【摘要】：目的探討慢性阻塞性肺疾病(簡稱慢阻肺)合并支氣管擴張患者的臨床特征,以提高對該病的診治水平。方法選取2015年1月~2015年12月入住我科慢阻肺急性加重期130例患者作為研究對象,分為慢阻肺合并支氣管擴張組(n=22)和慢阻肺組(n=108),記錄患者一般情況及入院后白細胞計數、C反應蛋白、降鈣素原、纖維蛋白原、血清白蛋白、痰細菌培養(yǎng)結果、肺功能及動脈血氣分析結果,隨訪6個月記錄兩組患者的急性加重次數和死亡人數。比較兩組患者在臨床特征、肺功能及實驗室檢查方面的差異。結果1、本研究共納入慢阻肺急性加重期患者130例,其中確診為慢阻肺合并支氣管擴張者22例(占16.9%),其中男性8例,女性14例,年齡43-85歲,平均年齡(64.2±12.2)歲,病程(16.5±5.8)年,吸煙指數(283.2±72.0)包/年;慢阻肺患者108例,男性72例,女性36例,年齡50-91歲,平均年齡(67.5±9)歲,病程(18.2±3.2)年,吸煙指數(250.6±66.8)包/年。兩組資料均無統計學意義,具有可比性(P0.05)。2、慢阻肺合并支氣管擴張組mMRC評分明顯高于慢阻肺組,分別為(2.36±0.7)、(1.93±0.6),兩組差異有統計學意義(t=2.87,P0.01);慢阻肺合并支氣管擴張組日�？饶撔蕴当壤秊�90.9%,合并肺心病比例68.2%,均顯著高于慢阻肺組(P0.05);慢阻肺合并支氣管擴張組患者平均住院時間明顯高于慢阻肺組,分別為(11.9±5.7)天、(9.0±3.2)天,兩組差異有統計學意義(t=2.31,P0.05)。3、慢阻肺合并支氣管擴張組患者FEV1%pred、FEV 1/FVC、FVC%pred、DLCO%pred降低較單純慢阻肺組更為顯著,差異有統計學意義(t值分別為-4.37、-2.76、-4.24、-3.24,P0.01)。慢阻肺合并支氣管擴張組低氧血癥的發(fā)生率高于慢阻肺組,兩組差異有統計學意義(P0.05)。4、慢阻肺合并支氣管擴張組C-反應蛋白、降鈣素原、纖維蛋白原水平均顯著高于慢阻肺組,組間差異有統計學意義(t值分別為2.66、2.25、2.77,P0.05);慢阻肺合并支氣管擴張組白蛋白水平明顯低于慢阻肺組,分別為(31.2±2.5)g/L、(32.9±2.5)g/L,具有顯著差異(t=-2.97,P0.01)。5、慢阻肺合并支氣管擴張組患者6個月內急性加重次數顯著高于慢阻肺組,分別為(1.68±0.48)次/人、(1.28±0.45)次/人,差異有統計學意義(t=2.97,P0.01)。慢阻肺合并支氣管擴張組死亡率為27.3%,明顯高于慢阻肺組,結果具有顯著差異(P0.05)。結論慢阻肺合并支氣管擴張者病情更嚴重、炎癥反應更強、療程更長、肺功能更差、急性加重更為頻繁。故臨床上對于確診為慢阻肺的患者,應常規(guī)行胸部高分辨CT檢查,以早期明確診斷,早期治療,改善患者預后。
[Abstract]:Objective to investigate the clinical features of patients with chronic obstructive pulmonary disease (COPD) complicated with bronchiectasis in order to improve the diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Methods from January 2015 to December 2015, 130 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled in this study. The patients were divided into two groups: chronic obstructive pulmonary disease with bronchiectasis group (nm22) and slow obstructive lung group (nnm108). The results of C reactive protein, procalcitonin, fibrinogen, serum albumin and sputum bacterial culture were recorded. The results of pulmonary function and arterial blood gas analysis were followed up for 6 months to record the number of acute exacerbations and the number of deaths in the two groups. The differences in clinical features, pulmonary function and laboratory examination were compared between the two groups. Results 1. A total of 130 patients with acute exacerbation of COPD were included in this study, of whom 22 (16.9%) were diagnosed as COPD complicated with bronchiectasis, including 8 males and 14 females, aged 43-85 years, with an average age of (64.2 鹵12.2) years and course of disease (16.5 鹵5.8) years. The smoking index was (283.2 鹵72.0) bag / year, and the smoking index was (250.6 鹵66.8) years in 108 patients with chronic obstructive pulmonary disease (COPD), 72 males and 36 females, aged 50-91 years, mean age (67.5 鹵9) years, course of disease (18.2 鹵3.23) years. There was no statistical significance between the two groups (P0.05). The mMRC score in COPD with bronchiectasis group was significantly higher than that in COPD group. (2.36 鹵0.7), (1.93 鹵0. 01), there was significant difference between the two groups (t = 2.87, P0.01), the proportion of daily cough and purulent phlegm was 90.9 and the ratio of cor pulmonale was 68.2 in COPD combined bronchiectasis group, which was significantly higher than that in COPD group (P0.05), and the average residence in COPD combined with bronchiectasis group was higher than that in COPD group (P0.05). Hospital time was significantly longer than that in COPD group. The difference between the two groups was statistically significant (t = 2.31, P 0.05). The decrease of FEV1%pred,FEV 1 / FV C in the COPD group was significantly lower than that in the simple COPD group (t = -4.37 鹵2.76 鹵4.24 鹵3.24 P0.01), and the difference was statistically significant (t = -4.37 ~ (-1) ~ (-2.76) ~ (-2.76) ~ (-4.24) (P ~ (0.01), P ~ (0.01). The difference was significant (t = -4.37 ~ (-2.76) ~ (-2.76) ~ (-4.24) ~ (-1) P ~ (-1) ~ (-1) in chronic obstructive pulmonary disease with bronchiectasis. The incidence of hypoxemia in COPD with bronchiectasis group was higher than that in COPD group, the difference was statistically significant (P0.05). The levels of C-reactive protein, procalcitonin and fibrinogen in COPD with bronchiectasis group were significantly higher than those in COPD group. There was significant difference between the two groups (t = 2.66 鹵2.25, P 0.05), and the albumin level in COPD with bronchiectasis group was significantly lower than that in COPD group. It was (31.2 鹵2.5) g / L and (32.9 鹵2.5) g / L, respectively, with significant difference (tr -2.97 鹵P0.01) .5.The times of acute exacerbation in patients with COPD complicated with bronchiectasis within 6 months were significantly higher than those in COPD group (1.68 鹵0.48 times / person, 1.28 鹵0.45 times / person, respectively) (t = 2.97, P 0.01). The mortality rate of COPD with bronchiectasis group was 27.3%, which was significantly higher than that of COPD group (P0.05). Conclusion the patients with COPD complicated with bronchiectasis are more serious, inflammatory reaction is stronger, the course of treatment is longer, the lung function is worse, and the acute exacerbation is more frequent. Therefore, high resolution CT should be performed clinically in patients with chronic obstructive pulmonary disease (COPD) in order to make early diagnosis, early treatment and improve the prognosis of the patients.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.9;R562.22

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