作者：顾馨雨，於江泉，杨艳霞，龚浩，周罗晶

单位：

1.扬州大学临床医学院2.江苏省苏北人民医院重症医学科3.江苏省苏北人民医院科技处

Units：

1.Yangzhou University Medical College, Yangzhou 225001, China 2.Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China 3.Science and Technology Division, Northern Jiangsu People's Hospital, Yangzhou 225001, China

关键词：

肺疾病,慢性阻塞性; 急性加重期; 呼吸衰竭; 危险因素; Meta分析;

Keywords：

　Pulmonary disease, chronic obstructive; Acute exacerbation; Respiratory failure; Risk factors; Metaanalysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.080

Funds：

江苏省高层次卫生人才“六个一工程”拔尖人才科研项目（LGY2019036）； 扬州市科技发展计划项目（YZ2018075）；

摘要：

目的 系统评价慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭的危险因素。方法 计算机检索PubMed、Medline、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、维普网、万方数据知识服务平台、中国知网公开发表的AECOPD并发呼吸衰竭危险因素的病例对照研究和队列研究，对照组为未并发呼吸衰竭的AECOPD患者，病例组为并发呼吸衰竭的AECOPD患者。检索时限为建库至2022-04-30。提取纳入文献的资料，采用纽卡斯尔-渥太华量表(NOS)进行文献质量评价，采用Stata 15.1软件进行Meta分析。结果 本研究纳入20篇文献，共2 997例患者，其中病例组1 248例、对照组1 749例。Meta分析结果显示，第1秒用力呼气容积(FEV1)降低、FEV1/用力肺活量(FVC)降低、动脉血氧分压(PaO2)降低、动脉血二氧化碳分压(PaCO2)升高、血清白蛋白水平降低、白细胞计数升高、中性粒细胞计数升高、C反应蛋白(CRP)升高、高血压病史、合并心力衰竭、脑钠肽升高、心肌肌钙蛋白T(cTnT)升高、D-二聚体升高、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分升高是AECOPD患者并发呼吸衰竭的危险因素(P<0.05)。结论 现有证据显示，FEV1降低、FEV1/FVC降低、PaO2降低、PaCO2升高、血清白蛋白水平降低、白细胞计数升高、中性粒细胞计数升高、CRP升高、有高血压病史、合并心力衰竭、脑钠肽升高、cTnT升高、D-二聚体升高、APACHEⅡ评分升高是AECOPD患者并发呼吸衰竭的危险因素，在临床工作中针对上述危险因素积极采取预防措施，有望改善患者预后。

Abstract：

Objective To systematically evaluate the risk factors of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure. Methods Databases including PubMed, Medline, Web of Science, Embase, Cochrane Library, CBM, VIP, Wanfang Data and CNKI were retrieved to search for case-control studies and cotort studies on the risk factors of AECOPD complicated with respiratory failure from inception to April 30, 2022. The control group was AECOPD patients without respiratory failure, and the case group was AECOPD patients with respiratory failure. The data of the included literature were extracted, the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included literature, Stata 15.1 was used for meta-analysis. Results A total of 20 articles were included, and involving 2 997 patients, including 1 248 cases in case group and 1 749 cases in control group. Meta-analysis results showed that decreased forced expiratory volume in the first second (FEV1) , decreased FEV1/forced vital capacity (FVC) , decreased partial pressure of oxygen (PaO2) , increased partial pressure of carbon dioxide (PaCO2) , decreased serum albumin level, increased white blood cell count, increased neutrophil count, increased C-reactive protein (CRP) , history of hypertension, heart failure, increased brain natriuretic peptide, increased cardiac troponin T (cTnT) , increased D-dimer, and increased acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were risk factors of AECOPD complicated with respiratory failure (P < 0.05) . Conclusion The available evidence shows that decreased FEV1, decreased FEV1/FVC, decreased PaO2, increased PaCO2, decreased serum albumin level, increased white blood cell count, increased neutrophil count, increased CRP, history of hypertension, heart failure, increased brain natriuretic peptide, increased cTnT, increased D-dimer, and increased APACHEⅡ score are risk factors of AECOPD complicated with respiratory failure. Active preventive measures against the above risk factors in clinical work are expected to improve patients' prognosis.

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