非阻塞性慢性支气管炎与全因死亡率的关系：系统文献回顾和荟萃分析。

Association of Nonobstructive Chronic Bronchitis With All-Cause Mortality: A Systematic Literature Review and Meta-analysis.

机构信息

Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA; Department of Epidemiology, College of Public Health, Iowa City, IA.

Department of Epidemiology, College of Public Health, Iowa City, IA.

出版信息

Chest. 2022 Jul;162(1):92-100. doi: 10.1016/j.chest.2022.02.003. Epub 2022 Feb 10.

DOI:10.1016/j.chest.2022.02.003

PMID:35150657

Abstract

BACKGROUND

The effect of nonobstructive chronic bronchitis (CB) on mortality is unclear.

RESEARCH QUESTION

Is nonobstructive CB associated with increased all-cause mortality?

STUDY DESIGN AND METHODS

We conducted a systematic literature review and meta-analysis to assess the association of nonobstructive CB and all-cause mortality. We searched for articles that included both CB and mortality in the title, abstract, or both in PubMed and EMBASE. We excluded studies in which participants demonstrated obstructive spirometry findings and studies in which CB and mortality were not defined. We used the Newcastle-Ottawa Quality Assessment Scale to assess study quality. We pooled adjusted hazard ratios (HRs) using the random effects model and inverse variance weighting. We conducted stratified analysis by the definition of CB and smoking status. We used Cochran's Q and I to assess for heterogeneity. We assessed publication bias by visual inspection of a funnel plot.

RESULTS

Of 5,014 titles identified, eight fulfilled the inclusion and exclusion criteria. Overall nonobstructive CB was associated with all-cause mortality (HR, 1.37; 95% CI, 1.26-1.50) with no statistically significant heterogeneity (P = .14; I = 29%). Nonobstructive CB was associated with increased mortality in studies that defined CB as any respiratory symptoms (broad definition; HR, 1.28; 95% CI, 1.10-1.48; I = 0%) as well as in the rest of the studies (HR, 1.40; 95% CI, 1.26-1.56; I = 37%). Nonobstructive CB was associated with increased mortality in ever smokers (HR, 1.49; 95% CI, 1.35-1.64; I = 0%), but was not associated with increased mortality in never smokers (HR, 1.22; 95% CI, 0.90-1.66), and moderate heterogeneity was found (P = .10; I = 49%). The funnel plot did not indicate evidence of a publication bias because it showed symmetrical distribution of studies.

INTERPRETATION

Nonobstructive CB is associated with increased all-cause mortality, and this association seems to be present only in current and former smokers. Further research should investigate whether this high-risk population may benefit from early therapeutic intervention.

TRIAL REGISTRY

PROSPERO; No.: CRD42021253596; URL: www.crd.york.ac.uk/prospero.

摘要

背景

非阻塞性慢性支气管炎（CB）对死亡率的影响尚不清楚。

研究问题

非阻塞性 CB 是否与全因死亡率增加有关？

研究设计和方法

我们进行了系统的文献综述和荟萃分析，以评估非阻塞性 CB 与全因死亡率之间的关系。我们在 PubMed 和 EMBASE 中搜索了标题、摘要或两者都包含 CB 和死亡率的文章。我们排除了参与者表现出阻塞性肺功能检查结果的研究，以及未定义 CB 和死亡率的研究。我们使用纽卡斯尔-渥太华质量评估量表来评估研究质量。我们使用随机效应模型和逆方差加权法对调整后的危险比（HRs）进行了汇总。我们按 CB 的定义和吸烟状况进行了分层分析。我们使用 Cochran's Q 和 I 来评估异质性。我们通过视觉检查漏斗图来评估发表偏倚。

结果

在 5014 个标题中，有 8 个符合纳入和排除标准。总体而言，非阻塞性 CB 与全因死亡率相关（HR，1.37；95%CI，1.26-1.50），且无统计学显著异质性（P=.14；I=29%）。在将 CB 定义为任何呼吸道症状（广义定义；HR，1.28；95%CI，1.10-1.48；I=0%）的研究以及其余研究中（HR，1.40；95%CI，1.26-1.56；I=37%），非阻塞性 CB 与死亡率增加相关。非阻塞性 CB 与现吸烟者（HR，1.49；95%CI，1.35-1.64；I=0%）死亡率增加相关，但与从不吸烟者（HR，1.22；95%CI，0.90-1.66）死亡率增加无关，且存在中度异质性（P=.10；I=49%）。漏斗图并未表明存在发表偏倚的证据，因为它显示了研究的对称分布。