重症监护病房COVID-19相关肺曲霉病结局的系统评价和荟萃分析  

Clinical outcomes of ICU patients with COVID-19-associated pulmonary aspergillosis: a systematic review and meta-analysis

作　　者：李连红[1] 孙玥 成晨 李霞[1] 宋林霞[1] 饶友花[1] 沈会红[1] 王冬梅[1] LI Lian-hong;SUN Yue;CHENG Chen;LI Xia;SONG Lin-xia;RAO You-hua;SHEN Hui-hong;WANG Dong-mei(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)

机构地区：[1]南京医科大学第二附属医院感染管理办公室,江苏南京210011

出　　处：《中华医院感染学杂志》2022年第10期1468-1472,共5页Chinese Journal of Nosocomiology

基　　金：江苏省中医药科技发展计划基金资助项目(YB201984)。

摘　　要：目的 旨在系统描述新型冠状病毒肺炎(COVID-19)相关肺曲霉病(CAPA)结局。方法 检索从2019年12月31日-2021年12月1日ScienceDirect、PubMed、CNKI和MEDLINE (OVID),获取所有报道CAPA临床结局的研究。由2名作者按照纳入与排除标准筛选文献、提取数据及质量评价后,进行Meta分析。结果 最终纳入14项队列研究,包括2 056例COVID-19重症患者,其中338例CAPA患者,1 718例Non-CAPA患者,入住ICU患者中CAPA发生率为16.4%。相对于Non-CAPA患者,CAPA病死率增加21%[风险差异(RD)]=0.21, 95%CI:0.15~0.27,I^(2)=0%。未检测到统计学意义的异质性及出版偏倚(t=1.98,P=0.069)。基础疾病中带有慢性阻塞性肺疾病(COPD)的患者发生CAPA的风险是Non-CAPA组的2.37倍(95%CI:1.15~4.88,P=0.020),CAPA患者肌酐水平较Non-CAPA显著升高(33.32μmol/L,95%CI:6.81~59.83,P=0.014),相对于Non-CAPA患者,接受肾脏替代治疗的患者,发生CAPA的风险增加2.33倍(95%CI:1.43~3.80,P=0.001)。结论 16.4%COVID-19重症患者发生CAPA,病死率高,COPD、血肌酐、接受肾脏替代治疗显著增加CAPA发生风险,建议对重症COVID-19患者进行CAPA前瞻性筛查。OBJECTIVE To systematically describe the outcomes of patients with COVID-19-associated pulmonary aspergillosis(CAPA). METHODS All of the researches covering the clinical outcomes of CAPA were retrieved from databases such as ScienceDirect, PubMed, CNKI and MEDLINE(OVID) from Dec 31, 2019 to Dec 1, 2021. The literatures were screened out based on inclusion and exclusion criteria by 2 writers, the data were extracted, the quality of the literatures was evaluated, and meta-analysis was performed. RESULTS Totally 14 cohort studies were included in this study, with 2 056 severe COVID-19 patients involved, including 338 CAPA patients and 1 718 non-CAPA patients. The incidence rate of CAPA was 16.4% among the ICU patients. As compared with the non-CAPA patients, the mortality rate of the CAPA patients was increased by 21% [risk difference(RD)]=0.21, 95%CI:0.15~0.27,I^(2)=0%. No heterogeneity or publication bias was detected(t=1.98,P=0.069). Among the patients with underlying diseases, the patients with chronic obstructive pulmonary disease(COPD) were 2.37 times the risk of CAPA as high as the patients of the non-CAPA group(95%CI:1.15~4.88,P=0.020). The creatinine level of the CAPA patients was higher than that of the non-CAPA patients(33.32 μmol/L,95%CI:6.81~59.83,P=0.014). As compared with the non-CAPA patients, the patients who received renal replacement therapy were 2.33 times the risk of CAPA(95%CI:1.43~3.80,P=0.001). CONCLUSION 16.4% of the severe COVID-19 patients have CAPA, the mortality rate is high. COPD, serum creatinine and renal replacement therapy may remarkably increase the risk of CAPA, and it is suggested that a prospective screening of CAPA should be carried out for the severe COVID-19 patients.

关 键 词：新型冠状病毒肺炎 重症监护病房 肺曲霉病 病死率 荟萃分析 

分 类 号：R563[医药卫生—呼吸系统]