Centre de recherche, Centre de pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec- Université Laval, Quebec City, QC, Canada.
Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.
Lancet Respir Med. 2022 Nov;10(11):1029-1037. doi: 10.1016/S2213-2600(22)00179-5. Epub 2022 Jul 8.
Long-term oxygen therapy (LTOT) improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia. However, the best method of management of moderate hypoxaemia not qualifying for LTOT (including isolated nocturnal desaturation) is uncertain. We examined the effect of home oxygen (either LTOT or nocturnal oxygen therapy) on overall survival in patients with COPD and moderate hypoxaemia.
In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINHAL, and Web of Science from database inception to Jan 13, 2022, for parallel-group randomised trials of long-term or nocturnal oxygen in patients with COPD and moderate daytime hypoxaemia or isolated nocturnal desaturation, or both. Control groups received usual care or ambient air through sham concentrators (placebo) throughout the study period. The primary outcome of interest was 3-year mortality. Crossover trials and trials of oxygen in severe hypoxaemia were excluded. Two reviewers applied inclusion and exclusion criteria to titles and abstracts and screened the full-text articles and reference lists of relevant studies. Aggregate data were extracted manually in duplicate using structured data collection forms. Methodological quality was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool individual studies. We considered the minimal clinically important difference for home oxygen to be a relative risk reduction in mortality at 3-year follow-up of 30-40%. The meta-analysis is registered on PROSPERO, CRD42021225372.
We identified 2192 studies and screened 1447 after removal of duplicates, of which 161 were subjected to full-text screening, and six were identified as being eligible for inclusion. These six randomised trials were published between 1992 and 2020 and the quality of evidence was high. In the primary meta-analysis (five trials; 1002 patients), we found the effect of home oxygen in reducing 3-year mortality to be small or absent (relative risk 0·91 [95% CI 0·72-1·16]; τ = 0·00), hence the lower limit of the 95% CI did not meet the prespecified minimal clinically important difference.
The results of our meta-analysis suggest that home oxygen probably makes little or no difference to 3-year mortality in patients with COPD and moderate hypoxaemia. The data do not support the widespread use of home oxygen in this patient population.
None.
长期氧疗（LTOT）可改善慢性阻塞性肺疾病（COPD）和严重低氧血症患者的生存率。然而，对于不符合 LTOT 条件的中度低氧血症（包括孤立性夜间低氧血症）的最佳管理方法尚不确定。我们研究了家庭氧疗（LTOT 或夜间氧疗）对 COPD 合并中度低氧血症患者总体生存率的影响。
在这项系统评价和荟萃分析中，我们检索了 MEDLINE、Embase、Cochrane 对照试验中心注册库、CINHAL 和 Web of Science，从数据库建立到 2022 年 1 月 13 日，以纳入 COPD 患者中接受长期或夜间氧疗治疗的平行组随机试验，这些患者存在中度日间低氧血症或孤立性夜间低氧血症，或同时存在两种情况。对照组在整个研究期间接受常规治疗或通过模拟集中器（安慰剂）吸入空气。主要观察终点为 3 年死亡率。排除了交叉试验和严重低氧血症患者的氧疗试验。两名评审员根据标题和摘要应用纳入和排除标准，并对相关研究的全文文章和参考文献列表进行筛选。使用结构化数据收集表手动提取汇总数据。使用 Cochrane 偏倚风险工具评估方法学质量。使用随机效应荟萃分析对个体研究进行汇总。我们认为家庭氧疗的最小临床重要差异是在 3 年随访时死亡率相对降低 30-40%。该荟萃分析已在 PROSPERO 上注册，CRD42021225372。
我们共检索到 2192 项研究，并在去除重复项后筛选出 1447 项，其中 1447 项经进一步筛选后，有 161 项进行了全文筛选，最终确定 6 项符合纳入标准。这 6 项随机试验发表于 1992 年至 2020 年之间，证据质量较高。在主要的荟萃分析（五项试验；1002 名患者）中，我们发现家庭氧疗在降低 3 年死亡率方面的效果较小或不存在（相对风险 0.91 [95%CI 0.72-1.16]；τ=0.00），因此 95%CI 的下限未达到预先设定的最小临床重要差异。
荟萃分析的结果表明，家庭氧疗可能对 COPD 合并中度低氧血症患者的 3 年死亡率影响较小或没有影响。这些数据不支持在该患者群体中广泛使用家庭氧疗。
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