支气管扩张症合并慢性阻塞性肺疾病临床特征及相关因素

Clinical Characteristics and Related Factors of Bronchiectasis Complicated with Chronic Obstructive Pulmonary Disease

摘要: 目的：采用病例对照研究，探讨支气管扩张症合并慢性阻塞性肺疾病患者的临床特征及相关因素，为该病的诊治提供参考依据。方法：以2021年9月至2024年9月就诊于华北理工大学附属医院的支气管扩张症(Bronchiectasis)的患者共245例作为研究对象，选择其中108例合并慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease, COPD)的支气管扩张患者作为病例组，其余137例不合并COPD的单纯支扩患者作为对照组。对比分析两组患者的基本特征、临床症状及实验室指标方面的差异，并探究相关因素，研究结果以P < 0.05为差异有统计学意义。结果：1) 基本特征比较：病例组年龄、病程、住院天数、糖尿病史的人数高于对照组，差异具有统计学意义(P ≤ 0.01)。2) 临床表现比较：病例组呼吸频率及有喘息症状人数高于对照组，病例组有咯血症状人数低于对照组，差异均具有统计学意义(P < 0.01)。3) 实验室检查比较：病例组pH、pO₂、pO₂(a)/FO₂(I)低于对照组，病例组pCO₂、尿素氮、D-二聚体、系统免疫炎症指数高于对照组，差异均具有统计学意义(P < 0.01)；病例组白蛋白低于对照组，差异有统计学意义(P = 0.044)。4) 年龄、病程、住院天数、糖尿病史、呼吸频率、喘息、pCO₂、白细胞、SII是支扩合并慢阻肺的独立危险因素；咯血、pH、pO₂、pO₂(a)/FO₂(I)为支扩合并慢阻肺的保护因素。结论：1) 与单纯支扩患者相比，支扩合并慢阻肺的患者年龄更大、病程及住院天数更长、有糖尿病史的更多，有咯血症状的更少，缺氧及二氧化碳储留更重，全身炎症反应更重，D-二聚体更高，SII更高。2) 年龄、病程、住院天数、糖尿病史、呼吸频率、喘息、pCO₂、白细胞、SII升高的支扩患者易合并慢阻肺；咯血、pH、pO₂、pO₂(a)/FO₂(I)升高的支扩患者不易合并慢阻肺。

Abstract: Objective: To explore the clinical characteristics and related factors of patients with bronchiectasis complicated with chronic obstructive pulmonary disease through a case-control study, and to provide a reference basis for the diagnosis and treatment of this disease. Methods: A total of 245 patients with bronchiectasis who visited the Affiliated Hospital of North China University of Science and Technology from September 2021 to September 2024 were selected as the research subjects. Among them, 108 patients with bronchiectasis complicated with chronic obstructive pulmonary disease (COPD) were assigned to the case group, and the remaining 137 patients with simple bronchiectasis without COPD were assigned to the control group. The differences in basic characteristics, clinical symptoms, and laboratory indicators between the two groups were compared and analyzed, and the related factors were explored. The results were considered statistically significant when P < 0.05. Results: 1) Comparison of basic characteristics: The age, disease duration, hospital stay, and the number of patients with a history of diabetes in the case group were higher than those in the control group, and the differences were statistically significant (P ≤ 0.01). 2) Comparison of clinical manifestations: The respiratory rate and the number of patients with wheezing symptoms in the case group were higher than those in the control group, while the number of patients with hemoptysis symptoms in the case group was lower than that in the control group, and the differences were statistically significant (P < 0.01). 3) Comparison of laboratory tests: The pH, pO₂, and pO₂(a)/FO₂(I) in the case group were lower than those in the control group, while the pCO₂, blood urea nitrogen, D-dimer, and systemic immune-inflammation index in the case group were higher than those in the control group, and the differences were statistically significant (P < 0.01); the albumin in the case group was lower than that in the control group, and the difference was statistically significant (P = 0.044). 4) Age, disease duration, hospital stay, history of diabetes, respiratory rate, wheezing, pCO₂, white blood cells, and SII were independent risk factors for bronchiectasis complicated with COPD; hemoptysis, pH, pO₂, and pO₂(a)/FO₂(I) were protective factors for bronchiectasis complicated with COPD. Conclusion: 1) Compared with patients with simple bronchiectasis, patients with bronchiectasis complicated with COPD were older, had a longer disease duration and hospital stay, a higher number of patients with a history of diabetes, a lower number of patients with hemoptysis symptoms, more severe hypoxia and carbon dioxide retention, a more severe systemic inflammatory response, higher D-dimer, and higher SII. 2) Patients with bronchiectasis who have elevated age, disease duration, hospital stay, history of diabetes, respiratory rate, wheezing, pCO₂, white blood cells, and SII are more likely to develop COPD; patients with bronchiectasis who have elevated hemoptysis, pH, pO₂, and pO₂(a)/FO₂(I) are less likely to develop COPD.