内科学教学资料 支气管扩张.ppt

支气管扩张BRONCHIECTASIS APPOINTMENT Cheng Yuanxiong MD. Associate Professor Department of Respiratory Nanfang Hospital Southern Medical University Guangzhou 510120, P.R.China Phone ：(020E-mail: Drchengyx@ 定义 是指支气管及周围组织的慢性炎症所导致的支气管壁肌肉和弹性组织破坏，管腔形成不可逆的扩张、变型。 患者多有童年麻疹、百日咳或支气管肺炎等病史。 临床症状为慢性咳嗽，咳大量脓性痰和（或）反复咯血。 病因 一、支气管-肺组织感染 婴幼儿百日咳、麻疹支气管肺炎（特点；儿童支气管管腔细窄、管壁薄弱、易阻塞） →感染→平滑肌和弹性纤维破坏→支撑作用减弱 细支气管周围肺组织纤维化（结核等）→牵拉管壁→支气管变形扩张。 二、支气管阻塞 支气管阻塞（内外因素）→肺不张→胸腔负压直接牵拉支气管管壁→支气管扩张。 （三）支气管先天性发育缺损和 遗传因素 （四）全身性疾病 类风湿关节炎、系统性红斑狼疮、支气管哮喘、溃疡性结肠炎、Crohn 病、HIV感染、黄甲综合征等，可同时伴有支气管扩张 Causes of Bronchiectasis Respiratory infections Bacterial infection, such as whooping cough or infections caused by Klebsiella, Staphylococcus, or Pseudomonas Fungal infection, such as aspergillosis Mycobacterial infection, such as tuberculosis Viral infection, such as influenza, adenoviral infection, respiratory syncytial virus infection, or measles Mycoplasma infection Bronchial obstruction Inhaled object Enlarged lymph glands Lung tumor Mucus plug Inhalation injuries Injury from noxious fumes, gases, or particles Inhalation of stomach acid and food particles Causes of Bronchiectasis Hereditary conditions Cystic fibrosis Primary ciliary dyskinesia, including Kartagener’s syndrome Marfan syndrome Immunologic abnormalities Immunoglobulin deficiency syndromes White blood cell dysfunction Complement deficiencies Certain autoimmune or hyperimmune disorders, such as rheumatoid arthritis and ulcerative colitis Other conditions Drug abuse, such as heroin abuse Human immunodeficiency virus (HIV) infection Young’s syndrome (obstructive azoospermia) Yellow nail syndrome (with lymphedema) 发病机制 感染→支气管管腔粘膜充血、水肿→咳嗽 ↘分泌物→阻塞管腔 ↓ ↘管腔狭窄 ↓ 结构破坏 引流不畅 气道高压 发育 障碍 ②遗传 免疫缺陷 牵拉 ④纤维化、胸腔负压 支扩发生 病理 大体改变 多发于双下肺支气管 支气管