慢性阻塞性肺疾病患者中重度加重的预后危险因素：系统文献回顾。

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD exacerbations are associated with a worsening of lung function, increased disease burden, and mortality, and, therefore, preventing their occurrence is an important goal of COPD management. This review was conducted to identify the evidence base regarding risk factors and predictors of moderate-to-severe exacerbations in patients with COPD. METHODS: A literature review was performed in Embase, MEDLINE, MEDLINE In-Process, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches were conducted from January 2015 to July 2019. Eligible publications were peer-reviewed journal articles, published in English, that reported risk factors or predictors for the occurrence of moderate-to-severe exacerbations in adults age ≥ 40 years with a diagnosis of COPD. RESULTS: The literature review identified 5112 references, of which 113 publications (reporting results for 76 studies) met the eligibility criteria and were included in the review. Among the 76 studies included, 61 were observational and 15 were randomized controlled clinical trials. Exacerbation history was the strongest predictor of future exacerbations, with 34 studies reporting a significant association between history of exacerbations and risk of future moderate or severe exacerbations. Other significant risk factors identified in multiple studies included disease severity or bronchodilator reversibility (39 studies), comorbidities (34 studies), higher symptom burden (17 studies), and higher blood eosinophil count (16 studies). CONCLUSIONS: This systematic literature review identified several demographic and clinical characteristics that predict the future risk of COPD exacerbations. Prior exacerbation history was confirmed as the most important predictor of future exacerbations. These prognostic factors may help clinicians identify patients at high risk of exacerbations, which are a major driver of the global burden of COPD, including morbidity and mortality.

背景：慢性阻塞性肺疾病（COPD）是全球发病率和死亡率的主要原因。COPD 加重与肺功能恶化、疾病负担增加和死亡率增加有关，因此预防其发生是 COPD 管理的重要目标。本综述旨在确定 COPD 患者中中度至重度加重的危险因素和预测因素的证据基础。

方法：在 Embase、MEDLINE、MEDLINE In-Process 和 Cochrane 对照试验中心注册库（CENTRAL）中进行文献检索。检索时间为 2015 年 1 月至 2019 年 7 月。符合条件的出版物为同行评议的期刊文章，以英文发表，报告了年龄≥40 岁的 COPD 患者发生中度至重度加重的危险因素或预测因素。

结果：文献综述共确定了 5112 条参考文献，其中 113 篇出版物（报告了 76 项研究的结果）符合纳入标准，并纳入了本综述。在纳入的 76 项研究中，61 项为观察性研究，15 项为随机对照临床试验。加重史是未来加重的最强预测因素，34 项研究报告了加重史与未来中度或重度加重风险之间存在显著关联。在多项研究中确定的其他重要危险因素包括疾病严重程度或支气管扩张剂可逆性（39 项研究）、合并症（34 项研究）、更高的症状负担（17 项研究）和更高的血嗜酸性粒细胞计数（16 项研究）。

结论：本系统文献综述确定了几个预测 COPD 加重未来风险的人口统计学和临床特征。既往加重史被确认为未来加重的最重要预测因素。这些预后因素可能有助于临床医生识别高风险加重的患者，而加重是 COPD 全球负担的主要驱动因素，包括发病率和死亡率。