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Cardiovascular events after acute exacerbation of bronchiectasis

Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.

Risk factors for acute exacerbation in patients with bronchiectasis

ObjectiveTo explorer the risk factors for acute exacerbation in patients with bronchiectasis within one year.MethodsFour hundred and twenty-two patients with non-cystic fibrosis bronchiectasis hospitalized were enrolled in The East Region of the People’s hospital of Sichuan between October 2014 and October 2016. The patients’ clinical data were collected, and follow-up began at the time of discharged. The study endpoint was the first acute exacerbation, all patients were followed-up for one year after discharged. The patients were classified into two groups by the occurrence of acute exacerbation or no occurrence. Logistic regression analysis was used to explore the risk factors for acute exacerbation with bronchiectasis.ResultsThe age, sick time, body mass index (BMI) less than 18.5 kg/m2, smoking index, expectoration, hemoptysis, dyspnea, moist sounds, wheezing sounds, types of imaging, CT scores, lung lesion site, sputum culture, whether infected Pseudomonas aeruginosa, level of serum C-reactive protein (CRP), level of serum PCT, serum albumin, arterial carbon dioxide partial pressure, types of respiratory failure, combined with chronic cor pulmonale differed significantly between the two groups (P<0.05), while gender, history of Infection, smoking, cough, chest pain, fever, clubbed-finger, white blood cell counts, neutrophil counts, erythrocyte sedimentation rate, serum globulins, arterial oxygen partial pressure did not significantly differ (P>0.05). Multivariate Logistic regression analysis found that infection with Pseudomonas aeruginosa, BMI<18.5 kg/m2, high level of serum CRP, high level of arterial carbon dioxide partial pressure (PaCO2), high CT score with bronchiectasis, combination with chronic cor pulmonale were risk factors for acute exacerbation in patients with bronchiectasis (P<0.05).ConclusionsInfection with pseudomonas aeruginosa, BMI < 18.5 kg/m2, high serum CRP level, high arterial blood PaCO2 level, high CT score with bronchiectasis and combination of chronic cor pulmonale are risk factors for acute aggravation within 1 year for patients with bronchiectasis. Doctors can identify these risk factors and intervene early, so as to reduce the acute exacerbation of bronchiectasis.

胸部物理疗法联合口咽通气管吸痰在支气管扩张症无创通气中的应用

目的 探讨胸部物理疗法联合口咽通气管吸痰对行无创正压通气的支气管扩张症患者的治疗效果及安全性。 方法 选取 2013 年 1 月—2015 年 8 月存在不同程度急性呼吸衰竭的急性加重期支气管扩张症患者 27 例，在给予抗菌药物治疗、对症治疗、营养支持的基础上行无创正压通气，护理上给予手法叩背、应用体外震动排痰机、体位引流等胸部物理疗法联合经口咽通气管吸痰。 结果 经综合治疗和护理后，患者最终显效 16 例，有效 9 例，无效 2 例，治疗有效率达 92.6%。 结论 对伴有呼吸衰竭的支气管扩张症急性加重期患者，在实施无创正压通气时，用胸部物理疗法配合口咽通气管吸痰能解决无创正压通气中患者无力咳痰的问题，保持呼吸道通畅，保障无创正压通气的顺利实施，改善患者预后。

肺段支气管剔除治疗支气管扩张症的疗效

目的　观察肺段支气管剔除治疗支气管扩张症的疗效与安全性。　方法　回顾性分析武警甘肃总队医院2004年12月至2007年12月均经支气管碘油造影、胸部X线片及胸部CT检查确诊的支气管扩张症30例患者的临床资料，其中男21例，女9例；年龄31.9 （16～41）岁。其中囊性扩张6例，柱状扩张9例，混合性扩张15例；双侧病变8例，单侧病变22例。全组患者均行肺段支气管剔除术，观察其疗效。　结果　共剔除肺段支气管64支，手术时间为50～180 min。术中失血量380 （300～600） ml，手术当天胸腔引流量350～550 ml，无手术死亡。术后第3～5 d拔除胸腔引流管。术后胸部X线片示肺膨胀良好，无残腔。术后1例出现肺不张，经纤维支气管镜吸痰后肺复张。住院时间2～3周。随访6个月，患者症状消失，复查血气分析检查均正常，胸部X线片示肺膨胀良好，未发现残腔、积液。无1例复发，病理诊断均为支气管扩张症。　结论　掌握好手术条件，采用肺段支气管剔除术代替肺段切除术治疗支气管扩张症可行，手术方法简单，出血少，减少了术后并发症，克服了以往手术术式的不足，值得临床推广。

The mechanism of Wnt5a and its receptor in bronchiectasis

Objective To explore the potential roles and mechanism of Wnt5a and its receptors in the pathogenesis of bronchiectasis. Methods From October 2017 to April 2018, outpatients with bronchiectasis who needed bronchoscopy were recruited in the Department of Respiratory and Critical Care Medicine of West China Hospital of Sichuan University. The control group was patients with pulmonary nodules less than 10 mm in diameter by health inspection. Patients who used antibiotics and/or glucocorticoids within the past 4 weeks or had other airway diseases were excluded. Serum and bronchial mucosa were collected for detection of Wnt5a by enzyme-linked immunosorbent assay and real-time polymerase chain reaction (PCR), respectively. The receptor of Wnt5a, Ror2, and the downstream pro-inflammatory cytokines, interleukin (IL)-1β and IL-6, were measured in the bronchial mucosa by real-time PCR. Results From October 2017 to April 2018, 32 outpatients with bronchiectasis were found but only 17 patients finished this study, and simultaneously 18 patients with pulmonary nodules were chosen as control. The level of serum Wnt5a in patients with bronchiectasis were significantly higher than that in the control group (P<0.05). Correlation analyses showed that serum Wnt5a level was positively correlated with the level of serum C reactive protein (r=0.806, P<0.05), but had no relation with the level of white blood cell count, blood neutrophil percentage, pulmonary function or bronchiectasis severe index. The mRNA levels of Wnt5a and its receptor Ror2 in bronchial mucosa of patients with bronchiectasis were significantly higher than those in the control group (P<0.001). The mRNA levels of IL-1β and IL-6 in bronchial mucosa of patients with bronchiectasis were higher than those in the control group (P<0.05). Conclusion Wnt5a may play crucial roles in the development of bronchiectasis through Wnt5a/Ror2 signaling pathways to regulate the release of pro-inflammatory cytokines including IL-1β and IL-6.

