Asthma as aetiology of bronchiectasis in Finland
Asthma as aetiology of bronchiectasis in Finland
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DOI：
10.1016/j.rmed.2019.04.022
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发表时间：
2019-06-01
影响因子：
4.3
通讯作者：
Kauppi, Paula
中科院分区：
文献类型：
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作者：
Mantyla, Jarkko;Mazur, Witold;Kauppi, Paula
背景资料：根据定义，支气管扩张（BE）是指由于频繁的细菌感染和炎症而导致的正常支气管结构的破坏。在许多意义上，BE是一种被忽视的孤儿病。为了更好地了解BE的病理生理学、更好的患者表型和个体化管理，最近进行了一项泛欧登记研究EMBARC。目的：研究芬兰首都地区BE的病因和共病情况。2016年至2017年期间，赫尔辛基大学医院的205例BE诊断和随访患者被邀请参加study.将基线人口统计学、肺功能、影像学、微生物学和治疗数据以及合并症输入EMBARC数据库。临床特点，病因因素，共病，广泛BE的危险因素进行了explored.Results：本研究包括95例成人患者和79%的BE患者是女性。平均年龄为69岁（SD +/-13）。哮喘是68%患者的共病，但估计26%的患者是BE的原因。如果哮喘早于BE被诊断，则哮喘是BE的病因。由于41%的BE是特发性的，11%的疾病是感染后的，其他的与风湿性疾病、α-1-抗胰蛋白酶缺乏症、IgG缺乏症和Kartagener综合征有关。除哮喘外，最常见的合并症为心血管疾病（30%）、胃食管反流病（26%）、超重（22%）、糖尿病（16%）、非活动性肿瘤（15%）和免疫缺陷（12%）。广泛BE被发现在68%的BE患者中，其中四个或更多的叶受到影响。广泛BE的危险因素是哮喘（OR 2.7），哮喘作为BE的病因（OR 4.3）和鼻窦炎（OR 3.1）。结论：68%的BE与哮喘相关，估计每4例患者中就有1例哮喘是BE的病因。然而，回顾性地，在有哮喘样症状和呼吸道感染的患者中，很难排除哮喘作为背景原因。我们建议哮喘作为BE的病因学因素，如果它被诊断早于BE。哮喘和鼻窦炎是广泛BE的预测因素。
Background: By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management.Aim: To examine the aetiology and co-morbidity of BE in the capital area in Finland.Methods: Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored.Results: To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD +/- 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1).Conclusions: Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.