合并支气管扩张对慢性阻塞性肺疾病影响的Meta分析

Impact of Bronchiectasis on Chronic Obstructive Pulmonary Disease:A Meta-analysis

目的应用Meta分析的方法评价合并支气管扩张对慢性阻塞性肺疾病的影响。方法在中文数据库(万方数据库、中国知网、维普数据库、中国生物医学文献数据库等),以及外文数据库(Pubmed、Embase、Cochrane library、Web of Science等)检索2019年1月前收录的报道关于慢性阻塞性肺疾病合并支气管扩张与未合并支气管扩张比较的临床研究,使用Newcastle-Ottawa scale(NOS)量表进行文献质量评价,提取数据使用RevMan5. 3软件进行Meta分析。结果最终纳入12篇NOS评分≥5分的文献进行Meta分析,结果显示:COPD合并支气管扩张组的每日咳痰患者数[OR=2. 28,95%CI(1. 48,3. 50),P=0. 0002]、每年急性加重次数[MD=1. 13,95%CI(0. 67,1. 59),P<0. 00001]、C反应蛋白水平[MD=4. 16,95%CI(2. 41,5. 92),P<0. 00001]、细菌感染率[OR=4. 50,95%CI(1. 33,15. 25),P=0. 02]、铜绿假单胞菌感染率[OR=4. 28,95%CI(2. 37,7. 72),P<0. 00001]高于未合并支气管扩张组,而身体质量指数(BMI)[MD=-0. 91,95%CI(-1. 59,-0. 22),P=0. 009]、白蛋白水平[MD=-1. 01,95%CI (-1. 43,-0. 59),P <0. 00001]、第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)[MD=-7. 58,95%CI(-9. 75,-5. 41),P<0. 00001]、第1秒用力呼气容积(FEV1)/用力肺活量(FVC)占预计值百分比(FEV1/FVC%)[MD=-3. 91,95%CI (-6. 69,-1. 13),P=0. 006]、用力肺活量占预计值百分比(FVC%)[MD=-10. 26,95%CI(-15. 79,-4. 72),P=0. 0003]低于未合并支气管扩张组。结论 COPD合并支气管扩张较未合并支气管扩张患者更易存在咳痰症状,且存在细菌感染包括铜绿假单胞菌感染风险更高,全身及局部炎症指标更高,急性加重发作更频繁,同时患者营养状态更差,且气流受限更严重。

Objective To explore the impact of bronchiectasis on chronic obstructive pulmonary disease( COPD)with meta-analysis.Methods Literatures about COPD complicated with bronchiectasis and COPD without bronchiectasis published up to Jan,2019 were searched in WANFANG DATA,CNKI,CQVIP,SinoMed,PubMed,Embase,Cochrane Library and Web of Science;Newcastle-Ottawa Scale( NOS) was applied in evaluating the quality of the literatures and RevMan 5. 3 in extracting data for meta analysis. Results In total,12 literatures with NOS score ≥5 were selected and meta-analysis was conducted;the case number of coughing up phlegm in a day [OR = 2. 28,95% CI( 1. 48,3. 50),P = 0. 0002],the times of acute exacerbation in a year [MD = 1. 13,95%CI( 0. 67,1. 59),P<0. 00001],C-reactive protein level [MD = 4. 16,95% CI( 2. 41,5. 92),P < 0. 00001],bacterial infection rate[OR = 4. 50,95%CI( 1. 33,15. 25),P = 0. 02] and Pseudomonas aeruginosa infection rate [OR = 4. 28,95%CI( 2. 37,7. 72),P<0. 00001] were higher;while the body mass index( BMI) [MD =-0. 91,95%CI(-1. 59,-0. 22),P = 0. 009],albumin level [MD =-1. 01,95% CI(-1. 43,-0. 59),P < 0. 00001],FEV1% [MD =-7. 58,95%CI(-9. 75,-5. 41),P<0. 00001],FEV1/FVC% [MD =-3. 91,95%CI(-6. 69,-1. 13),P = 0. 006]and FVC% [MD =-10. 26,95% CI(-15. 79,-4. 72),P = 0. 0003] were lower in COPD with bronchiectasis group than those in COPD without bronchiectasis group. Conclusions COPD cases with bronchiectasis have a higher risk of phlegm coughing,bacterial and pseudomonas infection,more frequent acute exacerbation,higher inflammatory markers,worse nutritional status and aggravated airflow limitation.