手足多汗症患者中肺大疱及气胸的临床研究

目的：探讨手足多汗症患者中肺大疱及气胸的发生情况，为临床提供参考数据。方法行针形胸腔镜双侧T3～4交感神经链切断术的426例手足多汗症患者为研究对象，所有患者术前均无肺或胸膜疾病。术中观察并记录426例双肺肺大疱发生情况，并将其分为肺大疱组及无肺大疱组，分析BMI以及吸烟与肺大疱的发生关系，术后随访有肺大疱及无肺大疱者气胸的发生情况。结果肺大疱组24例、无肺大疱组402例，肺大疱发生率为5.6％。肺大疱组患者BMI明显小于无肺大疱组（20.9±2.2）kg/m2 vs （22.2±2.7）kg/m2，P＜0.05）]。肺大疱组吸烟人数与无肺大疱组比较差异无统计学意义，但肺大疱组吸烟者的吸烟指数明显高于无肺大疱组（172.0±67.2 vs 75.7±50.9，P＜0.05）。吸烟指数为肺大疱的危险因素（OR 1.01，95％CI 1.003～1.018），BMI为肺大疱的保护因素（OR为0.81，95％CI为0.665～0.985）。在吸烟且BMI≤18.5 kg/m2的患者中，肺大疱的发生率明显升高（OR为2.185，95％CI为1.144～33.198）。全组患者随访0.5～7.5年，无气胸发生。结论手足多汗症患者肺大疱的发生与低BMI及高吸烟指数相关，但肺大疱与气胸发生的相关性尚需经进一步研究证实。

Analysis of pulmonary bullae and spontaneous pneumothorax among hyperhidrosis patients

Objective To explore the incidence of pulmonary bullae and spontaneous pneumothorax in hyperhidrosis patients,and provide useful data for clinic. Method Four hundred and twenty-six patients with hyperhidrosis received T3-4 sympathectomy using needle thoracoscopy. No patients had pulmonary or pleu-ral diseases before operation. According to the status of pulmonary bullae observed during thoracoscopy,pa-tients were divided into bullae positive group and bullae negative group. The relationships between pulmonary bullae and BMI or smoking index were analyzed. All patients were followed up after operation to see whether they would suffer from spontaneous pneumothorax. Results There were 24 patients （5.6%）in bullae positive group. Bullae positive group had a significantly lower BMI when compared with bullae negative group （20.9 ±2.2）kg/m2 vs （22.2 ±2.7）kg/m2,P〈0.05）]. The smoking ratios of two groups had no statistically sig-nificance,but the smoking index of bullae positive group was significantly higher than that of bullae negative group （1 72.0 ±67.2 vs 75.7 ±50.9,P〈0.05）. Smoking index was the risk factor of pulmonary bullae （OR 1.01 ,95%CI 1.003~1.01 8）,while BMI was the protect factor （OR 0.81 ,95%CI 0.665 ~0.985）. Bul-lae were most prevalent among slim individuals （BMI≤1 8.5 kg/m2 ）who are smoking （OR 2.1 85 ,95%CI 1.1 44~33.1 98）. All patients were followed up from 6 months to 7.5 years,no spontaneous pneumothorax oc-cured. Conclusion Low BMI and high smoking index may have an important role in the development of pul-monary bullae in patients with hyperhidrosis. However,pulmonary bullae may not be responsible for future spontaneous pneumothorax.