Dretzke Janine, Wang Jingya, Yao Mi, Guan Naijie, Ling Myra, Zhang Erica, Mukherjee Deyashini, Hall James, Jowett Sue, Mukherjee Rahul, Moore David J, Turner Alice M
Institute of Applied Health Research, University of Birmingham, United Kingdom.
Birmingham Medical School, University of Birmingham, United Kingdom.
Chronic Obstr Pulm Dis. 2022 Apr 29;9(2):237-251. doi: 10.15326/jcopdf.2021.0242.
Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base.
Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries.
A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China.
The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.
对于稳定期慢性阻塞性肺疾病（COPD）患者以及近期病情加重（出院后）的患者，家庭无创通气（NIV）的益处仍存在不确定性。本系统评价的目的是：（1）用任何语言发表的研究更新证据库，包括未被标准医学数据库收录的中文研究，以及（2）探讨额外研究对证据库的影响。
采用标准的系统评价方法来识别和评估研究。纳入报告死亡率、住院率、病情加重情况、生活质量、不良事件或依从性的随机对照试验（RCT）和非随机研究。对死亡率和住院率进行随机效应荟萃分析，研究按人群和研究设计进行亚组分析。进行敏感性分析以探讨纳入来自西方国家和非西方国家研究的影响。
共纳入103项研究，比之前的评价多得多。对于稳定期人群，对死亡率没有显著影响。基于非随机研究或来自非西方国家的RCT，NIV对出院后人群有益。在所有亚组中，NIV使住院次数有小幅但显著的减少（每年1 - 2次），住院时间有不同程度的缩短，中国的研究中缩短幅度更大。
关于家庭NIV的证据库比之前所呈现的要大得多。虽然NIV可能会减少住院次数并改善生活质量，但无论在哪个国家，仍几乎没有证据表明其能降低死亡率。个体参与者数据分析可能会阐明哪些患者将从NIV中获益最大。
