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

doi:10.3761/j.issn.0254-1769.2019.05.026

摘要/Abstract

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。

关键词: 慢性阻塞性肺疾病, 静脉血栓栓塞症, 危险因素, Meta分析

Abstract:

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 May 2018. 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.

Key words: Chronic Obstructive Pulmonary Disease, Venous Thromboembolism, Risk Factors, Meta-Analysis

朱晓敏,罗健,李苗苗,谢霖,胡霞. 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[J]. 中华护理杂志, 2019, 54(5): 746-752.

ZHU Xiaomin,LUO Jian,LI Miaomiao,XIE Lin,HU Xia. Risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease：a meta-analysis[J]. Chinese Journal of Nursing, 2019, 54(5): 746-752.

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纳入研究	发表年份研究对象样本量(例）			VTE诊断方法	研究类型	VTE发生率文献质量评价(分）
李燕芳等[⑴	2018	COPD	377	肺动脉CT;肺通气/灌注扫描; 超声心动图	回顾性研究	25.2%	6
董洪英等^[12]	2017	AECOPD	239	多普勒超声和CTPA	回顾性研究	21.8%	6
李金玲等^[13]	2016	AECOPD	81	血管多普勒超声	回顾性研究	未报告	6
曾以萍等M	2015	AECOPD	96	CIPA、肢体多普勒超声和	回顾性研究	46.8%	4
吴永红等^[15]	2015	COPD	362	D-二聚体、CTPA	回顾性研究	21.55%	5
Akpinar 等^[16]	2014	AECOPD	172	多普勒超声	前瞻性研究	29.1%	6
Choia 等^[17]	2013	COPD	103	CTPA	前瞻性研究	5%	7
梁新梅等^[18]	2013	AECOPD	148	肢体多普勒检查和CTPA	前瞻性研究	10.7%	4
Barba 等^[19]	2012	COPD	313 233	影像学检查	回顾性研究	1.32%	7
毛晓群等^[20]	2011	COPD	504	彩色多普勒超声	前瞻性研究	14.4%	6
Duan 等^[21]	2010	AECOPD	520	彩色多普勒超声和D-二聚体	前瞻性研究	9.7%	7
Gunen 等^[5]	2010	COPD	131	CTPA和多普勒超声	前瞻性研究	16%	7
Tillie-Leblond 等[22]	2006	COPD	211	CTA和超声	前瞻性研究	25%	8
Akgun 等^[23]	2006	COPD	120	多普勒超声和CTPA	前瞻性研究	13.3%	6

纳入研究	发表年份研究对象样本量(例）			VTE诊断方法	研究类型	VTE发生率文献质量评价(分）
李燕芳等[⑴	2018	COPD	377	肺动脉CT;肺通气/灌注扫描; 超声心动图	回顾性研究	25.2%	6
董洪英等^[12]	2017	AECOPD	239	多普勒超声和CTPA	回顾性研究	21.8%	6
李金玲等^[13]	2016	AECOPD	81	血管多普勒超声	回顾性研究	未报告	6
曾以萍等M	2015	AECOPD	96	CIPA、肢体多普勒超声和	回顾性研究	46.8%	4
吴永红等^[15]	2015	COPD	362	D-二聚体、CTPA	回顾性研究	21.55%	5
Akpinar 等^[16]	2014	AECOPD	172	多普勒超声	前瞻性研究	29.1%	6
Choia 等^[17]	2013	COPD	103	CTPA	前瞻性研究	5%	7
梁新梅等^[18]	2013	AECOPD	148	肢体多普勒检查和CTPA	前瞻性研究	10.7%	4
Barba 等^[19]	2012	COPD	313 233	影像学检查	回顾性研究	1.32%	7
毛晓群等^[20]	2011	COPD	504	彩色多普勒超声	前瞻性研究	14.4%	6
Duan 等^[21]	2010	AECOPD	520	彩色多普勒超声和D-二聚体	前瞻性研究	9.7%	7
Gunen 等^[5]	2010	COPD	131	CTPA和多普勒超声	前瞻性研究	16%	7
Tillie-Leblond 等[22]	2006	COPD	211	CTA和超声	前瞻性研究	25%	8
Akgun 等^[23]	2006	COPD	120	多普勒超声和CTPA	前瞻性研究	13.3%	6