慢性阻塞性肺疾病不同临床表型患病率及临床特征的Meta分析

Prevalence and clinical characteristics of different clinical phenotypes of chronic obstructive pulmonary disease:a Meta-analysis

目的系统评价慢性阻塞性肺疾病(COPD)不同临床表型患病率及临床特征。方法制订检索策略和纳入、排除标准,计算机检索PubMed、Cochrane Library、万方、维普、知网等数据库,采用横断面研究质量评价标准对纳入文献质量进行评价,使用Stata软件对纳入的文献进行数据分析。结果纳入相关文献11篇,文献总体质量一般,共计12553例患者。COPD非急性加重型患病率为50%(95%CI:44%~57%),急性加重肺气肿型患病率为11%(95%CI:8%~14%),急性加重慢性支气管炎型患病率为24%(95%CI:20%~28%),哮喘-COPD重叠患病率为13%(95%CI:10%~16%)。除哮喘-COPD重叠患病率与急性加重肺气肿型患病率之间差异无统计学意义(P=0.552),其余COPD不同临床表型患病率之间的差异均有统计学意义(P<0.05)。急性加重慢性支气管炎型患者组平均年龄69.24岁(95%CI:67.64~70.83)、体质量指数(BMI)27.73 kg/m2(95%CI:27.18~28.27)、第1秒用力呼气容积占预计值百分比(FEV1%pre)48.58%(95%CI:46.41~50.74)、CAT评分22.40分(95%CI:21.18~23.62);哮喘-COPD患者组平均年龄64.85岁(95%CI:63.41~66.29)、BMI 27.61 kg/m2(95%CI:26.88~28.34)、FEV1%pre 56.68(95%CI:53.79~59.57)、CAT评分18.32分(95%CI:15.95~20.69);急性加重肺气肿型患者组BMI 26.38 kg/m2(95%CI:25.90~26.87)、FEV1%pre 46.03%(95%CI:43.90~48.16)。结论COPD具有显著异质性,需根据临床表型及特征进行个体化治疗。

Objective To make a systematic evaluation of the prevalence and clinical characteristics of different clinical phenotypes of chronic obstructive pulmonary disease(COPD).Methods Retrieval strategies and inclusion and exclusion criteria were made,and computer retrieval databases such as PubMed,Cochrane Library,WanFang,VIP,CNKI were searched,and the quality of the included literatures was evaluated by quality evaluation criteria of cross-sectional studies,and data analysis of the included literatures was performed by Stata software.Results Eleven related literatures were included,and the overall quality of the literatures was general.A total of 12553 patients were included.The prevalence of non-exacerbator phenotype was 50%(95%CI:44%-57%),the prevalence of exacerbator phenotype with emphysema was 11%(95%CI:8%-14%),the prevalence of exacerbator phenotype with chronic bronchitis was 24%(95%CI:20%-28%),and the overlap prevalence of Asthma-and COPD was 13%(95%CI:10%-16%).The prevalence of COPD with different clinical phenotypes was statistically significant(P<0.05),except that there was no statistical difference between the overlap prevalence of Asthma-and COPD and the prevalence of exacerbator phenotype with emphysema(P=0.552).Patients with exacerbator phenotype with chronic bronchitis had the mean age of 69.24 years old(95%CI:67.64-70.83),BMI of 27.73 kg/m2(95%CI:27.18-28.27),FEV1(%pre)of 48.58%(95%CI:46.41-50.74),and CAT score of 22.40(95%CI:21.18-23.62).Patients with Asthma-COPD overlap had the mean age of 64.85 years old(95%CI:63.41-66.29),BMI of 27.61 kg/m2(95%CI:26.88-28.34),FEV1(%pre)of 56.68(95%CI:53.79-59.57),and CAT score of 18.32(95%CI:15.95-20.69).Patients with exacerbator phenotype with emphysema had BMI of 26.38 kg/m2(95%CI:25.90-26.87)and FEV1(%pre)of 46.03%(95%CI:43.90-48.16).Conclusion COPD is a significant heterogeneity disease and should be treated individually according to clinical phenotype and characteristics.