支气管扩张症合并慢性肺源性心脏病临床特点分析
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摘要
目的:分析支气管扩张症合并慢性肺源性心脏病患者的临床特点。方法:回顾首都医科大学附属北京安贞医院2013年1月至2014年12月,就诊住院的支气管扩张症急性加重患者125例,分为支气管扩张症不合并慢性肺源性心脏病组(n=62),支气管扩张症合并慢性肺源性心脏病组(n=63),比较两组患者在临床资料、超声心动图参数、急性加重期病原学、实验室检查及胸部高分辨CT等方面的差异。结果:两组患者在年龄、性别、BMI、糖尿病、结核病病史等方面,差异均无统计学意义(P>0. 05)。与不合并慢性肺源性心脏病相比,支气管扩张症合并慢性肺源性心脏病患者的病程长,吸烟指数高,呼吸困难评分(mMRC)高(P<0. 05),BNP水平、超声估测的肺动脉收缩压力较高(P<0. 05),而超声心动图LVEF、血气分析氧分压低于不合并慢性肺源性心脏病组。急性加重病原学方面,两组差异无统计学意义(P>0. 05),但病毒感染在两组急性加重病原学中均占有重要比重(>10%)。两组患者胸部CT表现差异无统计学意义(P>0. 05)。结论:支气管扩张症合并慢性肺源性心脏病患者较不合并患者的病程长,临床指标偏重,需要临床医生早期预警及筛查。
Objective: To analysis the clinical features of bronchiectasis patients with chronic cor pulmonale. Methods: Consecutive 125 patients diagnosed with acute exacerbation of bronchiectasis were enrolled in department of pulmonary and critical care medicine in Beijing Anzhen Hospital from January 2013 to December 2014. General profile, echocardiographic parameters, acute exacerbation pathogens, laboratory tests, and chest high-resolution CT were compared between the patients with and without cor pulmonale(n=63 and 62 respectively). Results: There were no statistically significant differences in age, gender, body mass index, history of diabetes and tuberculosis between the two groups(P>0.05). Compared to patients without cor pulnomale, patients with bronchiectasis complicated with cor pulmonale had a longer course of disease, a higher smoking index and a higher dyspnea score(mMRC)(P<0.05) as well as BNP and ultrasound-estimated pulmonary systolic pressure(P<0.05). The PO_2 and echocardiographic left ventricular ejection fraction of bronchiectasis patients with cor pulmonale were lower than those without(P<0.05).There was no significant difference between the two groups in etiology including incidences of bacterial, viral or fungal infections during acute exacerbation(P>0.05). However, viral infections accounted for a large proportion(both over 10%) in both groups during acute exacerbation. No significant difference was observed in chest CT findings between two groups. Conclusions: It indicated that bronchiectasis patients with cor pulmonale have longer courses of disease, more severe clinical parameters which required paying early attention and screening by physicians.
Objective: To analysis the clinical features of bronchiectasis patients with chronic cor pulmonale. Methods: Consecutive 125 patients diagnosed with acute exacerbation of bronchiectasis were enrolled in department of pulmonary and critical care medicine in Beijing Anzhen Hospital from January 2013 to December 2014. General profile, echocardiographic parameters, acute exacerbation pathogens, laboratory tests, and chest high-resolution CT were compared between the patients with and without cor pulmonale(n=63 and 62 respectively). Results: There were no statistically significant differences in age, gender, body mass index, history of diabetes and tuberculosis between the two groups(P>0.05). Compared to patients without cor pulnomale, patients with bronchiectasis complicated with cor pulmonale had a longer course of disease, a higher smoking index and a higher dyspnea score(mMRC)(P<0.05) as well as BNP and ultrasound-estimated pulmonary systolic pressure(P<0.05). The PO_2 and echocardiographic left ventricular ejection fraction of bronchiectasis patients with cor pulmonale were lower than those without(P<0.05).There was no significant difference between the two groups in etiology including incidences of bacterial, viral or fungal infections during acute exacerbation(P>0.05). However, viral infections accounted for a large proportion(both over 10%) in both groups during acute exacerbation. No significant difference was observed in chest CT findings between two groups. Conclusions: It indicated that bronchiectasis patients with cor pulmonale have longer courses of disease, more severe clinical parameters which required paying early attention and screening by physicians.
