结核后支气管扩张的临床特征及危险因素

摘要 目的：探讨结核后支气管扩张的临床特征,并阐述相关危险因素。方法：2020年6月到2022年1月选择在本院诊治的支气管扩张患者113例作为研究对象,其中结核后支气管扩张51例（合并组）,非结核后支气管扩张62例（非合并组）,调查所有患者的临床特征,并进行血液学、肺功能与影像学检查。结果：合并组的血清C-反应蛋白（CRP）含量明显高于非合并组,血清白蛋白（ALB）、血清总蛋白（TP）含量明显低于非合并组（P<0.05）。合并组的第一秒用力肺活量（FEV₁）、FEV₁/用力呼气容积（FVC）%明显低于非合并组（P<0.05）。合并组的斑片渗出影、"树芽征"、胸腔积液、"马赛克征"等CT特征占比分别为84.3 %、72.5 %、70.6 %、62.7 %,明显高于非合并组的35.5 %、33.9 %、37.1 %、40.3 %（P<0.05）。在113例患者中,Spearsman分析显示体重指数、CRP、支气管扩张病程、ALB与结核后支气管扩张的发生存在相关性（P<0.05）。二元Logistic回归模型分析显示体重指数、CRP、支气管扩张病程、ALB都为导致结核后支气管扩张发生的重要因素（P<0.05）。结论：结核后支气管扩张比较常见,可导致患者出现营养不良与肺功能下降,也使得肺部影像学特征发生改变,体重指数、CRP、支气管扩张病程、血清ALB都为导致结核后支气管扩张发生的重要因素。

Clinical Features and Risk Factors of Bronchiectasis after Tuberculosis

ABSTRACT Objective: To investigate the clinical features of post-tuberculosis bronchiectasis and to describe the related risk factors. Methods: From August 2018 to January 2022, 113 cases of patients with bronchiectasis who were diagnosed and treated in our hospital were selected as the research subjects, included 51 cases of bronchiectasis after tuberculosis (combined group) and 62 cases of bronchiectasis after non-tuberculosis (non-combined group). All the cases were to investigate the clinical characteristics of all patients, and to perform hematological, pulmonary function, and imaging studies. Results: The contents of serum C-reactive protein (CRP) in the combined group were significantly higher than those in the non combined group, and the contents of serum albumin (ALB) and serum total protein (TP) were significantly lower than those in the non combined group(P<0.05). The forced vital capacity in the first second (FEV1) and FEV1/forced expiratory volume(FVC)% of the combined group were significantly lower than those of the non-combined group(P<0.05). The CT features of patch exudation, "tree in bud", pleural effusion, and "mosaic sign" in the combined group accounted for 84.3 %, 72.5 %, 70.6 %, and 62.7 %, respectively, which were significantly higher than 35.5% in the non-combined group of 33.9 %, 37.1 %, 40.3 %(P<0.05). In the 113 patients, Spearsman analysis showed that body mass index, C-reactive protein, course of bronchiectasis, and ALB were associated with the occurrence of bronchiectasis after tuberculosis (P<0.05). Binary Logistic regression model analysis showed that body mass index, C-reactive protein, course of bronchiectasis, and ALB were all important factors leaded to bronchiectasis after tuberculosis(P<0.05). Conclusion: Bronchiectasis is common after tuberculosis, which can lead to malnutrition and decreased lung function in patients, and also changes the lung imaging characteristics. Body mass index, C-reactive protein, course of bronchiectasis, and serum ALB are all important factors leading to the occurrence of bronchiectasis after tuberculosis.