COPD 中的生物标志物和临床结局：系统评价和荟萃分析。
Biomarkers and clinical outcomes in COPD: a systematic review and meta-analysis.
机构信息
Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.
Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
出版信息
Thorax. 2019 May;74(5):439-446. doi: 10.1136/thoraxjnl-2018-211855. Epub 2019 Jan 7.
BACKGROUND
Conventional measures to evaluate COPD may fail to capture systemic problems, particularly musculoskeletal weakness and cardiovascular disease. Identifying these manifestations and assessing their association with clinical outcomes (ie, mortality, exacerbation and COPD hospital admission) is of increasing clinical importance.
OBJECTIVE
To assess associations between 6 min walk distance (6MWD), heart rate, fibrinogen, C reactive protein (CRP), white cell count (WCC), interleukins 6 and 8 (IL-6 and IL-8), tumour necrosis factor-alpha, quadriceps maximum voluntary contraction, sniff nasal inspiratory pressure, short physical performance battery, pulse wave velocity, carotid intima-media thickness and augmentation index and clinical outcomes in patients with stable COPD.
METHODS
We systematically searched electronic databases (August 2018) and identified 61 studies, which were synthesised, including meta-analyses to estimate pooled HRs, following Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Shorter 6MWD and elevated heart rate, fibrinogen, CRP and WCC were associated with higher risk of mortality. Pooled HRs were 0.80 (95% CI 0.73 to 0.89) per 50 m longer 6MWD, 1.10 (95% CI 1.02 to 1.18) per 10 bpm higher heart rate, 3.13 (95% CI 2.14 to 4.57) per twofold increase in fibrinogen, 1.17 (95% CI 1.06 to 1.28) per twofold increase in CRP and 2.07 (95% CI 1.29 to 3.31) per twofold increase in WCC. Shorter 6MWD and elevated fibrinogen and CRP were associated with exacerbation, and shorter 6MWD, higher heart rate, CRP and IL-6 were associated with hospitalisation. Few studies examined associations with musculoskeletal measures.
CONCLUSION
Findings suggest 6MWD, heart rate, CRP, fibrinogen and WCC are associated with clinical outcomes in patients with stable COPD. Use of musculoskeletal measures to assess outcomes in patients with COPD requires further investigation.
TRIAL REGISTRATION NUMBER
CRD42016052075.
背景
评估 COPD 的常规方法可能无法捕捉到全身问题，尤其是肌肉骨骼无力和心血管疾病。识别这些表现并评估其与临床结局（即死亡率、加重和 COPD 住院）的关联具有越来越重要的临床意义。
目的
评估 6 分钟步行距离（6MWD）、心率、纤维蛋白原、C 反应蛋白（CRP）、白细胞计数（WCC）、白细胞介素 6 和 8（IL-6 和 IL-8）、肿瘤坏死因子-α、股四头肌最大自主收缩、嗅探鼻吸气压力、短体适能电池、脉搏波速度、颈动脉内膜中层厚度和增强指数与稳定 COPD 患者临床结局之间的关联。
方法
我们系统地检索了电子数据库（2018 年 8 月），并确定了 61 项研究，这些研究进行了综合分析，包括荟萃分析，以根据观察性研究的荟萃分析（MOOSE）和系统评价和荟萃分析的首选报告项目（PRISMA）指南估算汇总 HR。
结果
6MWD 较短和心率、纤维蛋白原、CRP 和 WCC 升高与死亡率风险增加相关。每增加 50m 的 6MWD，HR 为 0.80（95%CI 0.73 至 0.89），每增加 10bpm 的心率，HR 为 1.10（95%CI 1.02 至 1.18），纤维蛋白原增加两倍，HR 为 3.13（95%CI 2.14 至 4.57），CRP 增加两倍，HR 为 1.17（95%CI 1.06 至 1.28），WCC 增加两倍，HR 为 2.07（95%CI 1.29 至 3.31）。6MWD 较短和纤维蛋白原、CRP 升高与加重有关，6MWD 较短、心率、CRP 和 IL-6 升高与住院有关。很少有研究检查与肌肉骨骼测量的关联。
结论
研究结果表明，6MWD、心率、CRP、纤维蛋白原和 WCC 与稳定 COPD 患者的临床结局相关。使用肌肉骨骼措施评估 COPD 患者的结局需要进一步研究。
试验注册
CRD42016052075。
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