Baseline characteristics of patients in the Chinese Bronchiectasis Registry (BE-China): a multicentre prospective cohort study

Jin-Fu Xu, Hui-Zhen Zheng, Hai-Wen Lu, et al

Lancet Respir Med Available online 10 January 2025

https://doi.org/10.1016/S2213-2600(24)00364-3

Summary

Background

Bronchiectasis is a disease with a global impact, but most published data come from high-income countries. We aimed to describe the clinical characteristics of patients with bronchiectasis in China.

背景：支气管扩张症是一种在全球范围内具有重要影响的疾病，但大多数已发表的数据来自高收入国家。本研究旨在描述中国支气管扩张症患者的临床特征图谱。

Methods

The Chinese Bronchiectasis Registry (BE-China) is a prospective, observational cohort enrolling patients from 111 hospitals in China. Data on demographics, comorbidities, and aetiological testing results were collected from adult patients with bronchiectasis at baseline and annual follow-up. Patients who met the inclusion criteria (age ≥18 years; received chest high-resolution CT in the past year showing bronchiectasis affecting one or more lung lobes; and clinical history consistent with bronchiectasis, including chronic cough, daily sputum production, and history of exacerbations) were included. Patients with known cystic fibrosis were excluded. To investigate variations according to different economic regions, two groups were compared based on whether per capita disposable income of residents was greater than US$5553. Clinical characteristics were compared with the European (EMBARC) registry and other national registries.

方法：中国支气管扩张症注册登记研究（BE-China）是一项前瞻性、观察性队列研究，招募了来自中国 111 家医院的患者。研究收集成年支气管扩张症患者在基线和年度随访时的人口统计学、合并症和病因学检测结果等数据。本研究纳入符合支扩诊断标准（年龄≥18 岁，在过去一年中接受过胸部高分辨率 CT 检查，显示一个或
多个肺叶存在支气管扩张，临床病史符合支气管扩张症，有慢性咳嗽、每日咳痰和急性加重史）的患者。已知患有囊性纤维化的患者被排除在外。为了研究不同经济状况区域的患者特征差异，基于居民人均可支配收入是否超过 5553 美元，将患者分为了两组进行比较。同时，中国患者临床特征与欧洲支扩注册登记（EMBARC）和其他国家的注册登记研究数据进行了比较。

Findings

Between Jan 10, 2020, and March 31, 2024, 10 324 patients from 97 centres were included in the study. Among 9501 participants with available data, the most common cause of bronchiectasis was post-infective disease (4101 [43·2%] patients), followed by idiopathic (2809 [29·6%] patients). 6676 (70·0%) of 9541 patients with available data had at least one exacerbation in the year before enrolment and 5427 (57·2%) of 9489 patients with available data were hospitalised at least once due to exacerbations. Treatments commonly used in high-income countries, such as inhaled antibiotics and macrolides, were infrequently used in China. Implementation of airway clearance in China was scarce, with only 1177 (12·2%) of 9647 patients having used at least one method of airway clearance. Compared with upper-middle-income regions, patients from lower-middle-income regions were younger (61·0 years [SD 14·0] vs 63·9 years [14·2]) with a higher proportion of pulmonary comorbidities (521 [17·8%] of 2922 patients vs 639 [8·6%] of 7402 with chronic obstructive pulmonary disease and 194 [6·6%] of 2922 patients vs 364 [4·9%] of 7402 patients with asthma), a higher tuberculosis burden (442 [16·0%] of 2768 patients vs 715 [10·6%] of 6733 patients), more severe radiological involvement (1160 [42·4%] of 2736 patients vs 2415 [35·4%] of 6816 patients with cystic bronchiectasis), more exacerbations (median 1·4 [IQR 0–2] in both groups; mean 1·4 [SD 1·6] vs 1·2 [1·4] in the previous year) and hospitalisations (1662 [60·6%] of 2743 patients vs 3765 [55·8%] of 6746 patients hospitalised at least once in the previous year), and poorer quality of life (median 57·4 [IQR 53·5–63·1] vs 58·7 [54·8–64·8] assessed by the Bronchiectasis Health Questionnaire).

结果：2020 年 1 月 10 日至 2024 年 3 月 31 日期间，最终共有来自 97 个中心的 10,324 名患者被纳入研究。在 9501 名有足够数据的患者中，支气管扩张症最常见的病因是感染后（4101 例/43·2%），其次是特发性（2809 例/29·6%）。6676 例（70·0%）患者在入组前一年至少有一次急性加重，5427 例（57·2%）患者因急性加重至少住院治疗过一次。在高收入国家常用的治疗方法，如吸入性抗生素和大环内酯类药物长期维持治疗，在中国报道使用较少。气道清除治疗在中国患者的应用比例较低，9647 名患者中仅有 1177 例（12·2%）进行过至少一种气道清除治疗。与中高收入地区相比，来自中低收入地区的患者更年轻（61·0
±14·0 岁 vs 63·9±14·2 岁），合并肺部合并症的比例更高（17·8%合并慢性阻塞性肺疾病 vs 8·6%合并慢性阻塞性肺疾病； 6·6%合并哮喘 vs 4·9%合并哮喘），结核负担更重（16·0% vs 10·6%），影像学表现更重（42·4%为囊性支气管扩张 vs 35·4%为囊性支气管扩张），急性加重次数更多（入组前一年中位数相同，为 1 次[四分位数间距 0-2]，但平均值不同，分别为 1·4 次[标准差 1·6] 和1·2 次[1·4]，住院次数更多（60·6%在入组前一年至少住院一次 vs55·8%在入组前一年至少住院一次），生活质量更差（根据支气管
扩张症健康问卷评估，中位数 57·4[四分位数间距 53·5–63·1] vs58·7[54·8–64·8]）。

Interpretation

The clinical characteristics of patients with bronchiectasis in China show differences compared with cohorts in Europe and India. Bronchiectasis is more severe with a higher burden of exacerbations in lower-income regions. The management of patients with bronchiectasis in China urgently needs standardisation and improvement.

结论：中国支气管扩张症患者的临床特征与欧洲和印度相比存在差异。在中国低收入地区，支气管扩张症更为严重，急性加重的负担更高。中国支气管扩张症患者的管理亟待规范和改进。

Funding

National Natural Science Foundation of China, Innovation Program of the Shanghai Municipal Education Commission, Program of the Shanghai Municipal Science and Technology Commission, and Program of the Shanghai Shenkang Development Center.

基金：国家自然科学基金委项目、上海市教育委员会项目、上海市科学技术委员会项目、上海市申康医院发展中心项目。