Prognostic significance of pulmonary hypertension in patients with cystic fibrosis: A systematic review and meta-analysis.
Prognostic significance of pulmonary hypertension in patients with cystic fibrosis: A systematic review and meta-analysis.
复制标题
囊性纤维化患者肺动脉高压的预后意义系统评价和荟萃分析
DOI：
10.1097/md.0000000000009708
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发表时间：
2018-03
期刊：
影响因子：
1.6
通讯作者：
Liu Q
中科院分区：
文献类型：
--
作者：
Li D;Wang B;Wang H;Liu Q
肺高压(PH)常见于囊性纤维化(CF)等晚期肺实质疾病，但PH在CF患者临床转归中的作用尚不清楚。本研究的目的是通过Meta分析来确定PH对CF种群存活率的影响。从电子数据库中选择关于PH与CF患者的总生存期(OS)或其他临床特征之间的关系的出版物。使用优势比(ORs)或平均差值(MDs)来评估PH与临床特征之间的关系。提取或计算具有95%可信区间(CI)的危险比(HR)，以评估PH与CF生存结局之间的关系。还进行了亚组分析。我们的荟萃分析纳入了7项研究，其中包括2141名符合纳入标准的CF患者。就临床特征而言，PH与较低的PaO2(P <； .001)、较高的PaCO2(P = .02)、较低的1秒用力呼气量百分比(P <； .001)和较低的用力肺活量百分比(P <； .001)显著相关。而PH对CF患者的OS无显著影响(HR = 为1.2 9，95%CI为0.81~2.0 6，P = 为.2 83)。此外，亚组分析也没有证据表明PH在CF患者中的预后作用(所有P值和GT；0.05)。我们的研究结果表明，PH的存在与较差的血气参数和较差的肺功能密切相关，但令人惊讶的是，对CF患者的生存没有显著的预后价值。需要进一步的大规模和前瞻性研究来证实这些发现。
Pulmonary hypertension (PH) is frequently found in advanced parenchymal lung diseases like cystic fibrosis (CF), but the role played by PH in the clinical outcome of CF patients remains unclear. The aim of this study is to determine the influence of PH on survival in the CF population by meta-analysis. Publications addressing the associations between PH and overall survival (OS) or other clinical characteristics in CF patients were selected from electronic databases. Odds ratios (ORs) or mean differences (MDs) were used to estimate the association between PH and the clinical characteristics. The hazard ratios (HRs) with 95% confidence interval (CI) were abstracted or calculated to evaluate the association between PH and CF survival outcome. Subgroup analyses were also conducted. Seven studies including 2141 CF patients who met the inclusion criteria were included in our meta-analysis. With respect to clinical features, PH was significantly associated with lower PaO2 (P < .001), higher PaCO2 (P = .02), lower forced expiratory volume in 1 second percent (P < .001) and lower forced vital capacity percent (P < .001). However, PH had no significant impact on CF patients’ OS (HR = 1.29, 95% CI 0.81 to 2.06, P = .283). Furthermore, subgroup analyses also showed no evidence of prognostic role of PH in CF patients (all P values >.05). Our findings suggest that the presence of PH was strongly correlated with worse blood-gas parameters and worse lung function, but surprisingly had no significant prognostic value on survival among CF patients. Further large-scale and prospective studies are needed to confirm these findings.