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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (03) : 289 -295. doi: 10.3877/cma.j.issn.1674-6902.2019.03.005

所属专题： 文献；

论著

肺纤维化合并肺气肿综合征并发肺动脉高压的Meta分析
石涵宇1, 董彦2,†(), 魏路清3, 殷大伟3, 宗庆芸4   
  1. 1. 300162　天津，中国人民武装警察部队特色医学中心呼吸与重症医学科；300309　天津，武警后勤学院
    2. 300162　天津，中国人民武装警察部队特色医学中心超声心动图室
    3. 300162　天津，中国人民武装警察部队特色医学中心呼吸与重症医学科
    4. 300162　天津，天津下瓦房医院；300309　天津，武警后勤学院
  • 收稿日期:2018-07-10 出版日期:2019-06-20
  • 通信作者: 董彦
  • 基金资助:
    天津市自然科学基金资助项目(15JCZDJC35000)

Systematic review and meta-analysis on pulmonary hypertension in patients with combined fibrosis and emphysema syndrome

Hanyu Shi1, Yan Dong2,†(), Luqing Wei3, Dawei Yin3, Qingyun Zong4   

  1. 1. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics University of Chinese People′s Armed Police Forces, Tianjin 300162, China; Armed Police Logistics College, Tianjin 300309, China
    2. Department of Ultrasound, Affiliated Hospital of Logistics University of Chinese People′s Armed Police Forces, Tianjin 300162, China
    3. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics University of Chinese People′s Armed Police Forces, Tianjin 300162, China
    4. Hospital of Xiawafang, Tianjin 300162, China; Armed Police Logistics College, Tianjin 300309, China
  • Received:2018-07-10 Published:2019-06-20
  • Corresponding author: Yan Dong
  • About author:
    Corresponding author: Dong Yan, Email:
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石涵宇, 董彦, 魏路清, 殷大伟, 宗庆芸. 肺纤维化合并肺气肿综合征并发肺动脉高压的Meta分析[J]. 中华肺部疾病杂志(电子版), 2019, 12(03): 289-295.

Hanyu Shi, Yan Dong, Luqing Wei, Dawei Yin, Qingyun Zong. Systematic review and meta-analysis on pulmonary hypertension in patients with combined fibrosis and emphysema syndrome[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(03): 289-295.

目的

系统评价肺纤维化合并肺气肿(CPFE)综合征与特发性肺纤维化(IPF)或肺气肿/COPD相比肺动脉高压的发生率及肺动脉压力水平。

方法

计算机检索CBM、CNKI(中国知网)、Wan Fang Data(万方数据库)、VIP(维普)、PubMed、Embase及Cochrane Library，查找报道肺纤维化合并肺气肿综合征的全部文献，检索时间为2005年至2018年1月。由两位评价员按照纳入排除标准分别筛选文献，提取数据、评估文献，采用Revman5.3及Stata14.0软件进行分析。

结果

纳入13篇文献，共1 385例患者。Meta结果分析表明：CPFE综合征与独立存在的IPF相比，无论是肺动脉高压发生率[OR＝1.93，95%CI(1.17，3.17)，P＝0.010]还是肺动脉压力水平[MD＝11.89，95%CI(7.39，16.39)，P<0.00001]都较高而且存在统计学差异。CPFE综合征与肺气肿/COPD相比，肺动脉高压的发生率[OR＝2.62，95%CI(1.42，4.81)，P＝0.002]及肺动脉压力水平[MD＝7.49，95%CI(5.27，9.72)，P<0.00001]也较高且具有显著差异。

结论

CPFE综合征与IPF相比，肺动脉高压发生率及肺动脉压力水平均较高；CPFE综合征与肺气肿/COPD相比，肺动脉高压发生率及肺动脉压力水平也较高。CPFE综合征更容易并发肺动脉高压且更严重，对CPFE综合征患者应定期监测肺动脉压力从而实现早期诊断及治疗。

关键词: 肺纤维化, 肺气肿, 肺动脉高压, Meta分析, 系统分析
Objective

To evaluate systematically the incidence and the level of pulmonary hypertension in the patients with combined pulmonary fibrosis with emphysema (CPFE) syndrome compared with those of the patients with idiopathic pulmonary fibrosis (IPF) or pulmonary emphysema/chronic obstructive pulmonary disease (COPD).

