Morgan Ann D, Sharma Chetna, Rothnie Kieran J, Quint Jennifer K
Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
University College London, London, UK.
BMJ Open. 2016 Nov 29;6(11):e011898. doi: 10.1136/bmjopen-2016-011898.
There is good evidence to suggest that chronic obstructive pulmonary disease (COPD) increases the risk of ischaemic heart disease, in particular myocardial infarction (MI). The relationship between stroke and COPD, however, is not as well established, and studies conducted to date have generated conflicting results.
MEDLINE and Embase will be searched for relevant articles using a prespecified search strategy. We will target observational studies conducted in the general population that employ either a longitudinal cohort or case-control study design to estimate ORs, HRs or incident rate ratios for the association between COPD and a subsequent first stroke. Both stages of screening, title and abstract followed by full-text screening, will be conducted independently by two reviewers. The Population, Exposure, Comparator, Outcomes, Study characteristics (PECOS) framework will be used to systematise the process of extracting data from those studies meeting our selection criteria. Study quality will be assessed using an adapted version of the Newcastle-Ottawa risk of bias tool. The data extraction and the risk of bias assessment will also be conducted in duplicate. A meta-analysis will be considered if there is sufficient homogeneity across selected studies or groups of studies. If a meta-analysis is not justified, a narrative synthesis will be conducted. Selected Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria will be used to assess the quality of the cumulative evidence.
Currently ranking second and fourth in the list of global causes of mortality, respectively, stroke and COPD are important non-communicable diseases. With this review, we hope to clarify some of the current uncertainty that surrounds the COPD-stroke relationship and in turn improve understanding of the nature of the role of COPD in comorbid stroke.
CRD42016035932.
有充分证据表明，慢性阻塞性肺疾病（COPD）会增加缺血性心脏病的风险，尤其是心肌梗死（MI）。然而，中风与COPD之间的关系尚未明确确立，迄今为止进行的研究结果相互矛盾。
将使用预先指定的检索策略在MEDLINE和Embase中检索相关文章。我们将针对在一般人群中进行的观察性研究，这些研究采用纵向队列或病例对照研究设计，以估计COPD与随后首次中风之间关联的比值比（OR）、风险比（HR）或发病率比。标题和摘要筛选以及全文筛选这两个阶段将由两名评审员独立进行。将使用人群、暴露、对照、结局、研究特征（PECOS）框架来系统化从符合我们选择标准的研究中提取数据的过程。将使用纽卡斯尔-渥太华偏倚风险工具的改编版评估研究质量。数据提取和偏倚风险评估也将重复进行。如果所选研究或研究组之间存在足够的同质性，则将考虑进行荟萃分析。如果荟萃分析不合理，则将进行叙述性综合分析。将使用推荐分级、评估、制定和评价（GRADE）标准的选定标准来评估累积证据的质量。
中风和COPD分别是目前全球死亡率排名第二和第四的重要非传染性疾病。通过本综述，我们希望澄清目前围绕COPD与中风关系的一些不确定性，进而增进对COPD在合并中风中作用性质的理解。
PROSPERO注册号：CRD42016035932。
