高分辨率CT示支气管扩张的慢性阻塞性肺疾病急性加重期患者的临床及气道炎症特征

结核病与肺部健康杂志 ›› 2013, Vol. 2 ›› Issue (2): 95-99.

高分辨率CT示支气管扩张的慢性阻塞性肺疾病急性加重期患者的临床及气道炎症特征

王玉红，孙永昌

100730 首都医科大学附属北京同仁医院呼吸科

收稿日期:2013-04-06 出版日期:2013-06-30 发布日期:2013-06-30
通信作者: 孙永昌,Email: suny@ccmu.edu.cn

Characteristics of clinical and airway inflammation in patients with acute exacerbation of COPD complicated by bronchiectasis showed on lung HRCT

WANG Yu-hong, SUN Yong-chang

Department of Respiratory Medicine,Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China

Received:2013-04-06 Online:2013-06-30 Published:2013-06-30
Contact: SUN Yong-chang, suny@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨高分辨率CT(HRCT)示支气管扩张的慢性阻塞性肺疾病(COPD)急性加重期患者的临床及气道炎症特征。方法入选2011年11月1日至2012年2月29日就诊于北京同仁医院呼吸内科的COPD急性加重期患者51例(男27例,女24例),行肺部HRCT进行支气管扩张评分,依据Smith等建议的评分标准由2名放射科医师对每一个肺叶进行支气管扩张评分。支气管扩张评分平均值在1.5分及以上者定为支气管扩张组(支扩组,17例),支气管扩张平均值为0～1分者定为无支气管扩张组(非支扩组,34例)。比较两组患者在一般临床资料(年龄、性别、体质量指数、吸烟指数、急性加重频率)、肺功能、痰炎症细胞及炎症因子等方面的差异,分析支气管扩张对COPD急性加重期气道炎症反应及肺功能的影响。采用SPSS 17.0软件进行统计学分析,符合正态分布的计量资料以“x±s”表示,两组间比较采用t检验。非正态分布的计量资料,以中位数(四分位间距)表示,两组间比较采用非参数秩和检验。计数资料组间比较采用χ²检验,P<0.05为差异有统计学意义。结果入组患者中17例(33.3%,17/51)HRCT存在支气管扩张。诱导痰细胞总数支扩组 [5420(1250～13240)×10⁶/L]与非支扩组[4880(3180～18140)×10⁶/L]比较,Z=-0.52,P=0.603;中性粒细胞计数支扩组[(3490(820～8870)×10⁶/L)]与非支扩组[2200(1020～12160)×10⁶/L ]比较,Z=-0.200,P=0.842;淋巴细胞数支扩组[(1200±860)×10⁶/L]与非支扩组[(1430±1250)×10⁶/L ]比较,t=0.715,P=0.478;两组间差异均无统计学意义(P值均>0.05)。支扩组患者痰上清液IL-8[760.5(400.4～932.1)pg/ml]水平较非支扩组[396.3(12.7～964.2)] pg/ml]明显升高(Z=-2.278,P=0.023),支扩组患者第1秒用力呼气容积占预计值百分比(FEV₁%预计值)及第1秒用力呼气容积占用力肺活量百分比(FEV₁/FVC)均较非支扩组低,其中支扩组患者FEV₁%预计值[(47.5±11.8)%]、FEV₁/FVC[(51.3±12.1)%],非支扩组FEV₁%预计值[(55.9±14.7)%]、FEV₁/FVC[(58.1±10.3)%],差异有统计学意义(t值分别为2.049、2.111,P值均<0.05)。支气管扩张组咯黄痰的例数(52.9%,9/17)较无支气管扩张者(17.6%,6/34)高,差异有统计学意义(χ²=6.8,P=0.009)。结论肺部HRCT示支气管扩张的COPD急性加重期患者气道IL-8明显升高,肺功能相对较差。

Abstract: ObjectiveTo study the clinical features and airway inflammation in patients with acute exacerbation of COPD (AECOPD) complicated by bronchiectasis or not showed on lung HRCT.Methods Fifty-one patients (male 27, female 24) with AECOPD from the outpatient clinic and the respiratory ward were consecutively enrolled from November 1st 2011 to February 29 2012. According to Smith’s standard, each lobe of the lung on the CT scans was interpreted for the presence and grade of bronchiectasis by 2 radiologists for each patient performed by HRCT . Patients with a bronchiectasis score ≥1.5 were defined as the bronchiectasis group, while those with a score of 0-1 as the non-bronchiectasis group. The clinical data, pulmonary function tests and the cell counting and cytokines in the sputum were compared, and the association of bronchiectasis with inflammatory markers and pulmonary functions was analyzed.Results HRCT bronchiectasis was present in 17 (17/51, 33.3%) patients. There were no significant differences in age(t=0.911,P=0.367), body mass index(t=0.507,P=0.615), smoking history(χ²=－0.916,P=0.360),disease history(t=－0.768,P=0.442)and the frequency of exacerbations(χ²=1.138,P=0.286). The total number of cell count of the induced sputum is 5420(1250～13240)×10⁶/L in bronchiectasis group and 4880(3180～18140)×10⁶/L in the non-bronchiectasis group(Z=－0.52,P=0.603), neutrophils is 3490(820～8870)×10⁶/L in bronchiectasis group and 2200(1020～12160)×10⁶/L in non-bronchiectasis group(Z=－0.200,P=0.842), lymphocytes is(1200±860)×10⁶/L in bronchiectasis group and (1430±1250)×10⁶/L in non-bronchiectasis group(t=0.715,P=0.478),and there were no significant differences in the 2 groups. Patients with bronchiectasis[760.5(400.4,932.1) pg/ml] had a higher level of sputum IL-8 than that in the non-bronchiectasis group[396.3(12.7,964.2) pg/ml] (Z=－2.278,P=0.023), and they had more severe airway obstruction; The value of FEV₁% predicted value and FEV₁/FVC was (47.5±11.8)% and (51.3±12.1)% respectively in the bronchiectasis group, and the value of FEV₁% predicted value and FEV₁/FVC was (55.9±14.7)% and (58.1±10.3) % respectively in non-bronchiectasis group. The differences were significant statistically( t=2.049、2.111,P=0.046、0.040). More patients in the bronchiectasis group(52.9%,9/17) had yellow sputum as compared to the non-bronchiectasis group(17.6%, 6/34) (χ²=6.8,P=0.009).Conclusion This study shows that COPD patients with bronchiectasis on lung HRCT has more severe airway obstruction and increased level of sputum IL-8.

王玉红，孙永昌. 高分辨率CT示支气管扩张的慢性阻塞性肺疾病急性加重期患者的临床及气道炎症特征[J]. 结核病与肺部健康杂志, 2013, 2(2): 95-99.

WANG Yu-hong, SUN Yong-chang. Characteristics of clinical and airway inflammation in patients with acute exacerbation of COPD complicated by bronchiectasis showed on lung HRCT[J]. Journal of Tuberculosis and Lung Health, 2013, 2(2): 95-99.

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