俯身呼吸困难与慢性心力衰竭患者不良预后关系的Meta分析

A Meta-analysis of the Association Between Bendopnea and Outcome in Patients With Chronic Heart Failure

目的:系统评价俯身呼吸困难与慢性心力衰竭(心衰)患者发生不良预后的关系。方法:计算机检索Embase、Ovid、Cochrane图书馆、Web of Science、PubMed、中国生物医学文献数据库、中国知网、维普数据库、万方数据库等多个数据库自建库起至2021年9月31日的所有文献,并进行筛选文献、提取信息、质量评价,采用RevMan 5.3软件对纳入文献进行Meta分析。结果:共纳入9篇文献,总计9项研究1652例慢性心衰患者。存在俯身呼吸困难心衰患者的心衰再入院(RR=1.85,95%CI:1.34~2.56,P=0.0002)、心原性死亡(RR=1.50,95%CI:1.20~1.89,P=0.0004)、复合心血管不良事件(RR=1.54,95%CI:1.24~1.91,P=0.0001)的发生风险均显著高于无俯身呼吸困难心衰患者。其中,复合心血管不良事件包括再入院、死亡、左心室辅助装置植入、急性心肌梗死、心律失常、心脏移植等。亚组结果显示,俯身呼吸困难与慢性心衰再入院的关联强度在不同心衰类型、年龄、评估方式、风险效应指标值方面的差异都具有统计学意义(P均<0.05)。结论:有俯身呼吸困难的慢性心衰患者生活质量及心功能状态更差,且发生再入院、心原性死亡、心血管不良事件的风险显著增高。心衰类型、年龄、评估方式可能会影响俯身呼吸困难再入院的预测价值。

Objectives:This study aims to evaluate the predictive value of bendopnea for clinical prognosis of patients with chronic heart failure.Methods:A comprehensive and systematic search of potentially qualified articles published in Embase,Ovid,the Cochrane Library,Web of Science,PubMed,China Biology Medicine disc(CBM)and other databases from the inception of the databases to September 31,2021,was performed.Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of the included studies.Quantitative meta-analysis was performed using RevMan 5.3 software,and funnel chart was used to detect potential publication bias.Results:This systematic review included 9 studies with a total of 1652 subjects.The quantitative meta-analysis of eligible observational studies found that the risk of primary endpoints(including heart failure readmission,cardiogenic death,compound cardiovascular adverse events)was significantly higher in the bendopnea group than that in the non-bendopnea group(RR=1.85,95%CI:1.34-2.56,P=0.0002;RR=1.50,95%CI:1.20-1.89,P=0.0004;RR=1.54,95%CI:1.24-1.91,P=0.0001).Subgroup analyses showed that the distribution of the study area and the length of follow-up time did not affect the predictive value of bendopnea for readmission of patients with heart failure,but the predictive value of bendopnea for readmission of patients with heart failure was significantly affected by the type of heart failure,age,and assessment method.Conclusions:The risk of readmission,cardiogenic death,and adverse cardiovascular events significantly increased in chronic heart failure patients with bendopnea.The predictive value of bendopnea on readmission is not affected by the follow-up time and regional distribution.However,the type of heart failure,age,and evaluation method may affect the predictive value of bendopnea on readmission of patients with heart failure.