支气管扩张症是一种不可逆的疾病。典型的病程包括症状控制期与加重期交替出现。支气管扩张症常与其他呼吸系统疾病共存,使得难以单独评估支气管扩张症的预后。[70]Keistinen T, Saynajakangas O, Tuuponen T, et al. Bronchiectasis: an orphan disease with a poorly-understood prognosis. Eur Respir J. 1997;10:2784-2787.http://erj.ersjournals.com/content/10/12/2784.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/9493661?tool=bestpractice.com 与肺功能快速下降相关的因素包括严重加重的频率增加。[71]Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, et al. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132:1565-1572.http://www.ncbi.nlm.nih.gov/pubmed/17998359?tool=bestpractice.com 已经表明低氧血症、高碳酸血症、呼吸困难、放射影像学显示的病变程度与死亡率相关。与之相反,体重指数较高、定期就诊、疫苗接种可改善生存率。[51]Onen ZP, Gulbay BE, Sen E, et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med. 2007;101:1390.http://www.ncbi.nlm.nih.gov/pubmed/17374480?tool=bestpractice.com
支气管扩张症严重程度指数,已在英国和欧洲得到验证,可能有助于了解预后和指导治疗。[72]Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189:576-585.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977711/http://www.ncbi.nlm.nih.gov/pubmed/24328736?tool=bestpractice.com[73]Ellis HC, Cowman S, Fernandes M, et al. Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study. Eur Respir J. 2016;47:482-489.http://www.ncbi.nlm.nih.gov/pubmed/26585428?tool=bestpractice.com[74]McDonnell MJ, Aliberti S, Goeminne PC, et al. Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts. Thorax. 2016 Aug 11 [Epub ahead of print].http://thorax.bmj.com/content/71/12/1110.longhttp://www.ncbi.nlm.nih.gov/pubmed/27516225?tool=bestpractice.com
生活质量
根据 St. George 呼吸调查问卷 (St. George Respiratory Questionnaire),呼吸困难、FEV1 降低和日常痰量对支气管扩张症患者的生活质量影响最大。[75]Martinez-Garcia MA, Perpina-Tordera M, Roman-Sanchez P, et al. Quality-of-life determinants in patients with clinically stable bronchiectasis. Chest. 2005;128:739-745.http://journal.publications.chestnet.org/article.aspx?articleid=1083558http://www.ncbi.nlm.nih.gov/pubmed/16100162?tool=bestpractice.com
痰液中存在假单胞菌属
与没有假单胞菌属定植的支气管扩张症患者相比,痰液中有假单胞菌属的支气管扩张症患者的肺部疾病范围更为广泛,肺功能损害更加严重。一些研究显示,假单胞菌属定植是与肺功能下降较快相关的一个独立因素。证据之间存在不一致性。[71]Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, et al. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132:1565-1572.http://www.ncbi.nlm.nih.gov/pubmed/17998359?tool=bestpractice.com