ObjectiveTo investigate the application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis. Methods Basic information, serological indicators such as blood routine items, biochemical, blood coagulation, and inflammation index of 121 patients with bronchiectasis in Nanjing Jinling Hospital and Nanjing Drum Tower Hospital from July 2021 to June 2023 were collected. The value of fibrinogen and other serological indicators in identifying patients with acute exacerbation and severely impaired lung function (FEV1%pred<60%) was evaluated. Results The levels of leukocytes, neutrophils, platelets, C-reactive protein and fibrinogen were higher in the patients with acute exacerbation and in the FEV1%pred<60% group, negatively correlated with FEV1%pred. While the level of albumin was higher in the patients of the stable group and FEV1%pred≥60% group, and positively correlated with FEV1%pred. Compared with leukocytes, neutrophils, platelets, C-reactive protein and albumin, fibrinogen demonstrated the best recognition ability for the patients with FEV1%pred<60% (AUC=0.839). The sensitivity of identifying patients with FEV1%pred<60% was 91.18% and the specificity was 71.26% when the level of fibrinogen was over 3.35 g/L. Conclusions Leukocytes, neutrophils, platelets, C-reactive protein, albumin and fibrinogen have shown certain application value in recognition of patients with bronchiectasis in acute exacerbation stage and FEV1%pred<60%. These serological indicators may be helpful in precision treatment and individual management of patients with bronchiectasis.
Bronchiectasis is a heterogeneous disease characterized by abnormal expansion of the bronchi, manifested by cough, sputum, and recurring lung infections. As one of the common fungi of lung infection, aspergillus can not only appear as the outcome of the disease in bronchiectasis, but also as an inducement to participate in the disease progression, and ultimately complicate the course of bronchiectasis. This article describes the susceptibility factors and pathogenic mechanisms of aspergillus in bronchiectasis, and further introduces the diagnosis and treatment status of bronchiectasis combined with aspergillus infection, aiming to clarify the effect of aspergillus infection on bronchiectasis and provide new thinking directions for its clinical diagnosis and treatment.
ObjectiveA series of single-case randomized controlled trials (N-of-1 trials), with placebo Chinese herbs used as a control, were conducted to observe the efficacy of the syndrome differentiation treatment formula in the stable phase of bronchiectasis by using a modified mixed-effects model (MEM) to detect the "carryover effects" of Chinese herbs, and to explore the establishment of an N-of-1 trial method that reflects the characteristics of syndrome differentiation treatment in traditional Chinese medicine (TCM). MethodsA single-center clinical trial was conducted in which a single case was studied in a multiple crossover, randomized controlled, and blinded manner. There were three rounds of the trial, each with two observation periods (treatment period and control period) of 4 weeks each. In the treatment period, an individualized formula based on syndrome differentiation was given, and in the control period, a placebo formula was administered. The primary indicator was the patients’ self-rated 7-point symptom Likert scale score, and other indicators included chronic obstructive pulmonary disease assessment test (CAT) score, 24 h sputum volume, TCM syndrome score, and safety index. Paired t test was used to analyze single case data and MEM designed for "carryover effects" was used to analyze group data. ResultsA total of 21 subjects were formally enrolled, and 15 (75%) completed three rounds of N-of-1 trials. Three of the cases showed statistically significant differences in overall symptom Likert scale score. At the group level, the MEM designed for "carryover effects" found statistically significant residual effects on three indicators (overall symptom score, respiratory symptom score, and CAT score). After excluding the "carryover effects", the model analyzed the statistically significant differences between the intervention effects of the two formulas on the overall symptom score, respiratory symptom score, CAT score and TCM syndrome score. The sensitivity of the MEM was higher than that of the meta-analysis when residual effects existed in the N-of-1 trials. ConclusionThe N-of-1 trials of Chinese herbs designed in this study can well demonstrate the characteristics of TCM syndrome differentiation and treatment. The modified MEM can detect the residual effects of TCM and improve the sensitivity of data statistics. However, due to the inherent nature of N-of-1 trials, the sensitivity of this study method at the individual level is low and more cases and diseases need to be studied for further improvement.
Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
ObjectiveTo explore the risk factors for death in patients with bronchiectasis. MethodsTwo hundred and eighty-three patients diagnosed with bronchiectasis at Daxing Hospital of Capital Medical University from January 2011 to December 2013 were collected and followed up to October 2015 after discharge. Patients' age, gender, body mass index (BMI), smoking history, dyspnea score, image data, sputum culture, blood gas analysis and the results of spirometry were collected. The risk factors for death were analyzed with COX regression analysis. ResultsAmong 283 cases, 52 patients died. The 1-, 2-, 3-and 4-year cumulative survival rates were 97%, 86%, 71%, 45%, respectively. COX regression analysis showed that age≥70 years (RR=2.222, 95%CI 1.145-4.314), BMI < 18.5 kg/m2 (RR=2.328, 95%CI 1.205-4.497), bronchiectasis involving≥3 lobes in chest high-resolution computed tomography (RR=0.382, 95%CI 0.188-0.774) and FEV1% pred < 70% (RR=1.032, 95%CI 0.923-1.180) were the independent risk factors for death of patients with bronchiectasis (all P < 0.05). ConclusionsThere are multiple risk factors contribute to death of patients with bronchiectasis. Early identification of risk factors shall improve the prognosis of patients with bronchiectasis.