differential diagnosis is easily confused between COPD and bronchiectasis.It is very common that COPD patients are complicated with bronchiectasis,who show a lower lung function ,prolonged hospitalized course and and have a higher risk of exacerbation.