Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy.
Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy.
Radiology. 2023 Jul;308(1):e230535. doi: 10.1148/radiol.230535.
Background Radiological lung may explain the persistence of respiratory complaints in post-COVID-19 condition (long-COVID). Purpose To perform a systematic review and meta-analysis of the prevalence and type of COVID-19 residual lung abnormalities at 1-year chest CT. Materials and Methods A literature search of PubMed, Web of Science, Embase, and Medline databases was performed from January 2020 to January 2023. Full-text reports of CT lung in adults (≥18 years) with confirmed COVID-19 at 1-year follow-up were included. The prevalence of any residual lung abnormality and type (fibrotic or not) was analyzed according to the Fleischner Glossary. The meta-analysis included studies with chest CT data assessable in no less than 80% of individuals. A random-effects model was used to estimate pooled prevalence. Multiple sub-group (country, journal category, methodological quality, study setting, outcomes) and meta-regression analyses were performed to identify potential sources of heterogeneity. I statistics estimated low (25%), moderate (26-50%) and high (>50%) heterogeneity. 95% Prediction Intervals (95% PIs) were computed to describe the expected estimates range. Results Of 22 709 records, 21 studies were reviewed (20 prospective, 9 from China, and 7 in radiology journals). The meta-analysis included 14 studies with chest CT data in 1854 of 2043 individuals (M/F: 1109/934). Estimates of lung were highly heterogeneous (7.1-96.7%), with a pooled frequency of 43.5% (I=94%; 95% PI: 5.9%, 90.4%). This also applied to single non-fibrotic changes, including ground glass opacity, consolidations, nodules/masses, parenchymal bands, and reticulations. The prevalence range of fibrotic traction bronchiectasis/bronchiolectasis was 1.6-25.7% (I=93%; 95% PI: 0.0%, 98.6%;); honeycombing was unremarkable (0-1.1%; I=58%; 95% PI: 0%, 60%). Lung were unrelated to any characteristics of interest. Conclusion The prevalence of COVID-19 lung at 1-year chest CT is highly heterogeneous among studies. Heterogeneity determinants remain unknown suggesting caution in data interpretation with no convincing evidence. PROSPERO (CRD42022341258) COVID-19 pneumonia, pulmonary fibrosis, chest CT, long-COVID, systematic review, metaanalysis See also the editorial by Parraga and Svenningsen in this issue.
背景 放射影像学肺部改变可能解释了新冠病毒后(post-COVID-19)状况（长新冠(long-COVID))中持续性呼吸症状的原因。目的 对 COVID-19 患者 1 年胸部 CT 检查中残留肺部异常的患病率和类型进行系统回顾和荟萃分析。材料与方法 对 2020 年 1 月至 2023 年 1 月期间 PubMed、Web of Science、Embase 和 Medline 数据库进行文献检索。纳入了在 1 年随访时通过胸部 CT 确诊 COVID-19 的成年人（≥18 岁）的胸部 CT 报告全文。根据 Fleischner 术语表分析任何残留肺部异常的患病率和类型（纤维化或非纤维化）。对至少 80%个体可评估的胸部 CT 数据进行荟萃分析。使用随机效应模型估计汇总患病率。进行了多个亚组（国家、期刊类别、方法学质量、研究场所、结局）和荟萃回归分析，以确定潜在的异质性来源。I 统计量估计低（25%）、中（26-50%）和高（>50%）异质性。计算了 95%预测区间（95% PI）以描述预期估计范围。结果 在 22709 条记录中，回顾了 21 项研究（20 项前瞻性研究，9 项来自中国，7 项发表在放射学杂志上）。荟萃分析纳入了 14 项研究，其中包括 1854 名 2043 名个体中的胸部 CT 数据（M/F：1109/934）。肺部异常的估计存在高度异质性（7.1-96.7%），总体频率为 43.5%（I=94%；95% PI：5.9%，90.4%）。这同样适用于单个非纤维化改变，包括磨玻璃影、实变、结节/肿块、实质带和网状影。纤维化牵拉性支气管扩张/支气管扩张的患病率范围为 1.6-25.7%（I=93%；95% PI：0.0%，98.6%）；蜂巢样变无明显变化（0-1.1%；I=58%；95% PI：0%，60%）。肺部异常与任何感兴趣的特征无关。结论 1 年胸部 CT 检查中 COVID-19 肺部异常的患病率在研究之间存在高度异质性。异质性决定因素尚不清楚，提示在没有令人信服的证据的情况下，对数据解释应谨慎。PROSPERO（CRD42022341258）COVID-19 肺炎，肺纤维化，胸部 CT，长新冠，系统综述，荟萃分析 本期还刊登了 Parraga 和 Svenningsen 的社论。
