Lanzhou University Second Clinical Medical College, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Department of Respiratory Medicine, Lanzhou University Second Hospital, Lanzhou, China.
Respir Care. 2020 Oct;65(10):1561-1573. doi: 10.4187/respcare.07390. Epub 2020 Apr 7.
COPD and bronchiectasis frequently coexist, which creates an emerging phenotype with a worse prognosis. However, the impact of bronchiectasis on the natural history of COPD has not been fully evaluated and is still controversial. This meta-analysis was performed to clarify the associations of the presence of bronchiectasis with the prognosis and quality of life of patients with COPD.
A systematic review and meta-analysis was performed following a search of medical databases, and included articles published up to April 2019. The following outcome measures were analyzed: age, sex, smoking history, body mass index, exacerbation rate, lung function, inflammatory biomarkers, albumin, colonization by potentially pathogenic microorganisms, isolates, isolates, hospital admissions, and mortality.
A total of 415,257 subjects with COPD from 18 observational studies were eligible; bronchiectasis was present in 25,929 subjects (6.24%). The coexistence of COPD and bronchiectasis occurred more often in older subjects with lower body mass index. The presence of bronchiectasis in the subjects with COPD increased the risk of daily sputum production (odds ratio [OR] 1.80, 95% CI 1.24-2.61), exacerbation (weighted mean difference [WMD] 0.72 times, 95% CI 0.59-0.85), frequent hospital admissions (WMD 0.35 times, 95% CI 0.21-0.49), and follow-up (>3 years) mortality (OR 2.26, 95% CI 0.95-5.36). The subjects with COPD and bronchiectasis showed poorer pulmonary function (FEV/FVC: WMD -3.37%, 95% CI -5.63 to -1.11), lower albumin (Standardized mean difference [SMD] -0.17, 95% CI -0.26 to -0.08), elevated C-reactive protein (SMD 0.40, 95% CI 0.06-0.74), a greater proportion of chronic colonization by potentially pathogenic microorganisms (OR 6.65, 95% CI 4.44-9.95), and a higher isolation rate of (OR 5.13, 95% CI 4.89-5.38) or (OR 1.90, 95% CI 1.29-2.79) than the subjects with COPD without bronchiectasis.
This meta-analysis confirmed the significant associations of the presence of bronchiectasis with the natural history, disease course, and outcomes in COPD. The COPD-bronchiectasis phenotype had adverse effects on subjects' health condition and prognosis.
COPD 和支气管扩张症常同时存在，形成一种预后较差的新兴表型。然而，支气管扩张症对 COPD 自然史的影响尚未得到充分评估，仍存在争议。本荟萃分析旨在阐明支气管扩张症与 COPD 患者预后和生活质量的关系。
对医学数据库进行系统检索，纳入截至 2019 年 4 月发表的文章，进行综述和荟萃分析。分析以下结局指标：年龄、性别、吸烟史、体重指数、加重率、肺功能、炎症标志物、白蛋白、潜在致病微生物定植、分离株、分离株、住院和死亡率。
共有来自 18 项观察性研究的 415257 例 COPD 患者符合纳入标准，其中 25929 例（6.24%）存在支气管扩张症。在 COPD 患者中，COPD 和支气管扩张症同时存在时，患者年龄较大，体重指数较低。在 COPD 患者中存在支气管扩张症会增加每日咳痰量（优势比 [OR] 1.80，95%置信区间 [CI] 1.24-2.61）、加重（加权均数差 [WMD] 0.72 次，95% CI 0.59-0.85）、频繁住院（WMD 0.35 次，95% CI 0.21-0.49）和随访（>3 年）死亡率（OR 2.26，95% CI 0.95-5.36）。合并支气管扩张症的 COPD 患者肺功能更差（FEV/FVC：WMD -3.37%，95% CI -5.63 至 -1.11）、白蛋白水平更低（标准化均数差 [SMD] -0.17，95% CI -0.26 至 -0.08）、C 反应蛋白水平更高（SMD 0.40，95% CI 0.06-0.74）、潜在致病微生物慢性定植的比例更高（OR 6.65，95% CI 4.44-9.95）、分离株的分离率更高（OR 5.13，95% CI 4.89-5.38）或 （OR 1.90，95% CI 1.29-2.79）。
本荟萃分析证实了支气管扩张症与 COPD 的自然史、病程和结局之间存在显著关联。COPD-支气管扩张症表型对患者的健康状况和预后有不良影响。
