全球慢性阻塞性肺疾病患者营养不良的患病率：系统评价和荟萃分析。
Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis.
机构信息
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
出版信息
Clin Nutr. 2023 Jun;42(6):848-858. doi: 10.1016/j.clnu.2023.04.005. Epub 2023 Apr 11.
BACKGROUND
Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk.
RESULTS
Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition.
CONCLUSION
Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
背景
营养不良是慢性阻塞性肺疾病（COPD）的一种严重合并症，但它经常被忽视。迄今为止，COPD 患者的营养不良患病率及其与临床参数的关系尚未得到很好的描述。我们旨在通过系统评价和荟萃分析研究营养不良的患病率以及 COPD 患者发生营养不良风险的患病率，以及营养不良对 COPD 患者的临床影响。
方法
从 2010 年 1 月至 2021 年 12 月，我们在 PubMed、Embase、Cochrane 图书馆和 Web of Science 中搜索描述营养不良和/或营养不良风险患病率的文章。两名评审员独立进行了入选文章的筛选、数据提取和质量评估。进行荟萃分析以确定营养不良和发生营养不良风险的患病率，以及营养不良对 COPD 患者的临床影响。进行荟萃回归和亚组分析以探索异质性的来源。根据肺功能、呼吸困难程度、运动能力和死亡风险，比较有和无营养不良的个体。
结果
在确定的 4156 篇参考文献中，有 101 篇全文阅读，其中 36 项研究被纳入。本荟萃分析共纳入 5289 名患者。营养不良的患病率为 30.0%（95%CI 20.3 至 40.6），而发生营养不良风险的患病率为 50.0%（95%CI 40.8 至 59.2）。这两种患病率均与地区和测量工具有关。营养不良的患病率与 COPD 阶段（急性加重和稳定期）有关。患有营养不良的 COPD 患者的用力呼气量 1 秒%预计值较低（平均差值（MD）-7.19，95%CI -11.86 至 -2.52），改良的医学研究理事会呼吸困难评分较高（MD 0.38，95%CI 0.12 至 0.64），运动耐量较差（标准化均数差-0.29，95%CI -0.54 至 -0.05），死亡风险较高（风险比 2.24，95%CI 1.23 至 4.06）。
结论
营养不良和发生营养不良风险在 COPD 中很常见。营养不良对 COPD 的重要临床结局产生负面影响。
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