Ding Nan, Qiu Weida, Chen Jinmin, Wang Kaihao, Chen Zeyue, Cai Ruli, Chen Ailan
Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
Center of Cardiovascular Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Sep 3;20:3059-3072. doi: 10.2147/COPD.S545658. eCollection 2025.
Cardiac arrhythmias are commonly seen in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but their prevalence, risk factors, and prognostic significance are still not fully understood.
To estimate the prevalence of arrhythmias in patients with AECOPD, identify related clinical factors, and assess their influence on in-hospital mortality.
A systematic search of PubMed, Embase, Web of Science, CENTRAL, and Cochrane Reviews was conducted to identify observational studies and randomized controlled trials. A random-effects meta-analysis using the DerSimonian-Laird method was performed. Subgroup and sensitivity analyses were conducted to explore heterogeneity, and publication bias was assessed using Egger's and Begg's tests.
Twenty-eight studies were included. The pooled prevalence of arrhythmias in AECOPD patients was 15% (95% CI: 12-18%), with considerable heterogeneity (I² = 99.93%). Prevalence was higher in studies from developed countries, particularly those with larger sample sizes and older populations. Advanced age (WMD = 2.79 years) and elevated C-reactive protein levels (WMD = 5.32) were associated with increased arrhythmia risk. Use of long-acting beta-agonists (LABAs) was associated with a reduced risk (OR = 0.42), although the causal mechanism remains uncertain. Arrhythmias were significantly associated with increased in-hospital mortality (RR = 3.33, 95% CI: 3.27-3.38). In a predefined subgroup analysis, atrial fibrillation (AF) was also linked to a higher risk of death (RR = 3.70, 95% CI: 2.40-5.70). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected.
Arrhythmias are common during AECOPD and are associated with increased short-term mortality, especially in patients with AF. Aging and systemic inflammation appear to be key contributors. While LABA use may have a protective association, this finding requires cautious interpretation. Standardized ECG monitoring and individualized risk stratification are warranted to improve patient outcomes.
心律失常在慢性阻塞性肺疾病急性加重期（AECOPD）患者中很常见，但其患病率、危险因素及预后意义仍未完全明确。
评估AECOPD患者心律失常的患病率，识别相关临床因素，并评估其对住院死亡率的影响。
系统检索PubMed、Embase、Web of Science、CENTRAL和Cochrane系统评价，以识别观察性研究和随机对照试验。采用DerSimonian-Laird方法进行随机效应荟萃分析。进行亚组分析和敏感性分析以探讨异质性，并使用Egger检验和Begg检验评估发表偏倚。
纳入28项研究。AECOPD患者心律失常的合并患病率为15%（95%CI：12%-18%），存在相当大的异质性（I²=99.93%）。发达国家的研究中患病率较高，尤其是样本量较大和人群年龄较大的研究。高龄（加权均数差=2.79岁）和C反应蛋白水平升高（加权均数差=5.32）与心律失常风险增加相关。使用长效β受体激动剂（LABA）与风险降低相关（比值比=0.42），但其因果机制仍不确定。心律失常与住院死亡率增加显著相关（相对危险度=3.33，95%CI：3.27-3.38）。在预定义的亚组分析中，心房颤动（AF）也与较高的死亡风险相关（相对危险度=3.70，95%CI：2.40-5.70）。敏感性分析证实了这些发现的稳健性，未检测到显著的发表偏倚。
心律失常在AECOPD期间很常见，且与短期死亡率增加相关，尤其是AF患者。衰老和全身炎症似乎是关键因素。虽然使用LABA可能有保护作用，但这一发现需要谨慎解读。有必要进行标准化心电图监测和个体化风险分层以改善患者预后。
