慢性阻塞性肺疾病患者合并侵袭性肺曲霉菌感染危险因素的Meta分析

Meta-analysis on risk factors for invasive pulmonary aspergillosis(IPA)infections in patients with chronic obstructive pulmonary disease(COPD)

目的系统评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者并发侵袭性肺曲霉菌(invasive pulmonary aspergillosis,IPA)感染的危险因素。方法检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库从建库至2019年12月发表的有关COPD患者并发IPA感染危险因素的病例对照研究,2名研究员独立按照纳入与排除标准筛选文献、提取资料及质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入16篇文献,4篇为外文,12篇为中文。Meta分析结果显示,吸烟史(OR=1.89,95%CI:1.44~2.47)、COPD分级≥3级(OR=2.56,95%CI:2.02~3.24)、入住ICU(OR=3.29,95%CI:2.44~4.44)、低蛋白血症(OR=2.66,95%CI:1.93~3.66)、糖尿病(OR=3.10,95%CI:2.49~3.86)、肾功能不全(OR=2.59,95%CI:1.49~4.49)、呼吸衰竭(OR=4.32,95%CI:3.24~5.75)、有创机械通气(OR=4.59,95%CI:3.76~5.61)、侵袭性操作(OR=4.59,95%CI:3.60~5.84)、糖皮质激素全身给药(OR=2.17,95%CI:1.28~3.70)、糖皮质激素日剂量≥20mg(OR=3.92,95%CI:2.38~6.45)、糖皮质激素累积剂量≥700mg(OR=9.61,95%CI:5.80~15.94)、糖皮质激素用药≥14d(OR=4.64,95%CI:3.63~5.94)、广谱抗生素用药≥14d(OR=4.29,95%CI:2.43~7.58)、抗生素联用(OR=6.61,95%CI:3.03~11.58)和碳青霉烯类(OR=9.83,95%CI:4.02~24.06)是COPD患者并发IPA的危险因素(P<0.05)。患者年龄、性别、COPD病程、肝功能不全、心功能不全、糖皮质激素雾化吸入与IPA感染未见明显关联(P>0.05)。敏感度分析提示Meta分析结果稳定。结论COPD患者并发IPA感染危险因素较多,临床应采取针对性预防措施,以降低其感染风险。

Objective To systematically assess risk factors for invasive pulmonary aspergillosis(IPA)infections in patients with chronic obstructive pulmonary disease(COPD).Methods Literatures were retrieved from PubMed,Embase,Cochrane Library,CNKI,CBM database,and Wanfang database from the establishment of database to December of 2019.Data about the risk factors for IPA infections in patients with COPD were collected.Literatures were screened,extracted,and evaluated according to inclusion and exclusion criteria by two reviewers.Meta-analysis was conducted using RevMan 5.3 software.Results A total of 16 literatures were included,four in English and 12 in Chinese.Meta-analysis showed that the smoking history(OR=1.89,95%CI:1.44 to 2.47),the COPD grade over grade 3(OR=2.56,95%CI:2.02 to 3.24),admission to ICU(OR=3.29,95%CI:2.44 to 4.44),hypoproteinemia(OR=2.66,95%CI:1.93 to 3.66),diabetes(OR=3.10,95%CI:2.49 to 3.86),renal insufficiency(OR=2.5995%CI:1.49 to 4.49),respiratory failure(OR=4.32,95%CI:3.24 to 5.75),invasive mechanical ventilation(OR=4.59,95%CI:3.76 to 5.61),invasive operation(OR=4.59,95%CI:3.60 to 5.84),systemic administration of glucocorticoid(OR=2.17,95%CI:1.28 to 3.70),the daily dose of glucocorticoid over 20 mg(OR=3.92,95%CI:2.38 to 6.45),the cumulative dose of glucocorticoid over 700 mg(OR=9.61,95%CI:5.80 to 15.94),glucocorticoid over 14 days(OR=4.64,95%CI:3.63 to 5.94),broad-spectrum antibiotic over 14 days(OR=4.29,95%CI:2.43 to 7.58),combination of antibiotics(OR=6.61,95%CI:3.03 to 11.58),and carbapenes(OR=9.83,95%CI:4.02 to 24.06)were risk factors for IPA infections in patients with COPD(P<0.01),and Patients’age,gender,COPD course,hepatic insufficiency,cardiac insufficiency,and aerosolized glucocorticoid inhalation were not significantly correlated with IPA infections in patients with COPD(P>0.05).Sensitivity analysis suggested that the results of meta-analysis were stable.Conclusion There are many risk factors of IPA infections in COPD patients,and clinicians should take targeted preventive measures to reduce the risk of infections.