High prevalence of bronchiectasis in emphysema-predominant COPD patients.
High prevalence of bronchiectasis in emphysema-predominant COPD patients.
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DOI：
10.2147/copd.s163243
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发表时间：
2018
影响因子：
2.8
通讯作者：
Xiao W
中科院分区：
文献类型：
--
作者：
Dou S;Zheng C;Cui L;Xie M;Wang W;Tian H;Li K;Liu K;Tian X;Wang X;Zhang Q;Ai X;Che J;Liu Q;Li H;Xiao W
COPD已被确定为支气管扩张的病因或相关疾病，支气管扩张已被归类为COPD的合并症。在这项研究中，我们调查了支气管扩张在不同表型COPD受试者中的患病率，以及支气管扩张与不同表型之间的相关性，特别是肺气肿。从2012年4月至2015年12月招募COPD患者。对是否存在支气管扩张及相关信息进行统计学分析。COPD受试者以两种方式分为亚组：COPD伴和不伴支气管扩张组以及以肺气肿为主（肺气肿指数，EI≥9.9%）和以非肺气肿为主（EI<9.9%）组。共纳入1,739例COPD患者，其中140例（8.1%）伴有放射学支气管扩张。COPD合并支气管扩张组肺功能（FEV1%）较无支气管扩张组差（P<0.001），EI（15.0%vs13.4%，P<0.001）、肺动脉高压和肺心病的发生率（6.4%vs2.4%，P=0.005和23.6%vs16.1%，P=0.022）均高于无支气管扩张组。在所有COPD患者中，787例具有EI数据，分为肺气肿为主组（n=369）和非肺气肿为主组（n=418）。支气管扩张的比例分别为16.5%和10.3%（P=0.01）。支气管扩张的严重程度随气流受限程度（r=-0.371，P<0.001）和肺气肿程度（r=0.226，P=0.021）的增加而增加。调整混杂因素后，FEV1%预测值（OR，1.636，95%CI，1.219-2.197，P=0.001）和EI（OR，1.993，95%CI，1.199-3.313，P=0.008）与COPD患者是否存在支气管扩张显著相关。支气管扩张的比例在以肺气肿为主的COPD受试者中较高。EI测量的肺气肿和FEV1%预测值是COPD患者支气管扩张的独立预测因素，但其潜在机制值得进一步研究。
COPD has been identified as an etiology or related disease of bronchiectasis, and bronchiectasis has been classified as a comorbidity of COPD. In this study, we investigated the prevalence of bronchiectasis in different phenotypes of COPD subjects and the correlation between bronchiectasis and different phenotypes, especially emphysema. COPD patients were recruited from April 2012 to December 2015. The presence of bronchiectasis and related information were statistically analyzed. COPD subjects were separated into subgroups in two ways: COPD with and without bronchiectasis groups and emphysema-predominant (emphysema index, EI≥9.9%) and non-emphysema-predominant (EI<9.9%) groups. In total, 1,739 COPD patients were incorporated into the study, among which 140 cases (8.1%) were accompanied with radiological bronchiectasis. COPD patients with concomitant bronchiectasis presented worse pulmonary function (FEV1% predicted, P<0.001), higher EI (15.0% vs 13.4%, P<0.001), and higher proportion of pulmonary hypertension and cor pulmonale (6.4% vs 2.4%, P=0.005 and 23.6% vs 16.1%, P=0.022) than patients without bronchiectasis. Of all the COPD patients, 787 with EI data were divided into emphysema-predominant (n=369) and non-emphysema-predominant groups (n=418). The proportion of bronchiectasis was 16.5% and 10.3% (P=0.01), respectively. Severity of bronchiectasis increased as the degree of airflow limitation (r=−0.371, P<0.001) and emphysema increased (r=0.226, P=0.021). After adjusting confounding factors, FEV1% predicted (OR, 1.636; 95% CI, 1.219–2.197; P=0.001) and EI (OR, 1.993; 95% CI, 1.199–3.313; P=0.008) were significantly related with the presence of bronchiectasis in COPD patients. The proportion of bronchiectasis is higher in emphysema-predominant COPD subjects. Emphysema measured by EI and FEV1% predicted are independent predictors for bronchiectasis in COPD subjects, while the underlying mechanism deserves further investigation.