Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
ObjectiveTo investigate the relationship between the red blood cell distribution width (RDW) and the severity of acute exacerbation of bronchiectasis in elderly patients.MethodsThe clinical data of 216 elderly patients with acute exacerbation of bronchiectasis admitted from January 2015 to October of 2018 were analyzed retrospectively. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by bronchiectasis severity index (BSI) score. Meanwhile, 50 elderly people receiving qualified medical examination were collected as a healthy control group in the same period. The distributions of BSI score, RDW, procalcitonin (PCT), neutrophil percentage (NEU%) and C-reactive protein (CRP) were described in the patients with different risk degree. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by BSI. The patients were divided into three groups by BSI score: a low risk group, a middle risk group, and a high risk group. The indexes were described including the distribution of stratified BSI score, RDW, PCT, NEU%, CRP at different risk levels. The correlation of each index was analyzed by Spearman correlation. The threshold value of RDW was calculated by general linear regression, and the influencing factors of BSI score were analyzed by multivariate linear regression analysis.ResultsThe higher the risk stratification, the higher the BSI score, RDW, PCT, NEU% and CRP were. RDW was positively correlated with PCT, NEU% and CRP (r values were 0.425, 0.311, 0.177, respectively, P<0.05). BSI score was positively correlated with RDW, PCT, NEU%, and CRP (r values were 0.425, 0.394, 0.650, 0.578, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.425, P<0.05). The thresholds of RDW were 11.45% and 14.03%. Multiple linear regression showed that RDW, PCT, NEU% and CRP were all influential factors of BSI score and explained 52.3% of the total mutation rate.ConclusionRDW is related to the severity of acute exacerbation of bronchiectasis in the elderly, and can predict the severity of acute exacerbation of bronchiectasis in the elderly.
目的 提高对囊性纤维化的认识。 方法 2011年11月收治1例自幼有临床表现的囊性纤维化患者，回顾其诊断及治疗经过，复习相关文献总结其临床特征、诊疗进展及预后评价。 结果 囊性纤维化起病年龄较早，患者自幼年起即反复出现肺、消化道、肝脏等多系统病变，最终导致多器官功能衰竭。 结论 应提高对囊性纤维化的识别度，对于发病年龄过早、反复发作的严重支气管扩张，伴随生长发育延迟、肝硬化等临床征象应注意对囊性纤维化的筛查。
Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.
ObjectiveTo evaluate the combination efficacy with Qingfei Yihuo capsule and routine antibiotics as well as mucopolytic agents in the treatment of bronchiectasis acute exacerbation.MethodsThis was a prospective, multi-center, randomized controlled clinical study. The efficacy of Qingfei Yihuo capsule combine with routine antibiotics and mucopolytic agents in the treatment of bronchiectasis acute exacerbation was compared according to the symptom control as well as exacerbation duration. Through randomization, patients received Qingfei Yihuo capsule or placebo combine with routine antibiotics and mucopolytic agents treatment for 10 days. Symptom score of cough, sputum, short of breath pre- and post-treatment as well as the symptom score in daily card were compared between the two groups. The spirometry and St. George respiratory questionnaire (SGRQ) before and after treatment were compared.ResultsThis study was conducted from June 2017 to August 2018. One hundred and ninety patients from 7 centers in 6 hospitals with bronchiectasis acute exacerbation were enrolled in the study. There was statistically improvement of symptom score (including the 9th and 10th treatment days) according to the daily card recording in Qingfei Yihuo capsule group compared to the placebo group, but no statistically significant difference was found in spirometry results or SGRQ.ConclusionQingfei Yihuo capsule has assistant effect on improving respiratory symptoms of bronchiectasis exacerbation.
ObjectiveA series of single-case randomized controlled trials (N-of-1 trials), with placebo Chinese herbs used as a control, were conducted to observe the efficacy of the syndrome differentiation treatment formula in the stable phase of bronchiectasis by using a modified mixed-effects model (MEM) to detect the "carryover effects" of Chinese herbs, and to explore the establishment of an N-of-1 trial method that reflects the characteristics of syndrome differentiation treatment in traditional Chinese medicine (TCM). MethodsA single-center clinical trial was conducted in which a single case was studied in a multiple crossover, randomized controlled, and blinded manner. There were three rounds of the trial, each with two observation periods (treatment period and control period) of 4 weeks each. In the treatment period, an individualized formula based on syndrome differentiation was given, and in the control period, a placebo formula was administered. The primary indicator was the patients’ self-rated 7-point symptom Likert scale score, and other indicators included chronic obstructive pulmonary disease assessment test (CAT) score, 24 h sputum volume, TCM syndrome score, and safety index. Paired t test was used to analyze single case data and MEM designed for "carryover effects" was used to analyze group data. ResultsA total of 21 subjects were formally enrolled, and 15 (75%) completed three rounds of N-of-1 trials. Three of the cases showed statistically significant differences in overall symptom Likert scale score. At the group level, the MEM designed for "carryover effects" found statistically significant residual effects on three indicators (overall symptom score, respiratory symptom score, and CAT score). After excluding the "carryover effects", the model analyzed the statistically significant differences between the intervention effects of the two formulas on the overall symptom score, respiratory symptom score, CAT score and TCM syndrome score. The sensitivity of the MEM was higher than that of the meta-analysis when residual effects existed in the N-of-1 trials. ConclusionThe N-of-1 trials of Chinese herbs designed in this study can well demonstrate the characteristics of TCM syndrome differentiation and treatment. The modified MEM can detect the residual effects of TCM and improve the sensitivity of data statistics. However, due to the inherent nature of N-of-1 trials, the sensitivity of this study method at the individual level is low and more cases and diseases need to be studied for further improvement.