支气管哮喘合并支气管扩张患者的临床特点及影响因素分析

Analysis of Clinical Characteristics and Influencing Factors in Patients with Bronchial Asthma Complicated by Bronchiectasis

摘要: 目的：探讨支气管扩张在哮喘患者中的发病率及临床特点，并分析其影响因素。方法：回顾性收集该院呼吸与危重症医学科2022年01月至2025年01月收治的256例支气管哮喘住院患者为研究对象。按照其高分辨CT结果显示是否合并支气管扩张分为单纯哮喘组190例、哮喘合并支气管扩张组66例。比较两组患者一般情况、临床症状、实验室检查及影像学检查等指标之间的差异。结果：两组患者的性别、吸烟史、饮酒史、过敏性鼻炎、鼻息肉、药物食物过敏史、白细胞计数、嗜酸粒细胞计数、D－二聚体、血清总IgE、FeNO、CaNO、痰液性质及咯血的情况比较，差异无统计学意义(P > 0.05)。哮喘合并支气管扩张组的年龄、病程及一年内急性加重住院次数高于单纯哮喘组，差异有统计学意义(P < 0.05)；在临床表现方面，哮喘合并支气管扩张组的痰量、痰培养阳性率及听诊阳性体征比例高于单纯哮喘组，差异有统计学意义(P < 0.05)；实验室检查中，哮喘合并支气管扩张组的中性粒细胞计数、PCT、CRP高于单纯哮喘组，淋巴细胞计数低于单纯哮喘组，差异有统计学意义(P < 0.05)；在肺功能方面，哮喘合并支气管扩张组的FEV₁、FEV₁占预计值、FEV₁/FVC低于单纯哮喘组，差异有统计学意义(P < 0.05)。多元回归分析显示，一年内急性加重住院次数及痰培养阳性为支气管哮喘合并支气管扩张的危险因素(P < 0.05)。结论：支气管哮喘合并支气管扩张患者较单纯哮喘患者年龄更大、病程更长、肺功能更差，当患者一年内急性加重住院次数开始增多及痰培养阳性时，应警惕支气管哮喘合并支气管扩张的可能。

Abstract: Objective: To investigate the incidence and clinical characteristics of bronchiectasis in asthma patients and analyze its influencing factors. Methods: A total of 256 hospitalized patients with bronchial asthma admitted to the Department of Respiratory and Critical Care Medicine from January 2022 to January 2025 were retrospectively enrolled as the study subjects. Based on high-resolution CT findings, they were divided into two groups: the asthma-only group (n = 190) and the asthma with bronchiectasis group (n = 66). Differences in general information, clinical symptoms, laboratory tests, and imaging findings were compared between the two groups. Results: There were no statistically significant differences (P > 0.05) between the two groups in terms of gender, smoking history, alcohol consumption history, allergic rhinitis, nasal polyps, history of drug/food allergies, white blood cell count, eosinophil count, D-dimer, total serum IgE, FeNO, CaNO, sputum nature, and presence of hemoptysis. The asthma with bronchiectasis group had significantly higher age, disease duration, and number of acute exacerbation-related hospitalizations within one year compared to the asthma-only group (P < 0.05). Regarding clinical manifestations, the asthma with bronchiectasis group showed significantly higher sputum volume, positive sputum culture rate, and proportion of positive auscultation signs compared to the asthma-only group (P < 0.05). In laboratory tests, the asthma with bronchiectasis group had significantly higher neutrophil count, PCT, and CRP, and significantly lower lymphocyte count compared to the asthma-only group (P < 0.05). In pulmonary function tests, the asthma with bronchiectasis group had significantly lower FEV₁, FEV₁% predicted, and FEV₁/FVC compared to the asthma-only group (P < 0.05). Multivariate regression analysis indicated that the number of acute exacerbation-related hospitalizations within one year and positive sputum culture were risk factors for bronchial asthma complicated by bronchiectasis (P < 0.05). Conclusion: Patients with bronchial asthma complicated by bronchiectasis are generally older, have a longer disease duration, and worse lung function compared to those with asthma alone. When patients experience an increased frequency of acute exacerbation-related hospitalizations within a year and have positive sputum cultures, the possibility of asthma complicated by bronchiectasis should be considered.