[Hemoptysis in adults with bronchiectasis: correlation with disease severity and exacerbation risk].

Objective: To investigate the association between hemoptysis and disease severity and risks of acute exacerbations in patients with bronchiectasis. Methods: Between September 2012 and January 2014, we recruited 148 patients (56 males, 92 females, mean age: 44.6 years) with clinically stable bronchiectasis, who were classified into hemoptysis group (36 males, 70 females, mean age: 45.6 years) and non-hemoptysis group (20 males, 22 females, mean age: 41.8 years). We inquired the past history, and evaluated chest imaging characteristics, lung function, cough sensitivity assessed using capsaicin cough challenge tests, and airway inflammation. We also performed a 1-year follow-up to evaluate whether patients with hemoptysis would have greater risk of having acute exacerbations. Results: In the hemoptysis group, median 24-hour sputum volume was 20.0 ml, median Bronchiectasis Severity Index (BSI) was 7.0, median bronchiectatic lobes was 4.0, median chest CT score was 7.0, the geometric mean for eliciting 5 coughs following capsaicin cough sensitivity (C5) was 77 μmol/L, 67 cases (63%) had cystic bronchiectasis and 52 cases (49%) had pulmonary cavity shown on chest CT, and 35 cases (33%) had Pseudomonas aeruginosa colonization. In the non-hemoptysis group, median 24-hour sputum volume was 5.0 ml, median BSI was 4.0, median bronchiectatic lobes was 3.0, median chest CT score was 5.0, 15 cases (36%) had cystic bronchiectasis and 10 cases (24%) had pulmonary cavity, the geometric mean for C5 was 212 μmol/L, and 4 cases (10%) had Pseudomonas aeruginosa colonization. All the above parameters differed significantly between the hemoptysis and the non-hemoptysis group (P<0.05). In the hemoptysis group, 29 patients with pulmonary cavity (27%) had reported the use of intravenous antibiotics, and 44 cases (42%) had at least one hospitalization within the previous 2 years. In the non-hemoptysis group, 8 cases (19.0%) had reported the use of intravenous antibiotics, and 8 cases (19.0%) reported hospitalization within 2 years. A prior history of hemoptysis was associated with a greater risk of experiencing bronchiectasis exacerbations during follow-up, after adjusting for age, sex, smoking status and BSI (62 cases in the hemoptysis group, 18 cases in the non-hemoptysis group, χ(2)=16.06, P=0.03). In a multivariate model, cystic bronchiectasis was the sole risk factor for hemoptysis; 67 cases which accounted for 63% of patients in the hemoptysis group and 15 cases which accounted for 36% of patients in the non-hemoptysis group, odds ratio: 2.84, 95% confidence interval: 1.00-8.14, P=0.05 . Conclusions: In this study, 72% of bronchiectasis patients had experienced hemoptysis, which was associated with the severity of bronchiectasis. Patients with a prior history of hemoptysis had a greater risk of acute exacerbations during follow-up than those without.目的： 评估支气管扩张症(支扩症)患者咯血与疾病严重程度和急性加重的关系。 方法： 于2012年9月至2014年1月纳入148例稳定期支扩症患者，男56例，例女92例，平均年龄44.6岁。咯血组106例，男36例，女70例，平均年龄45.6岁；未咯血组42例，男20，女22例，平均年龄41.8岁。采集既往病史，评价胸部影像学、肺功能、辣椒素激发试验相关的咳嗽敏感性及气道炎症特征。对患者进行1年随访以判断咯血能否预测支扩症急性加重的风险。 结果： 咯血组24 h痰量中位数为20 ml，支扩症严重程度指数中位数为7.0，受累肺叶中位数为4.0个，胸部CT评分中位数为7.0分，胸部CT提示存在囊状支扩病变67例(63%)，肺部空洞形成52例(49%)，铜绿假单胞菌定植35例(33%)，辣椒素激发试验测定的咳嗽敏感度(引起≥5次咳嗽的辣椒素浓度)的几何均数为77 μmol/L。未咯血组24 h痰量中位数为5.0 ml，支扩严重程度指数中位数为4.0，受累肺叶中位数为3.0个，胸部CT评分中位数为5.0分，囊状支扩15例(36%)，肺部空洞形成10例(24%)，铜绿假单胞菌定植4例(10%)，辣椒素激发试验测定的咳嗽敏感度的几何均数为212 μmol/L。以上指标两组比较差异均有统计学意义(均P<0.05)。咯血组在入组前2年内因治疗急性加重而静脉滴注抗生素者29例(27%)，住院治疗44例(42%)；未咯血组在入组前2年内因治疗急性加重而静脉滴注抗生素8例(19%)，住院治疗8例(19%)。经性别、年龄、吸烟状况、支扩严重程度指数校正后，咯血组在1年随访期内急性加重的风险更高(咯血组62例、未咯血组18例出现过急性加重，χ(2)＝16.06，P＝0.03)。胸部CT提示存在囊状支扩的患者其咯血风险更高，咯血组67例(63%)，未咯血组15例(36%)，比值比为2.84(95%可信区间为1.00～8.14，P＝0.05)。 结论： 72%(106例)的支扩症患者出现过咯血，且咯血与疾病严重程度呈正相关；咯血患者较未咯血患者在随访期的急性加重风险更高。.