支气管镜灌洗治疗支气管扩张伴感染临床疗效分析

Efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis: a meta-analysis

ObjectivesTo systematically review the efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, VIP, CNKI and WanFang Data were electronically searched from inception to August 2018 to collect randomized controlled trials (RCTs) on ciprofloxacin in the treatment of non-cystic fibrosis bronchiectasis. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 1 666 patients were included. The results of meta-analysis showed that: compared with control group, the ciprofloxacin more efficiently eradicate bacteria from sputum (RR=4.34, 95%CI 2.04 to 9.23, P=0.000 1), decrease risk of the exacerbations (RR=0.81, 95%CI 0.71 to 0.93, P=0.002) and the mean bacterial load (MD=–4.08, 95%CI –6.29 to –1.87, P=0.001). However, there were no significant differences between two groups in clinical efficiency and adverse events.ConclusionsThe current evidence shows that, ciprofloxacin can decrease the mean bacterial load and risk of the exacerbation, and more efficiently eradicate bacteria from sputum in non-cystic fibrosis bronchiectasis patients. Due to limited quality and quantity of the included studies, more studies are required to verify the conclusions.

Kartagener 综合征四例报告并文献复习

目的探讨 Kartagener 综合征的临床特点，提高该病的诊治水平。方法回顾本院呼吸内科收治的 4 例 Kartagener 综合征患者的临床资料，综合复习相关文献后进行分析。结果4 例 Kartagener 综合征中，男 3 例，女 1 例，年龄 24～51 岁。1 例父母为表兄妹近亲结婚。患者均因咳嗽、咳痰，伴或不伴咯血痰、胸闷、气促、喘息、浮肿、发热等症状就诊。1 例在外院确诊 Kartagener 综合征、肺源性心脏病，余 3 例 CT 影像等检查提示存在内脏转位、支气管扩张、鼻窦炎三联征，入院后确诊 Kartagener 综合征。4 例均给抗感染、祛痰、分泌物引流治疗，合并肺源性心脏病者予以无创呼吸机辅助通气、抗心力衰竭等治疗后，病情缓解出院。复习国内外文献，咳嗽、咳痰、咯血、气促是 Kartagener 综合征就诊的主要症状；预防感染、及时控制感染是治疗 Kartagener 综合征的关键。随着对 Kartagener 综合征的基因遗传学研究的深入，有望寻找到有效的办法以早期诊断，有效治疗，甚至减少发病。结论Kartagener 综合征是一种以内脏转位、支气管扩张、鼻窦炎为表现的罕见的先天遗传性疾病。提高临床医生对该病的认识，早期诊断，综合治疗，有效控制慢性气道炎症，是控制疾病进展、改善预后的有效方法。

支气管扩张症138例

目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985～ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

慢性阻塞性肺疾病合并支气管扩张的相关临床研究

目的探讨慢性阻塞性肺疾病（简称慢阻肺）合并支气管扩张患者的临床特点及痰和血清中中性粒细胞弹性蛋白酶（NE）、基质金属蛋白酶-9（MMP-9）的表达情况。方法收集呼吸科门诊定期检查的中重度稳定期慢阻肺患者 25 例，行胸部高分辨 CT 检查，按照支气管扩张评分将患者分为单纯慢阻肺组 14 例及慢阻肺合并支气管扩张组 11 例。患者给予体重指数（BMI）、肺功能、改良英国医学研究委员会问卷（mMRC）、6 分钟步行距离（6MWD）评分，通过 BMI、气流受限程度、呼吸困难、运动耐量评定 BODE 指数。留取患者外周静脉血和诱导痰，采用酶联免疫吸附试验分别测定血清和痰的 NE 和 MMP-9 水平；根据痰涂片计数白细胞总数和分类。结果与单纯慢阻肺组相比，慢阻肺合并支气管扩张组 BODE 指数显著增高（5.2±1.2 比 3.6±1.3，P<0.01）；mMRC 评分显著升高［（1.5±0.5）分 比（0.8±0.6）分，P<0.01］。FEV1%pred、BMI、6MWD 无明显差异。慢阻肺合并支气管扩张组痰中巨噬细胞显著增多［（0.62±0.07）×106/ml 比（0.50±0.07）×106/ml，P<0.05］，MMP-9 表达增高［（32.6±5.08）ng/ml 比（28.1±5.14）ng/ml，P<0.05］。慢阻肺合并支气管扩张组支气管扩张评分与 BODE 指数呈显著正相关（r=0.869，P<0.01），与痰 MMP-9 也呈显著正相关（r=0.625，P<0.05）。结论慢阻肺合并支气管扩张的患者较单纯慢阻肺对比其 MMP-9 在痰上清水平增高，mMRC 评分及 BODE 指数更高，生活质量更差。