慢性阻塞性肺疾病患者并发静脉血栓栓塞症危险因素的Meta分析
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摘要
目的通过Meta分析明确住院COPD患者发生静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素。方法计算机检索PubMed、Web of Science、Cochrane Library、Embase、MEDLINE、中国生物医学文献数据库、中国知网、维普数据库及万方数据库,收集关于COPD患者并发VTE危险因素的研究,检索时限为从建库至2018年5月。由2名评价人员按照标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,包括316 297例研究对象,共14项危险因素。Meta分析显示,高龄、吸烟史、卧床史、合并糖尿病及肿瘤是COPD患者并发VTE的重要危险因素。结论高龄患者、有吸烟史和卧床史、合并糖尿病或肿瘤的COPD患者发生VTE的可能性较大。目前关于COPD患者并发VTE危险因素的研究证据尚不充足,且各研究样本量差异较大。肥胖、深静脉置管、PaO2异常的预测价值,证据尚不充分,后期尚需进行更多高质量研究进行验证。
Objective To identify the risk factors of venous thromboembolism in patients with chronic obstructive pulmonary disease using meta-analysis. Methods We performed a systematic search in PubMed,Web of Science,Cochrane Library,Embase,MEDLINE,CMB,CNKI,Wanfang Data and VIP to collect studies about risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease published from inception to May2018. Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria by two reviewers independently. Results Fourteen studies were recruited,including 316,297 cases. Fourteen risk factors were involved,among which advanced age,smoking,immobilization,diabetes mellitus and tumor were the main risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease. Conclusion Because of insufficient evidence on risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease and sample size of each study varied greatly,the effects of obesity,deep venous catheterization and PaO2 abnormality are still inconclusive,and more high-quality studies are needed to supplement and improve for future research.
Objective To identify the risk factors of venous thromboembolism in patients with chronic obstructive pulmonary disease using meta-analysis. Methods We performed a systematic search in PubMed,Web of Science,Cochrane Library,Embase,MEDLINE,CMB,CNKI,Wanfang Data and VIP to collect studies about risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease published from inception to May2018. Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria by two reviewers independently. Results Fourteen studies were recruited,including 316,297 cases. Fourteen risk factors were involved,among which advanced age,smoking,immobilization,diabetes mellitus and tumor were the main risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease. Conclusion Because of insufficient evidence on risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease and sample size of each study varied greatly,the effects of obesity,deep venous catheterization and PaO2 abnormality are still inconclusive,and more high-quality studies are needed to supplement and improve for future research.
引文
[1] Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease 2018 report[EB/OL].(2017-12-05).http://www.goldcopd.org
[2] Yang G,Wang Y,Zeng Y,et al. Rapid health transition in China,1990-2010:findings from the Global Burden of Disease Study[J]. Lancet,2013,381(9882):1987-2015.
[3] Ambrosetti M,Ageno W,Spanevello A,et al. Prevalence and prevention of thromboembolism in patients with acute exacerbation of COPD[J]. Thtomb Res,2003,112(4):203-207.
[4] Rizkallah J,Man SF,Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD:a systematic review and meta-analysis[J]. Chest,2009,135(3):786-793.
[5] Gunen H,Gulbas G,In E,et al. Venous thromboembolism and exacerbations of COPD[J]. Eur Respir J,2010,35(6):1243-1248.
[6]秦霞,田利,李慧玲,等.内科住院病人发生静脉血栓栓塞症危险因素的Meta分析[J].现代预防医学,2018,45(4):753-756.
[7]徐园,杨旭,王晓杰,等.国内深静脉血栓预防护理现状的调查研究[J].中华护理杂志,2015,50(10):1222-1225.
[8] Stroup DF,Berlin JA,Morton SC,et al. Meta-analysis of observational studies in epidemiology:a proposal for reporting. Metaanalysis of observational studies in epidemiology(MOOSE)group[J]. JAMA,2000,283(15):2008-2012.
[9] Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol,2010,25(9):603-605.
[10] Wells GA,Shea BJ,O'Connell D,et al. The Newcastle-Ottawa Scale(NOS)for assessing the quality of non-randomized studies in meta-analysis[J]. Appl Eng Agric,2014,18(6):727-734.
[11]李燕芳,方英,李琴,等.慢性阻塞性肺疾病合并肺血栓栓塞症的危险因素分析及护理对策[J].中华全科医学,2018,16(3):492-493.