Methods

All the reports about CPFE syndromes were collected by searching these databases including CBM, CNKI, Wan Fang Data, VIP, PubMed, Embase and the Cochrane library (12th in 2017) from January 2005 to January 2018. All the titles/abstracts were reviewed to identify the possible studies with predefined selection criteria. All the data were combined and analyzed using Review Manager 5.3 or Stata 14.0.

Results

A total of 1 385 patients included in 13 reports were selected for this meta-analysis. Compared with the IPF group, the CPFE group had a higher incidence [OR=1.93, 95%CI (1.17, 3.17), P=0.010] and a higher level [MD=11.89, 95%CI (7.39, 16.39), P<0.00001] of pulmonary hypertension. Meanwhile, the incidence [OR=2.62, 95%CI (1.42, 4.81), P=0.002] and the level [MD=7.49, 95%CI (5.27, 9.72), P<0.00001] of pulmonary hypertension also presented higher results compared with the pulmonary emphysema/COPD group.

Conclusion

CPFE syndrome manifests a higher incidence and a higher level of pulmonary hypertension when compared with the IPF group as well as the pulmonary emphysema/COPD group and should be monitored regularly.

Key words: Fibrosis, Pulmonary Emphysema, Pulmonary hypertension, Meta-analysis, Systematic review
图1 文献筛选流程及结果
表1 纳入研究的基本资料特征
作　者 研究周期(年) 年龄(CPFE/对照) 研究类型 研究地点 对照组疾病 CPFE(例数) 对照组(例数) 结局指标
赵丽娜2016[8] 3 71.38±10.14/68.53±7.64 CC 中国，吉林 IPF 21 30 ①②
陈锋2016[12] 6 71.23±7.03/69.96±7.85 Cohort 中国，北京 IPF 21 26 ①②
秦文婧2016[7] 2 85.1±10.6/63.9±8.6/73.9±11.4 CC 中国，河南 IPF＋COPD 34 78(IPF)41(COPD) ①②③④
陈恒屹2014[21] 3 68.7±4.1/71.1±6.0 Cohort 中国，重庆 IPF 31 36 ②
谭晓明2013[23] 12 84.11±11.00/74.84±13.46/70.86±7.70 CC 中国，北京 IPF＋COPD 55 40(IPF)55(COPD) ①②③④
Ye2014[22] 4 64±9/66±8 CC 中国，北京 IPF 70 55 ①
Zhang2016[9] 13 66±8.5/60±4.3 Cohort 中国，哈尔滨 IPF 87 105 ①
Tomioka2016[20] 8 76.5±7.1/73.4±9.0 Cohort 日本 COPD 17 49 ④
Sugino2013[19] 7.5 71.4±6.7/73.7±6.3 Cohort 日本 IPF 46 62 ②
Sato2016[10] 3 69.1/68.7 Cohort 日本 IPF 44 38 ①
Lee2011[13] 6 71a/71 Cohort 韩国 PE 45/135 51/135 ③④
Jacob2017[11] 8 69a/69 CC 美国 IPF 171 214 ①
Mejía2009[6] 10 63±10/67±7 Cohort 墨西哥 IPF 31 79 ①
表2 纳入文献偏倚风险评价表
作　者 研究类型 研究对象选择 可比性 结果/暴露因素测量 总分
赵丽娜2016 CC ★★★ ★ ★★ 6
陈锋2016 Cohort ★★★ ★ ★★★ 7
秦文婧2016 CC ★★★ ★ ★ 5
陈恒屹2014 Cohort ★★★ ★ ★ 6
谭晓明2013 CC ★★★ ★ ★★ 6
Zhang2016 Cohort ★★★ ★ ★★★ 7
Mejia2009 Cohort ★★★ ★ ★★★ 7
Tomiaka2016 Cohort ★★★ ★ ★★★ 7
Sugino2013 Cohort ★★★ ★ ★★★ 7
Sato2016 Cohort ★★★ ★ ★★ 6
Lee2011 Cohort ★★★ ★ ★★★ 7
Jacob2017 CC ★★★ ★ ★★ 6
Ye2014 CC ★★★ ★ ★★ 6
图2 CPFE综合征与IPF肺动脉高压发生率比较的森林图
图3 CPFE综合征与IPF的肺动脉压力水平比较的森林图
图4 CPFE综合征与肺气肿/COPD肺动脉高压发生率比较的森林图
图5 CPFE综合征较肺气肿/COPD的肺动脉压力水平的森林图
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