2022 年第 8 期 第 17 卷

支气管扩张症合并肺动脉高压患者的临床特征分析 

Clinical characteristics of patients with comorbid bronchiectasis and pulmonary hypertension

作者：高杨1谢江2王增智1陈如冲3

英文作者：Gao Yang1 Xie Jiang2 Wang Zengzhi1 Chen Ruchong3

单位：1首都医科大学附属北京安贞医院呼吸与危重症医学科，北京100029；2首都医科大学附属北京安贞医院睡眠医学中心，北京100029；3广州医科大学附属第一医院变态反应科呼吸疾病国家重点实验室广州呼吸健康研究院，广州510120

英文单位：1Department of Pulmonary and Critical Care Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Center for Sleep Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Department of Allergy First Affiliated Hospital of Guangzhou Medical University State Key Laboratory of Respiratory Disease Guangzhou Institute of Respiratory Health Guangzhou 510120 China

关键词：支气管扩张症；肺动脉高压；临床特点

英文关键词：Bronchiectasis;Pulmonaryhypertension;Cliniccharacteristics 

• 摘要：

• 目的 分析支气管扩张症（支扩）合并肺动脉高压（PH）患者的临床特征。方法 回顾性选取2018年1月至2021年12月在首都医科大学附属北京安贞医院住院治疗的支扩患者90例，根据是否合并PH分为合并PH组（30例）和不合并PH组（60例）。分析2组患者一般临床资料、超声心动图参数、实验室检查指标、急性加重期病原学及胸部CT特点。结果 合并PH组患者支扩病程、改良版英国医学研究委员会呼吸困难评分及入住重症监护室、心房颤动比例长于/高于不合并PH组患者（均P＜0.05）。合并PH组患者的右心室前后径和流出道直径、肺主动脉干直径均明显大于不合并PH组（均P＜0.001）。合并PH组的左心室射血分数明显低于不合并PH组患者（P=0.001），而肺动脉收缩压明显高于不合并PH组（P＜0.001）。合并PH组入院血气分析的二氧化碳分压明显高于不合并PH组（P=0.033），氧分压明显低于不合并PH组（P＜0.001）。合并PH组的C反应蛋白和B型脑钠肽水平均高于不合并PH组，差异均有统计学意义（均P＜0.001）。合并PH组的痰细菌培养阳性率高于不合并PH组［50.0%(15/30)比28.3%(17/60)］（P=0.043）。合并PH组真菌检出率高于不合并PH组［60.0%(18/30)比8.3%(5/60)］（P＜0.001）。合并PH组患者支扩病变累及肺叶数量多于不合并PH组［3(2,4)个比2(2,3)个］，累及双侧肺叶和左上肺、右上肺比例高于不合并PH组（均P＜0.05）。结论 与不合并PH的支扩患者比较，合并PH的支扩患者超声心动图、实验室检查、胸部影像学等多项临床指标均偏重，需要引起临床高度关注和积极干预。

• Objective To analyze the clinical characteristics of patients with comorbid bronchiectasis and pulmonary hypertension (PH). Methods Totally 90 inpatients with bronchiectasis in Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2021 were retrospectively selected. They were divided into PH group (30 cases) and non-PH group (60 cases) according to whether they were combined with PH. The general clinical data, echocardiographic parameters, laboratory examination indexes, etiology in acute exacerbation and chest CT characteristics of the two groups were analyzed. Results The course of bronchiectasis, modified British Medical Research Council dyspnea score and the proportions of admission to intensive care unit and atrial fibrillation in PH group were longer/higher than those in non-PH group (all P＜0.05). The right ventricular anteroposterior diameter, outflow tract diameter and pulmonary aortic trunk diameter in PH group were significantly larger than those in the non-PH group (all P＜0.001). The left ventricular ejection fraction in PH group was significantly lower than that in non-PH group (P=0.001), while the pulmonary systolic pressure was significantly higher than that in non-PH group (P＜0.001). The partial pressure of carbon dioxide in admission blood gas analysis in PH group was significantly higher than that in non-group (P=0.033), and the partial pressure of oxygen was significantly lower than that in non-PH group (P＜0.001). Levels of C-reactive protein and brain natriuretic peptide in PH group were significantly higher than those in non-PH group (both P＜0.001). The positive rate of sputum bacterial culture in PH group was higher than that in non-PH group ［50.0%(15/30) vs 28.3%(17/60)］(P=0.043). The detection rate of fungi in PH group was higher than that in non-PH group ［60.0%(18/30) vs 8.3%(5/60)］(P＜0.001). The number of pulmonary lobes involved in bronchiectasis in PH group was more than that in non-PH group ［3(2,4) vs 2(2,3)］, and the proportions of bilateral pulmonary lobes, left upper lobe and right upper lobe involved was higher than that in non-PH group (all P＜0.05). Conclusion Compared with patients of bronchiectasis without PH, patients with PH have more worsened clinical indicators such as echocardiography, laboratory examination, chest imaging, etc., which need to attract high clinical attention and active intervention.