引文
[1] Barker AF. Bronchiectasis. N Engl J Med,2002,346:1383-1393.
[2] 周玉民, 王辰, 姚婉贞, 等. 我国7省市城区40岁及以上居民支气管扩张症的患病情况及危险因素调查. 中华内科杂志, 2013,52:379-382.
[3] Shujaat A, Minkin R, Eden E. Pulmonary hypertension and chronic cor pulmonale in COPD. Int J Chron Obstruct Pulmon Dis 2007;2:273-282.
[4] 李晓云, 刘双. 支气管扩张患者271例病因分析. 中国医药,2013,8:1549-1550.
[5] 李晓云, 刘双. 支气管扩张病因的研究进展. 心肺血管病杂志, 2014,33:124-126.
[6] Organization WH. Chronic cor pulmonale-a report of the expert committee. Circulation,1963,27:594-615.
[7] 史乃楷. 慢性肺原性心脏病诊断标准(1977年全国第二次肺心病专业会议修订). 山西医药杂志, 1982,01:35-39.
[8] Kawut SM, Poor HD, Parikh MA, et al. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: The MESA COPD study. J Am Coll Cardiol,2014,64:2000-2009.
[9] Weitzenblum E, Chaouat A. Cor pulmonale. Chron Respir Dis,2009,6:177-185.
[10] Weitzenblum E. Chronic Cor Pulmonale. Heart, 2003,89:225-230.
[11] Hilde JM, Skj?rten I, Gr?tta OJ, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol,2013,62:1103-1111.
[12] 陈勇, 刘双, 焦瑞. 慢性阻塞性肺疾病合并支气管扩张患者的临床特点分析. 心肺血管病杂志, 2016,35:275-278.
[13] 程显声, 李景周, 张珍祥. 慢性阻塞性肺疾病、肺心病人群防治的研究基线资料分析. 中华结核和呼吸杂志, 1998,21:749-752.
[14] Altschule MD. Cor pulmonale: a disease of the whole heart. Dis Chest,1962,41:398-403.
[15] Alzeer AH, Al-Mobeirek AF, Al-Otair HAK, et al. Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis. Chest, 2008,133:468-473.
[16] Ju C, Chen M, Zhang J, et al. Higher plasma myostatin levels in cor pulmonale secondary to chronic obstructive pulmonary disease. PLoS One, 2016,11:e0150838.
[17] MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part One. Am J Respir Crit Care Med,1994,150:833-852.
[18] MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part two. Am J Respir Crit Care Med, 1994,150:1158-1168.
[19] Silverman HS, Wei S, Haigney MCP, et al. Myocyte adaptation to chronic hypoxia and development of tolerance to subsequent acute severe hypoxia. Circ Res, 1997,80:699-707.
[20] 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012,35:485-492.
[21] 焦瑞, 刘双. 支气管扩张症急性加重期研究进展. 心肺血管病杂志, 2015,34:236-238.
[22] Gao Y, Guan W, Xu G, et al. The role of viral infection in pulmonary exacerbations of bronchiectasis in adults: a prospective study. Chest,2015,147:1635-1643.
[23] Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med, 2006,173:1114-1121.
[24] Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001,164:1618-1623.
[25] 孙洪岩, 齐保龙. 成人支气管扩张症病原菌分布及咯血原因分析. 临床肺科杂志, 2018, 23:869-871.
[26] 李詝, 李久荣, 高金明. 北京协和医院136例支气管扩张症住院患者临床特征分析. 中国医学科学院学报, 2014,36:61-67.
[27] 关伟杰, 袁婧婧, 高永华, 等. 支气管扩张症患者咯血与疾病严重程度和急性加重的关系. 中华结核和呼吸杂志, 2017,40:16-23.
[28] Gencer M, Ceylan E, Yilmaz R, et al. Impact of bronchiectasis on right and left ventricular functions. Respir Med,2006,100:1933-1943.
