■考虑到中国支气管扩张和慢性阻塞性肺疾病(COPD)患者人数众多,我们旨在对支气管扩张-COPD重叠综合征(BCOS)的临床特征和预后进行全面分析.Further,我们旨在探讨与BCOS急性加重和死亡相关的因素,这可能对其早期诊断和干预有价值。
■我们于2016年8月在中国中南大学湘雅二医院招募COPD住院患者,随访至2022年3月。BCOS组患者必须符合诊断支气管扩张的标准。我们使用了自我完成问卷,临床记录,和自我报告数据作为主要数据收集方法。我们使用Kaplan-Meier生存分析和Cox比例风险模型评估随访期间BCOS严重急性加重和死亡的风险。
■共纳入875例患者并进行随访。BCOS组的患者有更多的女性,吸烟者较少,较低的出院COPD评估测试(CAT)评分,较低的强迫肺活量(FVC),同时发生活动性结核病的可能性更高,更高水平的嗜酸性粒细胞和炎症标志物,铜绿假单胞菌痰培养阳性率高于仅COPD组患者。急性加重组(AE+)患者的体重指数(BMI)较低,更频繁的急性加重,高等改良医学研究委员会(mMRC)入院时呼吸困难评分,更高的炎症标志物,较低的FVC,吸入性支气管扩张剂的使用率更高,痰培养阳性和铜绿假单胞菌阳性的比率更高。“死亡”组的患者年龄较大,BMI较低,在医院呆了更长时间,入院和出院时mMRC呼吸困难评分和CAT评分较高,有更高水平的炎症标志物,吸入性支气管扩张剂的使用率较低,更有可能患有肺心病和陈旧性肺结核,以及真菌阳性痰培养率较高。在多年的随访中,多变量分析证实基线时的红细胞沉降率和铜绿假单胞菌培养阳性是严重急性加重的独立预测因子。真菌培养阳性基线血尿素氮,基线淋巴细胞计数,在多年的随访过程中,多变量分析证实合并陈旧肺结核和合并肺心病是独立的死亡预测因子.生存分析下的Kaplan-Meier曲线表明,COPD和BCOS组的死亡率在全部情况下没有统计学上的显着差异,两个,和三年的随访。
■BCOS患者肺功能降低,对不同并发症的易感性增加,血液嗜酸性粒细胞和炎症标志物升高,铜绿假单胞菌培养阳性率升高。这些独特的标志物与严重急性加重和死亡的更大风险有关。
UNASSIGNED: Considering the large population of
bronchiectasis and chronic obstructive pulmonary disease (COPD) patients in China, we aimed to conduct a thorough analysis that investigates the clinical characteristics and prognosis of
bronchiectasis-COPD overlap syndrome (BCOS). Further, we aimed to explore factors associated with acute exacerbation and death in BCOS, which may be of value in its early diagnosis and intervention.
UNASSIGNED: We recruited inpatients with COPD from the second Xiangya Hospital of Central South University in China in August 2016, with follow-up until March 2022. Patients in the BCOS group had to meet the criteria for diagnosing
bronchiectasis. We used self-completion questionnaires, clinical records, and self-reported data as primary data collection methods. We used Kaplan-Meier survival analyses and Cox proportional hazard models to assess the risk of severe acute exacerbation and death for BCOS during the follow-up period.
UNASSIGNED: A total of 875 patients were included and followed up. Patients in the BCOS group had more females, fewer smokers, lower discharge COPD assessment test (CAT) scores, lower forced vital capacity (FVC), a higher likelihood of co-occurring active tuberculosis, higher levels of eosinophils and inflammatory markers, and a higher rate of positive sputum cultures for Pseudomonas aeruginosa than patients in the COPD-only group. Patients in the acute exacerbation group (AE+) were found to have lower body mass index (BMI), more frequent acute exacerbations, higher modified Medical Research Council (mMRC) dyspnoea grade on admission, higher inflammatory markers, lower FVC, higher rates of using inhaled bronchodilators, and higher rates of both positive and Pseudomonas aeruginosa positive sputum cultures. Patients in the \'death\' group were older, had a lower BMI, had spent longer time in the hospital, had higher mMRC dyspnoea grade and CAT scores upon admission and discharge, had higher levels of inflammatory markers, lower rates of using inhaled bronchodilators, were more likely to have a combination of pulmonary heart disease and obsolete pulmonary tuberculosis, as well as a higher rate of fungus-positive sputum cultures. Both erythrocyte sedimentation rate at baseline and Pseudomonas aeruginosa culture positivity were confirmed as independent predictors of severe acute exacerbation in multivariate analysis during the years of follow-up. Fungus culture positivity baseline blood urea nitrogen, baseline lymphocyte count, comorbidities with obsolete pulmonary tuberculosis and comorbidities with pulmonary heart disease were verified as independent predictors of death in multivariate analysis during the years of follow-up. Kaplan-Meier curves under survival analysis demonstrated no statistically significant difference in mortality between the COPD and the BCOS groups at the full one, two, and three years of follow-up.
UNASSIGNED: Patients with BCOS present with reduced lung function, increased susceptibility to different complications, elevated blood eosinophils and inflammatory markers, and elevated rates of positive Pseudomonas aeruginosa cultures. These distinctive markers are linked to a greater risk of severe acute exacerbations and mortality.