Analysis Of Related Factors Of Bronchiectasis Complicated With Irreversible Airflow Restriction

1 ObjectiveBronchiectasis is one of the most important respiratory diseases with high incidence.With the popularization of high-resolution CT and advances in technology,great progresses have been made in etiology,pathophysiology,pathogenesis and other aspects of this disease,while there are still few studies on bronchiectasis complicated with irreversible airflow restriction.The purpose of this study is to analyze and compare the clinical features of bronchiectasis patients with and without irreversible airflow restriction,so as to provide a basis for mitigating or even preventing the irreversible airflow restriction of bronchiectasis patients.2 MethodsFrom August,2018 to January,2020,207 patients with bronchiectasis were diagnosed by thin-layer CT in the Pulmonary and Critical Care Medicine Department of the First Affiliated Hospital of Shantou University Medical College.Among them,75 cases completed pulmonary function examination.According to the spirometric results,patients were divided into bronchiectasis without irreversible airflow restriction group(n=24)and bronchiectasis combined with irreversible airflow restriction group(n=51).The patients’ gender,age,smoking history,course of disease,etiology,serological examination,etiological examination and imaging of the two groups were analyzed and compared.The differences between the two groups were analyzed by SPSS19.0.Logistic multivariate regression was performed for the all the factors with statistical significance.3 Results3.1 Among the 207 patients,there were 120 males(58.0%)and 87 females(42.0%).The average age of the patients was 62.83±10.55 years old,and most of them were in the range of 50-79 years old.A total of 117 patients had smoking history,and 90 patients had no smoking history.The history of disease ranged from 1 week to40 years,with a mean length of 12.40±10.96 years.Among all the patients,150 cases(72.3%)had no clear etiology.Among the cases with clear etiology,45 of them had previous infection,of which 39 were diagnosed with tuberculosis.Cough and expectoration were the most common symptoms,while rales were the most common signs.146 cases had sputum or bronchoalveolar lavage fluid culture specimens.49 cases were with positive results,of which 16 were Pseudomonas aeruginosa,and 11 were Mycobacterium tuberculosis.The accuracy of chest X-ray in diagnosing bronchiectasis is limited.All the 207 cases had completed thin-layer CT,among which 77 cases were columnar bronchiectasis,followed by cystic columnar bronchiectasis,cystic bronchiectasis,and mixed bronchiectasis.Most of the cases(155)had multiple lobes involved.Among all the lobes the most commonly involved was the left lower lobe(156 cases),followed by the right lower lobe.There were no statistically significances in laboratory indicators among all types of bronchiectasis.3.2 75 patients completed pulmonary function examination,and were divided into bronchiectasis without irreversible airflow restriction group(n=24)and bronchiectasis group(n=51)with irreversible airflow limitation.Data analysis for each group was as follows:3.2.1The average age of bronchiectasis patients combined with irreversible airflow restriction group was higher than that of bronchiectasis without irreversible airflow restriction group,and the proportion of patients with smoking history was also higher,which prompt the difference was statistically significant.There was no significant difference in gender and course of disease between the two groups.3.2.2 In both groups,the etiology of bronchiectasis included tuberculosis,autoimmune disease,non-tuberculous mycobacteria and mucosal ciliary obstruction.There was no significant difference in etiology between the two groups.3.2.3 The symptoms and signs of bronchiectasis with irreversible airflow restriction were not significantly different from those of bronchiectasis without irreversible airflow restriction.3.2.4 Compared with bronchiectasis without irreversible airflow restriction group,bronchiectasis combined with irreversible airflow restriction group had lower alveolar blood oxygen partial pressure,and the proportion of type I respiratory failure was increased,which indicated the difference was statistically significant.3.2.5 There was no significant difference in the etiological results of sputum or bronchoalveolar lavage fluid between both groups.3.2.6 Thin-layer CT showed that the proportion of involvement of right lower lobe and left lingual lobe was higher in patients with irreversible airflow restriction and the proportion of columnar bronchiectasis was lower,and both of the differences were statistically significant.3.2.7 Among the 51 patients who were diagnosed with bronchiectasis combined with irreversible airflow restriction,there was no statistically significant difference between the degree of irreversible airflow limitation and different bronchiectasis types(columnar,cystic columnar,cystic,mixed)on CT.The involvement of the lower lobe of the right lung indicated that more severe irreversible airflow restriction,which was statistically significant.4 Conclusion4.1 In this study,most patients with bronchiectasis were middle-aged and elderly men,and most of them were smokers.The etiology of most of the patients was not clear,and most of the patients who with clear etiology were infection,mainly tuberculosis.The symptoms and signs of the patient were mainly cough,expectoration and rales on physical examination.In this study,the positive rate of sputum and bronchoalveolar lavage fluid culture was low.Pseudomonas aeruginosa was the most common etiologic agent,followed by Mycobacterium tuberculosis.Most of the cases were with multiple lobes involvement,of which the lower lobes of were the most involved and the main type was columnar bronchiectasis.Most patients with bronchiectasis have irreversible airflow limitation.4.2 Age and smoking history were associated with complicated irreversible airflow restriction.4.3 In this study,there was no significant correlation between gender,length of disease course,etiology,symptoms,signs,result of culture and irreversible airflow restriction.4.4 Decrease of arterial oxygen partial pressure and type I respiratory failure in bronchiectasis may indicate irreversible airflow restriction.4.5 Patients with irreversible airflow limitation may have a higher proportion of bronchiectasis in the right lower lobe and left lingual lobe.In patients with bronchiectasis with irreversible airflow restriction,involvement of the right inferior lobe may indicate more severe irreversible airflow restriction.4.6 In this study,age,smoking history,combined with type I respiratory failure,involvement of the lower lobe of the right lung,and involvement of the lingual lobe of the left lung were independent risk factors of bronchiectasis combined with irreversible airflow restriction.