[12]董洪英,张云霞.慢性阻塞性肺疾病急性加重期患者并发静脉血栓栓塞的危险因素分析[J].中华全科医学,2017,15(1):76-78.
[13]李金玲,杨林瀛,庞桂芬,等.慢性阻塞性肺疾病急性加重期合并深静脉血栓形成的相关因素分析[J].医学与哲学,2016,37(5B):39-41.
[14]曾以萍,张秀杰,白虹.慢性阻塞性肺疾病急性加重期患者发生静脉血栓栓塞症的危险因素及预防[J].临床肺科杂志,2015,20(3):509-511.
[15]吴永红,胡德春,张盼旺.慢性阻塞性肺疾病合并肺血栓栓塞危险因素分析[J].中华肺部疾病杂志,2015,8(3):299-302.
[16] Akpinar EE,Hosgun D,Akpinar S,et al. Incidence of pulmonary embolism during COPD exacerbation[J]. J Bras Pneumol,2014,40(1):38-45.
[17] Choia KJ,Chaa sl,Shinb KM,et al. Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease[J]. Respiration,2013,85(3):203-209.
[18]梁新梅,梁克诚,卢翠梅.慢性阻塞性肺病并发静脉血栓栓塞危险因素分析[J].临床肺科杂志,2013,18(12):2205-2206.
[19] Barba R,Zapatero A,Marco J,et al. Venous thromboembolism in COPD hospitalized patients[J]. J Thromb Thrombolysis,2012,33(1):82-87.
[20]毛晓群,钟冬婵,陈丽莉,等.慢性阻塞性肺疾病患者合并下肢深静脉血栓的危险因素分析[J].中华护理杂志,2011,46(10):1001-1002.
[21] Duan SC,Yang YH,Li XY,et al. Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin Med J,2010,123(12):1510-1514.
[22] Tillie-Leblond I,Marquette CH,Perez T,et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease:prevalence and risk factors[J].Ann Intern Med,2006,21,144(6):390-396.
[23] Akgun M,Merala M,Onbas O,et al. Comparison of clinical characteristics and outcomes of patients with COPD exacerbation with or without venous thromboembolism[J]. Respiration,2006,73(4):428-433.
[24]张晶晶,江智霞,吴华炼,等. ICU静脉血栓栓塞症风险因素的Meta分析[J].重庆医学,2017,46(9):1230-1234.
[25]刘永华,郑大东,葛才荣.老年人静脉血栓栓塞的研究现状[J].医学研究生学报,2003,16(4):290-293.
[26] Morgan AD,Herrett E,De Stavola BL,et al. COPD disease severity and the risk of venous thromboembolic events:a matched case–control study[J]. Int J Chron Obstruct Pulmon Dis,2016,11(1):899-908.
[27] Vestbo J,Hurd SS,Agusti AG,et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J]. Am J Respir Crit Care Med,2013,187(4):347-365.
[28] Elewa H,Elrefai R,Barnes GD. Cancer-associated venous thromboembolism[J].Curr Treat Options Cardiovasc Med,2016,18(4):1-9.
[29] Long B,Koyfman A. Current controversies in thrombolytic use in acute pulmonary embolism[J]. J Emerg Med,2016,51(1):37-44.
[30] Leung A,Heal C,Perera M,et al. A systematic review of patient-related risk factors for catheter-related thrombosis[J]. J Thromb Thrombolysis,2015,40(3):363-373.
[2] Yang G,Wang Y,Zeng Y,et al. Rapid health transition in China,1990-2010:findings from the Global Burden of Disease Study[J]. Lancet,2013,381(9882):1987-2015.
[3] Ambrosetti M,Ageno W,Spanevello A,et al. Prevalence and prevention of thromboembolism in patients with acute exacerbation of COPD[J]. Thtomb Res,2003,112(4):203-207.
[4] Rizkallah J,Man SF,Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD:a systematic review and meta-analysis[J]. Chest,2009,135(3):786-793.
[5] Gunen H,Gulbas G,In E,et al. Venous thromboembolism and exacerbations of COPD[J]. Eur Respir J,2010,35(6):1243-1248.
[6]秦霞,田利,李慧玲,等.内科住院病人发生静脉血栓栓塞症危险因素的Meta分析[J].现代预防医学,2018,45(4):753-756.
