Ter Haar Else A M D, Slebos Dirk-Jan, Hartman Jorine E
University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
Eur Respir Rev. 2025 Apr 2;34(176). doi: 10.1183/16000617.0258-2024. Print 2025 Apr.
Lung volume reduction, either surgical or bronchoscopic, is an effective therapeutic strategy that improves pulmonary function, quality of life and exercise capacity in patients with advanced emphysema. The aim of this review was to evaluate the extrapulmonary effects of this treatment.
PubMed, Embase and Web of Science were searched until 19 August 2024. The extrapulmonary effects were classified into nine distinct domains. Studies that reported outcomes related to one of the predefined extrapulmonary domains with a follow-up duration of at least 1 month were eligible for inclusion. A descriptive summary of the effects from all studies was compiled.
A total of 85 articles were included. The majority of studies were conducted in patients who underwent lung volume reduction surgery (74%). The greatest improvements were found in respiratory muscle strength, ventilatory drive, diaphragm morphology and body mass index. While the effects were less pronounced, beneficial outcomes were also observed for body composition, inflammation, oxidative stress, anxiety, depression and bone mineral density. The overall treatment effect of lung volume reduction on cardiac function and pulmonary arterial pressure was inconclusive; however, there is no evidence to suggest any significant deterioration. For the extrapulmonary domains of cognition, sleep and peripheral muscle function, evidence is currently insufficient to determine whether lung volume reduction has any impact.
Lung volume reduction treatment has multiple beneficial extrapulmonary effects in patients with severe emphysema and lung hyperinflation. These findings support the use of lung volume reduction as a treatment for this patient population.
肺减容术，无论是外科手术还是支气管镜手术，都是一种有效的治疗策略，可改善晚期肺气肿患者的肺功能、生活质量和运动能力。本综述的目的是评估这种治疗的肺外效应。
检索截至2024年8月19日的PubMed、Embase和Web of Science。肺外效应分为九个不同领域。报告与预定义的肺外领域之一相关的结果且随访时间至少为1个月的研究符合纳入标准。对所有研究的效应进行了描述性总结。
共纳入85篇文章。大多数研究是在接受肺减容手术的患者中进行的（74%）。在呼吸肌力量、通气驱动、膈肌形态和体重指数方面发现了最大的改善。虽然效果不太明显，但在身体成分、炎症、氧化应激、焦虑、抑郁和骨密度方面也观察到了有益结果。肺减容对心功能和肺动脉压的总体治疗效果尚无定论；然而，没有证据表明有任何显著恶化。对于认知、睡眠和外周肌肉功能的肺外领域，目前证据不足，无法确定肺减容是否有任何影响。
肺减容治疗对重度肺气肿和肺过度充气患者有多种有益的肺外效应。这些发现支持将肺减容作为该患者群体的一种治疗方法。
