摘要: |
目的:成人支气管扩张症是一种异质性疾病,关于这些患者预后因素的相关研究很少。本研究旨在评估队列患者不良预后的相关因素,并检验BSI和FACED两种评分系统在预测队列患者不良预后方面的能力,寻找更简易的评分系统用于临床对支气管扩张症患者不良预后的预测。
方法:这是一项回顾性队列研究,患者来源于 2017年1月1日至2019年12月31日期间在中山医院“支气管扩张”专病门诊就诊的患者,筛选出明确诊断为“支气管扩张症”且具有肺功能资料的患者160例。电话随访12个月,确定患者的预后情况。结局定义为预后良好(病情稳定和病情好转)和预后不良(死亡、每年急性加重次数≥3次、因支气管扩张急性加重导致的住院情况、出现并发症和生活质量降低)。将支气管扩张症患者按预后分为预后良好组和预后不良组,对其临床特征间的差异进行比较,并通过Logistic回归分析模型,筛选出与其预后相关的危险因素。基线记录为确定BSI和FACED评分提供了数据。绘制受试者工作特征曲线(ROC)分析BSI和FACED评分系统对评价支气管扩张症患者预后的预测价值。
结果:在多因素Logistic回归分析模型中,病程≥10(年)(OR=3.142,95%CI:1.325~7.451,P<0.05)、FEV1%pred<50%(OR=5.988,95%CI:1.715~20.833,P<0.01)、BMI<18.5kg/m2(OR=4.762,95%CI:1.247~18.120,P<0.05)、铜绿假单胞菌阳性(OR=3.534,95%CI:1.135~11.007,P<0.05)和咯血(OR=2.551,95%CI:1.070~6.097,P<0.05)是预后不良的独立预测因子。在ROC分析中,BSI(AUC=0.890)预测预后不良较FACED(AUC=0.753)预测预后不良的能力更强;将CT评分、mMRC和BMI三者结合评价支气管扩张症患者预后不良的准确性较好(AUC=0.842)。
结论:病程≥10(年)、FEV1%pred<50%、BMI<18.5kg/m2、铜绿假单胞菌阳性和咯血是预后不良的独立预测因子。BSI和FACED评分系统对于预测支气管扩张症患者预后不良均有较强的能力;CT评分、mMRC和BMI三者结合是一种更简易的预后预测模型。
临床试验注册:复旦大学附属中山医院伦理委员会 Y2018-312
关键词:支气管扩张症、预后、急性加重次数、BSI、FACED |
关键词: 支气管扩张症、预后、急性加重次数、BSI、FACED |
DOI:10.12025/j.issn.1008-6358.2023.20230533 |
分类号:R563 |
基金项目:上海市临床重点专科建设项目(shslczdzk02201),上海市肺部炎症与损伤重点实验室(20DZ2261200). |
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Prognostic Factors in Adult Patients with Bronchiectasis |
Zhou chu-jun1, Li hua-yin1, Li Zhuo-zhe2, Wang Qin2
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1.Zhongshan Hospital Fudan University;2.Zhongshan Hospital, Fudan University
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Abstract: |
Objectives: Adult bronchiectasis is a heterogeneous disease, and there are few studies on prognostic factors in these patients. Our objective was to evaluate the factors associated with poor prognosis of cohort patients, and to test the ability of BSI and FACED scoring systems in predicting poor prognosis of cohort patients, and to find a simpler scoring system for clinical prediction of poor prognosis in patients with bronchiectasis.
Methods: We recruited 160 patients diagnosed with bronchiectasis from January 1, 2017 to December 31, 2019 in Zhongshan Hospital to analysis this retrospective study. All patients were followed up for 12 months by telephone to analyze the prognosis. Outcomes were defined as good prognosis (stable disease and improvement) and poor prognosis (death, ≥3 exacerbations per year, hospitalization for bronchiectasis, complications, and reduced quality of life). They were distributed into two groups in accordance with prognosis and the differences between these above two groups of patients with bronchiectasis were compared. Baseline records provided data for determining BSI and FACED. Receiver operating characteristic curve was drawn to analyze the predictive value of BSI and FACED scoring system for prognostic risk of these patients.
Results: In the multivariate Logistic regression analysis model, the disease duration≥10 years(OR=3.142,95%CI:1.325~7.451,P<0.05), FEV1%pred<50%(OR=5.988,95%CI:1.715~20.833,P<0.01),BMI<18.5kg/m2(OR=4.762,95%CI:1.247~18.120,P<0.05), Pseudomonas aeruginosa positive(OR=3.534,95%CI:1.135~11.007,P<0.05)and hemoptysis(OR=2.551,95%CI:1.070~6.097,P<0.05)were independent predictors for poor prognosis. In ROC analysis, BSI(AUC=0.890)was more accurate in predicting poor prognosis than FACED(AUC=0.753)in clinical application. CT score, mMRC and BMI were combined to evaluate poor prognosis in patients with bronchiectasis,which had a good accuracy (AUC=0.842).
Conclusion: Disease duration≥10(years), FEV1%pred<50%, BMI<18.5kg/m2, Pseudomonas aeruginosa positivity and hemoptysis were independent predictors of poor prognosis. Both BSI and FACED scoring systems had a strong ability to predict poor prognosis in patients with bronchiectasis. The combination of CT score, mMRC and BMI was a simpler prognosis prediction model.
Keywords: Bronchiectasis,prognosis,number of acute exacerbations,BSI,FACED |
Key words: Bronchiectasis,prognosis,number of acute exacerbations,BSI,FACED |