[7]徐园,杨旭,王晓杰,等.国内深静脉血栓预防护理现状的调查研究[J].中华护理杂志,2015,50(10):1222-1225.
[8] Stroup DF,Berlin JA,Morton SC,et al. Meta-analysis of observational studies in epidemiology:a proposal for reporting. Metaanalysis of observational studies in epidemiology(MOOSE)group[J]. JAMA,2000,283(15):2008-2012.
[9] Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol,2010,25(9):603-605.
[10] Wells GA,Shea BJ,O'Connell D,et al. The Newcastle-Ottawa Scale(NOS)for assessing the quality of non-randomized studies in meta-analysis[J]. Appl Eng Agric,2014,18(6):727-734.
[11]李燕芳,方英,李琴,等.慢性阻塞性肺疾病合并肺血栓栓塞症的危险因素分析及护理对策[J].中华全科医学,2018,16(3):492-493.
[12]董洪英,张云霞.慢性阻塞性肺疾病急性加重期患者并发静脉血栓栓塞的危险因素分析[J].中华全科医学,2017,15(1):76-78.
[13]李金玲,杨林瀛,庞桂芬,等.慢性阻塞性肺疾病急性加重期合并深静脉血栓形成的相关因素分析[J].医学与哲学,2016,37(5B):39-41.
[14]曾以萍,张秀杰,白虹.慢性阻塞性肺疾病急性加重期患者发生静脉血栓栓塞症的危险因素及预防[J].临床肺科杂志,2015,20(3):509-511.
[15]吴永红,胡德春,张盼旺.慢性阻塞性肺疾病合并肺血栓栓塞危险因素分析[J].中华肺部疾病杂志,2015,8(3):299-302.
[16] Akpinar EE,Hosgun D,Akpinar S,et al. Incidence of pulmonary embolism during COPD exacerbation[J]. J Bras Pneumol,2014,40(1):38-45.
[17] Choia KJ,Chaa sl,Shinb KM,et al. Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease[J]. Respiration,2013,85(3):203-209.
[18]梁新梅,梁克诚,卢翠梅.慢性阻塞性肺病并发静脉血栓栓塞危险因素分析[J].临床肺科杂志,2013,18(12):2205-2206.
[19] Barba R,Zapatero A,Marco J,et al. Venous thromboembolism in COPD hospitalized patients[J]. J Thromb Thrombolysis,2012,33(1):82-87.
[20]毛晓群,钟冬婵,陈丽莉,等.慢性阻塞性肺疾病患者合并下肢深静脉血栓的危险因素分析[J].中华护理杂志,2011,46(10):1001-1002.
[21] Duan SC,Yang YH,Li XY,et al. Prevalence of deep venous thrombosis in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chin Med J,2010,123(12):1510-1514.
[22] Tillie-Leblond I,Marquette CH,Perez T,et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease:prevalence and risk factors[J].Ann Intern Med,2006,21,144(6):390-396.
[23] Akgun M,Merala M,Onbas O,et al. Comparison of clinical characteristics and outcomes of patients with COPD exacerbation with or without venous thromboembolism[J]. Respiration,2006,73(4):428-433.
[24]张晶晶,江智霞,吴华炼,等. ICU静脉血栓栓塞症风险因素的Meta分析[J].重庆医学,2017,46(9):1230-1234.
[25]刘永华,郑大东,葛才荣.老年人静脉血栓栓塞的研究现状[J].医学研究生学报,2003,16(4):290-293.
[26] Morgan AD,Herrett E,De Stavola BL,et al. COPD disease severity and the risk of venous thromboembolic events:a matched case–control study[J]. Int J Chron Obstruct Pulmon Dis,2016,11(1):899-908.
[27] Vestbo J,Hurd SS,Agusti AG,et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J]. Am J Respir Crit Care Med,2013,187(4):347-365.
[28] Elewa H,Elrefai R,Barnes GD. Cancer-associated venous thromboembolism[J].Curr Treat Options Cardiovasc Med,2016,18(4):1-9.
[29] Long B,Koyfman A. Current controversies in thrombolytic use in acute pulmonary embolism[J]. J Emerg Med,2016,51(1):37-44.
[30] Leung A,Heal C,Perera M,et al. A systematic review of patient-related risk factors for catheter-related thrombosis[J]. J Thromb Thrombolysis,2015,40(3):363-373.