肺纤维化合并肺气肿综合征并发肺动脉高压的Meta分析

Systematic review and meta-analysis on pulmonary hypertension in patients with combined fibrosis and emphysema syndrome

目的系统评价肺纤维化合并肺气肿(CPFE)综合征与特发性肺纤维化(IPF)或肺气肿/COPD相比肺动脉高压的发生率及肺动脉压力水平。方法计算机检索CBM、CNKI(中国知网)、Wan Fang Data(万方数据库)、VIP(维普)、PubMed、Embase及Cochrane Library,查找报道肺纤维化合并肺气肿综合征的全部文献,检索时间为2005年至2018年1月。由两位评价员按照纳入排除标准分别筛选文献,提取数据、评估文献,采用Revman5.3及Stata14.0软件进行分析。结果纳入13篇文献,共1 385例患者。Meta结果分析表明:CPFE综合征与独立存在的IPF相比,无论是肺动脉高压发生率[OR=1.93,95%CI(1.17,3.17),P=0.010]还是肺动脉压力水平[MD=11.89,95%CI(7.39,16.39),P<0.00001]都较高而且存在统计学差异。CPFE综合征与肺气肿/COPD相比,肺动脉高压的发生率[OR=2.62,95%CI(1.42,4.81),P=0.002]及肺动脉压力水平[MD=7.49,95%CI(5.27,9.72),P<0.00001]也较高且具有显著差异。结论CPFE综合征与IPF相比,肺动脉高压发生率及肺动脉压力水平均较高;CPFE综合征与肺气肿/COPD相比,肺动脉高压发生率及肺动脉压力水平也较高。CPFE综合征更容易并发肺动脉高压且更严重,对CPFE综合征患者应定期监测肺动脉压力从而实现早期诊断及治疗。

Objective To evaluate systematically the incidence and the level of pulmonary hypertension in the patients with combined pulmonary fibrosis with emphysema (CPFE) syndrome compared with those of the patients with idiopathic pulmonary fibrosis (IPF) or pulmonary emphysema/chronic obstructive pulmonary disease (COPD). Methods All the reports about CPFE syndromes were collected by searching these databases including CBM, CNKI, Wan Fang Data, VIP, PubMed, Embase and the Cochrane library (12th in 2017) from January 2005 to January 2018. All the titles/abstracts were reviewed to identify the possible studies with predefined selection criteria. All the data were combined and analyzed using Review Manager 5.3 or Stata 14.0. Results A total of 1 385 patients included in 13 reports were selected for this meta-analysis. Compared with the IPF group, the CPFE group had a higher incidence [OR=1.93, 95%CI (1.17, 3.17), P=0.010] and a higher level [MD=11.89, 95%CI (7.39, 16.39), P<0.00001] of pulmonary hypertension. Meanwhile, the incidence [OR=2.62, 95%CI (1.42, 4.81), P=0.002] and the level [MD=7.49, 95%CI (5.27, 9.72), P<0.00001] of pulmonary hypertension also presented higher results compared with the pulmonary emphysema/COPD group. Conclusion CPFE syndrome manifests a higher incidence and a higher level of pulmonary hypertension when compared with the IPF group as well as the pulmonary emphysema/COPD group and should be monitored regularly.