经支气管镜大容量灌洗治疗支气管扩张症并感染患者的前瞻性研究

目的评价经支气管镜大容量灌洗治疗支气管扩张症并感染的安全性和有效性。方法采用随机、对照的临床试验设计,对2009年8月至2014年1月收治的支气管扩张症并感染患者进行研究。入选病例在合理内科药物治疗前提下,65例患者随机分为大容量灌洗组（A组,n=21）、小容量灌洗组（B组,n=22）及对照组（C组,n=22）。灌洗组均接受一次治疗,大容量灌洗组灌洗量为500~2 000 m L,小容量灌洗组灌洗量为100~200 m L。观察记录患者的一般情况,记录并比较治疗前、后各组简化的临床肺部感染评分（CPIS）、C反应蛋白（CRP）水平、抗生素使用时间、住院时间及治疗有效率。结果 A组灌洗量为（1 250.0±403.3）m L,B组灌洗量为（141.0±41.2）m L。A组的住院时间和抗生素使用时间分别为（8.4±1.0）d和（7.9±1.1）d,短于B组[（13.5±1.6）d、（11.6±2.4）d]和对照组[（15.3±3.2）d、（13.3±2.6）d]（P〈0.05）;总有效率为95.23%,高于B组（81.82%）和C组（68.19%）;第7 d A组的CPIS评分为（1.9±1.4）分,低于B组[（2.7±0.8）分]和C组[（3.7±0.9）分]（P〈0.05）;A组CRP下降更为显著,差异均有统计学意义（P〈0.05）。A组和B组不良反应分别为一过性低氧血症（23.81%、9.09%）、窦性心动过速（100%、68.18%）、气道黏膜损伤（38.09%、13.64%）、血压升高（19.05%、13.64%）。结论经支气管镜选择性大容量支气管灌洗治疗支气管扩张并感染安全、有效,值得临床推广。     

最小临床重要差值在支气管扩张症疗效测评工具中的应用与思考

支气管扩张症(BE)发病率逐年增高,给患者及家庭造成了沉重的经济负担,对患者生存质量影响较大。随着患者报告结局(PRO)在BE临床应用中的增多,研究者不再只关注其统计学差异(P<0.05),其最小临床重要差值(MCID)也逐渐成为研究热点。当前对BE-PRO测评工具的MCID研究还缺乏相关数据,本文概述了MCID在BE-PRO测评工具中的研究现状,以期为BE相关临床疗效评价提供量化标准及参考依据。     

维生素D治疗不同FeNO水平支气管扩张患者的临床疗效研究

目的 探讨维生素D治疗不同FeNO水平支气管扩张患者的临床疗效。方法 选取2018年8月～2019年8月我院支气管扩张患者93例,根据FeNO水平分为高水平组(n=29)、中水平组(n=33)、低水平组(n=31)。入院后给予三组常规干预,在此基础上采用维生素D治疗。比较三组临床疗效、治疗前后呼吸状况评分、生活质量评分。结果 三组总有效率比较无显著差异(P0.05);治疗后三组呼吸状况、生活质量评分较治疗前降低(P0.05),但组间比较无显著差异(P0.05)。结论 采取维生素D治疗不同FeNO水平支气管扩张患者均可取得良好效果,改善呼吸状况并提高患者生活质量。     

The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

ObjectivesThe impact of Pseudomonas aeruginosa on the prognosis of bronchiectasis remains controversial. This study aimed to explore the prognostic value of P. aeruginosa in adult patients with bronchiectasis in central-southern China.Patients and methodsThis prospective cohort study enrolled 1,234 patients with bronchiectasis between 2013 and 2019. The independent impact of P. aeruginosa on all-cause mortality, annual exacerbations, and hospitalizations was assessed.ResultsP. aeruginosa was isolated from 244 patients (19.8%). A total of 188 patients died over a follow-up period of 16 (1–36) months. Patients with P. aeruginosa had a longer disease course, poorer lung function, more lung lobe involvement, and more severe Bronchiectasis Severity Index (BSI) stage than those without P. aeruginosa. The independent impact of P. aeruginosa was observed on frequent hospitalizations but not on mortality and frequent exacerbations. Moderate- or high-risk comorbidities increased the risk of mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.26–2.95), and this effect was magnified by the presence of P. aeruginosa (HR: 2.11, 95% CI: 1.28–3.48).ConclusionsP. aeruginosa infection acts as a marker of disease severity as well as predictor of frequent hospitalizations. P. aeruginosa had no independent effect on all-cause mortality. P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.

KEY MESSAGE:

1. P. aeruginosa increased the risk of frequent hospitalizations; however, it had no independent impact on all-cause mortality.
2. P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality.
3. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.

     

Airway inflammation and the lung

Assessment of inflammatory processes in the lung can be difficult and interpreting the clinical significance can be daunting. An important part of the diagnostic process is the assessment of the pattern and distribution of the disease process in the lungs. Inflammatory conditions by and large show a limited number of distributions—airway, parenchymal or both, with the last being split into those that show an airway distribution in the parenchyma and those that largely spare the airways. This article aims to review patterns of inflammation involving the airways and their clinical associations.     

支气管扩张型非结核分枝杆菌肺病临床特点及中医证型分析

<正>非结核分枝杆菌（non-tuberculous mycobacteria,NTM）属于结核分枝杆菌复合群以及麻风分枝杆菌以外的一大类分枝杆菌的总称。而NTM肺病（nontuberculous mycobacteria-pulmonary disease,NTMPD）是指人体感染NTM后引起支气管、肺组织病变。随着整体诊疗水平提升,当前NTM-PD的发病率和患病率仍然在普遍上升[1-3]。     

Lung transplantation for non-cystic fibrosis bronchiectasis in Turkey: An initial institutional experience

Background/objectiveLung transplantation is a well-established treatment in patients who have bronchiectasis with diffuse involvement, and with a progressive decline in respiratory function despite maximal medical therapy. We have aimed to present pre-transplantation factors and our results of lung transplantation for non-cystic fibrosis bronchiectasis.MethodsPatients who underwent lung transplantation for non-cystic fibrosis bronchiectasis between the dates of December 2016 and July 2019 were included. The patients' clinical parameters, pulmonary function tests, microbiological results, cardiac parameters, intraoperative data, and lung transplant outcomes were assessed retrospectively.ResultsBilateral lung transplantation for bronchiectasis were performed in eleven patients. The mean age was 36.5 years (range 22–57 years). There were 4 (36.4%) female patients and 7 (63.6%) male patients. All patients had a high score as per the bronchiectasis severity index (BSI). The FACED score was moderate in six patients and severe in five patients. Preoperative colonization with Pseudomonas aeruginosa was observed in five patients. Hospital mortality was 18.2% (2/11). The 1-year mortality was 27.2% (3/11). Eight patients were alive. The mean follow-up period of patients with survival was 28.2 months (range 13–42 months). One patient was diagnosed with chronic lung allograft dysfunction (CLAD). The 3-year survival rates were 73%.ConclusionLung transplantation for bronchiectasis with end-stage lung disease can improve the quality of life and increase survival in selected patients. Further studies are needed to identify the optimal time for lung transplantation referral due to the availability of limited data.