成人支气管扩张症的临床特点

目的 分析成人支气管扩张症的临床特点, 并探索不同影像学类型的差异。方法 选取从2011年9月至2014年8月, 于山东省2家三甲综合性医院收治、经高分辨率CT确诊为支气管扩张症的成人患者313例。分析其病因、临床表现、影像学、肺功能及痰培养等, 并比较不同影像学类型的临床表现的差异。结果 特发性(217例, 69.3%)是支气管扩张症最常见的病因, 其次为结核后(57例, 18.2%)。最常见的病变部位为左肺下叶(219例, 70.0%)。咳嗽(296例, 94.6%)、咯痰(285例, 91.1%)、咯血(127例, 40.6%)及湿罗音(195例, 62.3%)是支气管扩张症的特征表现。218例(69.6%)患者的肺功能异常, 最常见的是阻塞性通气功能障碍(136例, 62.4%)。144例(46.0%)患者的痰培养阳性, 最常见的病原菌为铜绿假单胞菌(106例, 73.6%)。囊状支气管扩张症患者更易出现咯痰、呼吸困难、发热及乏力症状(P均<0.001)。结论 特发性支气管扩张症最常见, 咳嗽、咯痰、咯血及固定湿罗音是支气管扩张症的特征表现, 囊状支气管扩张症的临床表现较严重。

Clinical evaluation of adult patients with bronchiectasis

Objective To evaluate the clinical manifestations of adult patients with bronchiectasis, and to explore the difference among diverse imaging types on high-resolution chest CT scan. Methods Adult patients diagnosed with bronchiectasis by high-resolution chest CT scan were consecutively recruited from 2 general hospitals in Shandong Province from September 2011 to August 2014. Etiology, clinical presentations, radiographic features, pulmonary function and sputum microbiology were analyzed. The difference among diverse imaging types on high-resolution chest CT scan was determined. Results A total of 313 adult patients with bronchiectasis were included. Idiopathic bronchiectasis (217 cases, 69.3%) was the most common reason, followed by post-tuberculosis bronchiectasis (57 cases, 18.2%). The most vulnerable lobe was lower lobe of left lung (219 cases, 70.0%). The characteristic presentations were cough (296 cases, 94.6%), expectoration (285 cases, 91.1%), hemoptysis (127 cases, 40.6%), and moist rales on chest examination (195 cases, 62.3%). Pulmonary function abnormalities were identified in 218 patients (69.6%), in whom obstructive ventilatory dysfunction was the most common type (136 cases, 62.4%). One hundred and forty-four patients' sputum specimens were tested positive (144 cases, 46.0%). The most commonly isolated pathogen was Pseudomonas aeruginosa (106 cases, 73.6%). Patients with cystic bronchiectasis had a higher frequency of expectoration, dyspnea, fever and fatigue (all P<0.001). Conclusion A large proportion of bronchiectasis patients are idiopathic. The predominant clinical features are cough, expectoration, hemoptysis and fixed moist rales. Patients with cystic bronchiectasis are prone to suffer from more severe clinical manifestations.