作者：武康宁 ，蔡成森 ，彭召云 ，于健健 ，杨胜真，王健 ，王珺

单位：

1.250014山东省济南市，山东中医药大学　2.250001山东省济南市，山东中医药大学第二附属医院呼吸与危重症医学科

Units：

1.Shandong University of Traditional Chinese Medicine, Jinan 250014, China 2.Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China

关键词：

新型冠状病毒感染；肺曲霉菌病；发病率；临床特征；治疗；预后；Meta分析

Keywords：

　COVID-19; Pulmonary aspergillosis; Incidence; Clinical characteristics; Therapy; Prognosis; Meta-analysis

CLC：

R 563.12 R 519.1

DOI：

10.12114/j.issn.1008-5971.2023.00.326

Funds：

新型冠状病毒感染中医药应急专项——中医药治疗新冠重症研究（2023ZYLCYJ02-13）；2020年山东省研究生教育 优质课程立项建设项目（SDYAL20052）；2022年山东省研究生教育优质课程立项建设项目（SDYKC2022042）

摘要：

目的　采用Meta分析方法评估COVID-19相关肺曲霉病（CAPA）发病率及其临床特征、治疗和预 后。方法　计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国生物医学文献数据库、维普网、万 方数据知识服务平台、中国知网中有关CAPA的文献，检索时间从建库至2023-03-01。采用RevMan 5.3软件进行Meta 分析，合并计算CAPA的发病率、临床特征、治疗及预后。结果　共纳入18篇文献，均为高质量文献，包括6 329例 COVID-19患者、1 028例CAPA患者。Meta分析结果显示：CAPA发病率为0.11〔95%CI（0.10，0.11）〕。CAPA患者 男性占比较高，为0.75〔95%CI（0.72，0.78）〕；发热、咳嗽、呼吸急促发生率较高，分别为0.90〔95%CI（0.86， 0.93）〕、0.64〔95%CI（0.58，0.70）〕、0.64〔95%CI（0.56，0.72）〕；斑片状浸润、肺实变检出率较高，分别为 0.88〔95%CI（0.83，0.94）〕、0.73〔95%CI（0.68，0.79）〕。CAPA患者皮质类固醇使用率最高，为0.96〔95%CI （0.95，0.98）〕。CAPA患者死亡率为0.52〔95%CI（0.48，0.56）〕。结论　CAPA发病率为11%，男性居多，其主 要临床表现为咳嗽、发热、呼吸急促，绝大多数患者接受皮质类固醇治疗，CT表现主要为斑片状浸润及肺实变，死亡 率为52%。

Abstract：

Objective To evaluate the incidence, clinical characteristics, treatment and prognosis of COVID-19- related pulmonary aspergillosis (CAPA) by Meta-analysis. Methods PubMed, Web of Science, Cochrane Library, Embase, Chinese Biomedical Literature Database, VIP, Wanfang Data, and CNKI were searched for literature on CAPA from inception to March 1, 2023. Meta-analysis was performed using RevMan 5.3 software to calculate the incidence, clinical characteristics, treatment and prognosis of CAPA. Results A total of 18 high-quality literature were included, including 6 329 patients with COVID-19 and 1 028 patients with CAPA. The results of Meta-analysis showed that: the incidence of CAPA was 0.11 [95%CI (0.10, 0.11) ] . The proportion of male patients with CAPA was higher, which was 0.75 [95%CI (0.72, 0.78) ] . The incidence of fever, cough and shortness of breath was higher in CAPA patients, which was 0.90 [95%CI (0.86, 0.93) ] , 0.64 [95%CI (0.58, 0.70) ] and 0.64 [95%CI (0.56, 0.72) ] , respectively. The detection rates of patchy infiltration and consolidation in CAPA patients were higher, which were 0.88 [95%CI (0.83, 0.94) ] and 0.73 [95%CI (0.68, 0.79) ] , respectively. The utilization rate of corticosteroid was the highest in CAPA patients, which was 0.96 [95%CI (0.95, 0.98) ] . The mortality rate of CAPA patients was 0.52 [95% CI (0.48, 0.56) ] . The funnel plot of the literature reporting the proportion of males was drawn. Conclusion The incidence of CAPA is 11%, and most of them are male. The main clinical manifestations of CAPA are cough, fever and shortness of breath. Most CAPA patients receive corticosteroid treatment. The main CT manifestations of CAPA patients are patchy infiltration and consolidation, and the mortality rate of CAPA is 52%.

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