[29] Ocal S, Portakal O, Ocal A, et al. Factors associated with pulmonary hypertension and long-term survival in bronchiectasis subjects. Respir Med,2016,119:109-114.
[2] 周玉民, 王辰, 姚婉贞, 等. 我国7省市城区40岁及以上居民支气管扩张症的患病情况及危险因素调查. 中华内科杂志, 2013,52:379-382.
[3] Shujaat A, Minkin R, Eden E. Pulmonary hypertension and chronic cor pulmonale in COPD. Int J Chron Obstruct Pulmon Dis 2007;2:273-282.
[4] 李晓云, 刘双. 支气管扩张患者271例病因分析. 中国医药,2013,8:1549-1550.
[5] 李晓云, 刘双. 支气管扩张病因的研究进展. 心肺血管病杂志, 2014,33:124-126.
[6] Organization WH. Chronic cor pulmonale-a report of the expert committee. Circulation,1963,27:594-615.
[7] 史乃楷. 慢性肺原性心脏病诊断标准(1977年全国第二次肺心病专业会议修订). 山西医药杂志, 1982,01:35-39.
[8] Kawut SM, Poor HD, Parikh MA, et al. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: The MESA COPD study. J Am Coll Cardiol,2014,64:2000-2009.
[9] Weitzenblum E, Chaouat A. Cor pulmonale. Chron Respir Dis,2009,6:177-185.
[10] Weitzenblum E. Chronic Cor Pulmonale. Heart, 2003,89:225-230.
[11] Hilde JM, Skj?rten I, Gr?tta OJ, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol,2013,62:1103-1111.
[12] 陈勇, 刘双, 焦瑞. 慢性阻塞性肺疾病合并支气管扩张患者的临床特点分析. 心肺血管病杂志, 2016,35:275-278.
[13] 程显声, 李景周, 张珍祥. 慢性阻塞性肺疾病、肺心病人群防治的研究基线资料分析. 中华结核和呼吸杂志, 1998,21:749-752.
[14] Altschule MD. Cor pulmonale: a disease of the whole heart. Dis Chest,1962,41:398-403.
[15] Alzeer AH, Al-Mobeirek AF, Al-Otair HAK, et al. Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis. Chest, 2008,133:468-473.
[16] Ju C, Chen M, Zhang J, et al. Higher plasma myostatin levels in cor pulmonale secondary to chronic obstructive pulmonary disease. PLoS One, 2016,11:e0150838.
[17] MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part One. Am J Respir Crit Care Med,1994,150:833-852.
[18] MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part two. Am J Respir Crit Care Med, 1994,150:1158-1168.
[19] Silverman HS, Wei S, Haigney MCP, et al. Myocyte adaptation to chronic hypoxia and development of tolerance to subsequent acute severe hypoxia. Circ Res, 1997,80:699-707.
[20] 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012,35:485-492.
[21] 焦瑞, 刘双. 支气管扩张症急性加重期研究进展. 心肺血管病杂志, 2015,34:236-238.
[22] Gao Y, Guan W, Xu G, et al. The role of viral infection in pulmonary exacerbations of bronchiectasis in adults: a prospective study. Chest,2015,147:1635-1643.
[23] Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med, 2006,173:1114-1121.
[24] Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001,164:1618-1623.
[25] 孙洪岩, 齐保龙. 成人支气管扩张症病原菌分布及咯血原因分析. 临床肺科杂志, 2018, 23:869-871.
[26] 李詝, 李久荣, 高金明. 北京协和医院136例支气管扩张症住院患者临床特征分析. 中国医学科学院学报, 2014,36:61-67.
[27] 关伟杰, 袁婧婧, 高永华, 等. 支气管扩张症患者咯血与疾病严重程度和急性加重的关系. 中华结核和呼吸杂志, 2017,40:16-23.
[28] Gencer M, Ceylan E, Yilmaz R, et al. Impact of bronchiectasis on right and left ventricular functions. Respir Med,2006,100:1933-1943.
[29] Ocal S, Portakal O, Ocal A, et al. Factors associated with pulmonary hypertension and long-term survival in bronchiectasis subjects. Respir Med,2016,119:109-114.