Risk factors of venous thromboembolism among patients with chronic obstructive pulmonary disease：a meta-analysis

doi:10.3761/j.issn.0254-1769.2019.05.026

Abstract

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

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

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.

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.

Figures/Tables 4

References 30

[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 DOI URL PMID
[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. DOI URL PMID
[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. DOI URL PMID
[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. DOI URL
[5]	Gunen H, Gulbas G, In E , et al. Venous thromboembolism and exacerbations of COPD[J]. Eur Respir J, 2010,35(6):1243-1248. DOI URL
[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. DOI URL
[8]	Stroup DF, Berlin JA, Morton SC , et al. Meta-analysis of observational studies in epidemiology:a proposal for reporting. Meta-analysis of observational studies in epidemiology(MOOSE)group[J]. JAMA, 2000,283(15):2008-2012. DOI URL
[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. DOI URL PMID
[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. DOI URL
[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. DOI URL
[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. DOI URL
[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. DOI URL
[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. DOI URL
[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. DOI URL PMID
[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. DOI URL PMID
[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. DOI URL
[19]	Barba R, Zapatero A, Marco J , et al. Venous thromboembolism in COPD hospitalized patients[J]. J Thromb Thrombolysis, 2012,33(1):82-87. DOI URL PMID
[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. DOI URL
[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. DOI URL PMID
[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. DOI URL
[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. DOI URL PMID
[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. DOI URL
[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. DOI URL
[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. DOI URL PMID
[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. DOI URL
[28]	Elewa H, Elrefai R, Barnes GD . Cancer-associated venous throm-boembolism[J]. Curr Treat Options Cardiovasc Med, 2016,18(4):1-9. DOI URL PMID
[29]	Long B, Koyfman A . Current controversies in thrombolytic use in acute pulmonary embolism[J]. J Emerg Med, 2016,51(1):37-44. DOI URL PMID
[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. DOI URL PMID

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