Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
Applied Statistics Group, University of West of England, Bristol, UK.
Eur Respir J. 2018 Sep 6;52(3). doi: 10.1183/13993003.00864-2018. Print 2018 Sep.
Primary spontaneous pneumothorax (PSP) recurrence rates vary widely in the published literature, with limited data describing the factors that influence recurrence. The aims of this systematic review were to determine an estimation of PSP recurrence rates and describe risk factors for recurrence.A systematic review was conducted of all studies reporting PSP recurrence. Electronic searches were performed to identify English language publications of randomised trials and observational studies. The population was adults with PSP, who underwent conservative management, pleural aspiration or chest drainage. The outcome of interest was recurrence. Articles were screened and data extracted from eligible studies by two reviewers.Of 3607 identified studies, 29 were eligible for inclusion, comprising 13 548 patients. Pooled 1-year and overall recurrence rates were 29.0% (95% CI 20.9-37.0%) and 32.1% (95% CI 27.0-37.2%), respectively. Female sex was associated with increased recurrence (OR 3.03, 95% CI 1.24-7.41), while smoking cessation was associated with a four-fold decrease in risk (OR 0.26, 95% CI 0.10-0.63). for random effects meta-analysis was 94% (p<0.0001), reflecting high heterogeneity between studies.This systematic review demonstrates a 32% PSP recurrence rate, with greatest risk in the first year. Female sex was associated with higher risk, suggesting possible sex-specific pathophysiology.
原发性自发性气胸（PSP）的复发率在文献中有很大差异，关于影响复发的因素的数据有限。本系统评价的目的是确定 PSP 复发率的估计值，并描述复发的危险因素。
对所有报告 PSP 复发的研究进行了系统评价。进行了电子检索，以确定报告随机试验和观察性研究的英文出版物。研究人群为接受保守治疗、胸膜抽吸或胸腔引流的成人 PSP 患者。感兴趣的结局是复发。由两名评审员对文章进行筛选并从合格研究中提取数据。
在 3607 项已确定的研究中，有 29 项符合纳入标准，包括 13548 名患者。1 年和总体复发率分别为 29.0%（95%CI 20.9-37.0%）和 32.1%（95%CI 27.0-37.2%）。女性与复发风险增加相关（OR 3.03，95%CI 1.24-7.41），而戒烟与风险降低四倍相关（OR 0.26，95%CI 0.10-0.63）。随机效应荟萃分析的 I² 为 94%（p<0.0001），反映了研究之间存在高度异质性。
本系统评价显示 PSP 复发率为 32%，第一年风险最高。女性与更高的风险相关，提示可能存在性别特异性的病理生理学。
