COPD 加重与急性心血管事件的关联：系统评价和荟萃分析。
Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis.
机构信息
AstraZeneca, Academy House, 136 Hills Rd., Cambridge CB2 8PA, UK.
AstraZeneca, Cambridge, UK.
出版信息
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221113647. doi: 10.1177/17534666221113647.
BACKGROUND
The majority of patients with chronic obstructive pulmonary disease (COPD) suffer from comorbid cardiovascular (CV) disease. Accumulating evidence suggests a temporal association between COPD exacerbations and acute CV events, possibly due to lung hyperinflation, increased hypoxemia and systemic inflammation. The aims of the study were to estimate the risk of (1) acute CV events [acute myocardial infarction (AMI), CV-related death] or stroke in the months following a COPD exacerbation and (2) COPD exacerbation in the months following an acute CV event.
METHODS
A systematic literature review of observational studies published since 2000 was conducted by searching literature databases (Medline and Embase). Studies were eligible if conducted in adults with COPD, exposed to either COPD exacerbation or acute CV events, with outcomes of acute CV events or COPD exacerbation reported. Studies were appraised for relevance, bias and quality. Meta-analyses, using random-effect models, were performed for each outcome of interest, thus providing a pooled relative risk (RR) and its 95% confidence interval.
RESULTS
Eight studies were identified, of which seven were used for the meta-analyses examining the risk of CV events 1-3 months after an exacerbation compared with none. For stroke (six studies), RR was 1.68 (95% CI = 1.19-2.38). For AMI (six studies), RR was 2.43 (95% CI = 1.40-4.20). No studies exploring risk of exacerbation following an acute CV event were identified.
CONCLUSION
This meta-analysis identified a markedly increased risk of stroke or AMI within a relatively short period of time following a COPD exacerbation. Although the underlying mechanisms are not fully elucidated, patients with COPD should be monitored for risk of CV outcomes after exacerbations. In addition, preventing exacerbations may decrease the risk of subsequent acute CV events.
REGISTRATION
The study protocol was published via PROSPERO: International Prospective Register of Systematic Reviews (#CRD42020211055).
背景
大多数慢性阻塞性肺疾病（COPD）患者患有合并心血管（CV）疾病。越来越多的证据表明，COPD 加重与急性 CV 事件之间存在时间关联，这可能是由于肺过度充气、缺氧增加和全身炎症所致。本研究的目的是评估（1）COPD 加重后 1-3 个月内发生急性 CV 事件（急性心肌梗死（AMI）、CV 相关死亡）或中风的风险，以及（2）急性 CV 事件后 1-3 个月内 COPD 加重的风险。
方法
通过检索文献数据库（Medline 和 Embase），对 2000 年以来发表的观察性研究进行了系统的文献回顾。如果研究对象为患有 COPD 的成年人，暴露于 COPD 加重或急性 CV 事件，且报告了急性 CV 事件或 COPD 加重的结局，则研究符合纳入标准。对研究的相关性、偏倚和质量进行了评估。使用随机效应模型对每个感兴趣的结局进行了荟萃分析，从而提供了汇总的相对风险（RR）及其 95%置信区间。
结果
共确定了 8 项研究，其中 7 项用于分析与无加重相比，COPD 加重后 1-3 个月内发生 CV 事件的风险的荟萃分析。对于中风（6 项研究），RR 为 1.68（95%CI=1.19-2.38）。对于 AMI（6 项研究），RR 为 2.43（95%CI=1.40-4.20）。没有发现探索急性 CV 事件后加重风险的研究。
结论
本荟萃分析确定了 COPD 加重后相对较短的时间内发生中风或 AMI 的风险显著增加。虽然潜在的机制尚未完全阐明，但 COPD 患者应在加重后监测 CV 结局的风险。此外，预防加重可能会降低随后发生急性 CV 事件的风险。
注册
研究方案已通过 PROSPERO（国际前瞻性系统评价注册库）发布，注册号为：CRD42020211055。
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