慢性阻塞性肺疾病合并骨质疏松症危险因素的Meta分析

Meta-analysis of Risk Factors for Chronic Obstructive Pulmonary Disease Complicated with Osteoporosis

目的分析慢性阻塞性肺疾病(COPD)并发骨质疏松症(OP)的危险因素。方法计算机检索中文数据库[中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、中国生物医学文献服务系统(SinoMed)、维普网(VIP)]及外文数据库(the Cochrane Library、PubMed、Web of Science),筛选出COPD合并OP的病例对照研究和横断面研究,检索时间限定为建库至2021年10月。由2名研究员独立筛选文献、提取资料并评价纳入文献的偏倚风险,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,病例对照研究8篇和横断面研究6篇。Meta分析显示,年龄[MD=4.52,95%CI(4.44,4.60)]、FEV1%[MD=-1.56,95%CI(-1.72,-1.39)]、FEV1/FVC%[MD=-6.75,95%CI(-10.98,-2.51)]、FEV1[MD=-0.52,95%CI(-0.79,-0.26)]、BMI[MD=-2.46,95%CI(-2.49,-2.42)]、吸烟[MD=4.44,95%CI(1.63,7.25)]、总骨密度值[MD=-1.52,95%CI(-2.09,-0.95)]、脊柱骨密度[MD=-0.60,95%CI(-0.78,-0.42)]、髋部骨密度[MD=-0.70,95%CI(-0.90,-0.50)]、PO_(2)[MD=-10.20,95%CI(-19.16,-1.25)]、PCO_(2)[MD=3.47,95%CI(1.44,5.50)]、CRP[MD=0.35,95%CI(-2.11,2.81)]、IL-6[MD=23.59,95%CI(21.10,26.08)]、TNF-α[MD=18.73,95%CI(17.21,20.26)]、Ca[MD=-0.05,95%CI(-0.10,0)]、P[MD=0.01,95%CI(-0.01,0.04)]、吸入激素[OR=2.22,95%CI(0.76,6.47)]、口服激素[OR=0,95%CI(0,0)]、CAT评分[MD=3.10,95%CI(-0.73,6.93)]是慢性阻塞性肺疾病合并骨质疏松症的危险因素。结论年龄、FEV1%、FEV1/FVC%、FEV1、BMI、吸烟、骨密度、PO_(2)、PCO_(2)、IL-6、TNF-α、吸入激素与COPD合并OP密切相关,但受纳入研究数量的影响,该结论尚待更大样本量研究的进一步验证。

Objective To analyze the risk factors of chronic obstructive pulmonary disease(COPD)complicated with osteoporosis(OP).Methods Chinese databases[China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,VIP]and foreign databases(the Cochrane Library,PubMed,Web of Science)were searched by computer to screen out case-control studies and cross-sectional studies of COPD complicated with OP.The search time was limited from the establishment of the database to October 2021.Two researchers independently screened the literature,extracted the data and evaluated the risk of bias of the included literature.Meta-analysis was performed using RevMan 5.3 software.Results A total of 14 literatures were included,including 8 case-control studies and 6 cross-sectional studies.Meta-analysis results showed that Meta-analysis showed that age[MD=4.52,95%CI(4.44,4.60)],FEV1%[MD=-1.56,95%CI(-1.72,-1.39)],FEV1/FVC%[MD=-6.75,95%CI(-10.98,-2.51)],FEV1[MD=-0.52,95%CI(-0.79,-0.26)],BMI[MD=-2.46,95%CI(-2.49,-2.42)],smoking[MD=4.44,95%CI(1.63,7.25)],total bone mineral density[MD=-1.52,95%CI(-2.09,-0.95)],spine bone mineral density[MD=-0.60,95%CI(-0.78,-0.42)],hip BMD[MD=-0.70,95%CI(-0.90,-0.50)],PO_(2)[MD=-10.20,95%CI(-19.16,-1.25)],PCO_(2)[MD=3.47,95%CI(1.44,5.50)],CRP[MD=0.35,95%CI(-2.11,2.81)],IL-6[MD=23.59,95%CI(21.10,26.08)],TNF-α[MD=18.73,95%CI(17.21,20.26)],Ca[MD=-0.05,95%CI(-0.10,0)],P[MD=0.01,95%CI(-0.01,0.04)],inhaled hormone[OR=2.22,95%CI(0.76,6.47)],oral hormone[OR=0,95%CI(0,0)],CAT score[MD=3.10,95%CI(-0.73,6.93)]were a risk factor for chronic obstructive pulmonary disease with osteoporosis.Conclusion Age,FEV1%,FEV1/FVC%,FEV1,BMI,smoking,bone mineral density,PO_(2),PCO_(2),IL-6,TNF-α,and inhaled hormones are closely related to COPD with OP.However,due to the number of included studies,this conclusion needs to be further verified by a larger sample size.