慢性阻塞性肺疾病急性加重风险预测模型的系统评价  

Risk prediction model for acute exacerbation of chronic obstructive pulmonary disease:a systematic review

作　　者：张紫薇 詹立睿 李文[1,2,3] 杨婧 张彩虹 ZHANG Ziwei;ZHAN Lirui;LI Wen;YANG Jing;ZHANG Caihong(Hainan Medical College,Haikou,Hainan 570100,P.R.China;Department of Respiratory Medicine,The First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570102,P.R.China;Nursing Homes in Hainan Province,Haikou,Hainan 570100,P.R.China)

机构地区：[1]海南医学院,海南海口570100 [2]海南医学院第一附属医院呼吸内科,海南海口570102 [3]海南省托老院,海南海口570100

出　　处：《中国呼吸与危重监护杂志》2022年第9期622-628,共7页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的系统评价慢性阻塞性肺疾病(简称慢阻肺)患者急性加重风险预测模型,以期为临床早期识别提供参考依据。方法检索中国知网、万方、维普、PubMed、The Cochrane Library、Embase、Web of Science等数据库系统,搜集关于建立慢阻肺急性加重风险预测模型的相关研究。检索时限为建库至2022-04-01,由2名研究者独立筛选文献和提取数据,对纳入研究的人群特征、研究类型、预测因素、模型构建方法及模型预测结果等进行分析和比较,采用PROBAST工具对纳入文献进行质量评价。结果纳入5项前瞻性研究、1项回顾性病例对照研究与7项回顾性队列研究,共计13篇文献,包含24个模型。其中12项研究(92.3%)报告了受试者操作特征曲线下面积,浮动区间在0.66~0.969。仅5个研究报告了校准后的统计数据,3项研究进行了内外部验证。13项研究的总体适用性较好,但存在较高的偏倚风险,主要表现在分析领域。结论纳入的24个模型间性能差异较大,预测因子的纳入方法不够全面,需要更好的方式来开发和验证高质量的预测模型。未来研究应完善研究设计和研究报告,对现有模型进行更新和验证;其次,医务人员应当基于预测的风险分级结果,制定并实施慢阻肺急性加重的风险分层预防策略,以降低慢阻肺患者急性加重频率,促进医疗资源的合理配置。Objective To systematically evaluate risk prediction models for acute exacerbation of chronic obstructive pulmonary disease(COPD),and provide a reference for early clinical identification.Methods The literature on the risk prediction models of acute exacerbation of COPD published by CNKI,VIP,Cochrane,Embase and Web of Science database was searched in Chinese and English from inception to April 2022,and relevant studies were collected on the development of risk prediction models for acute exacerbations of COPD.After independent screening of the literature and extraction of information by two independent researchers,the quality of the included literature was evaluated using the PROBASTA tool.Results Five prospective studies,one retrospective case-control study and seven retrospective cohort studies were included,totally 13 papers containing 24 models.Twelve studies(92.3%)reported the area under the receiver operator characteristic curve ranging 0.66 to 0.969.Only five studies reported calibrated statistics,and three studies were internally and externally validated.The overall applicability of 13 studies was good,but there was a high risk of bias,mainly in the area of analysis.Conclusions The existing predictive risk models for acute exacerbations of COPD are unsatisfactory,with wide variation in model performance,inappropriate and incomplete inclusion of predictors,and a need for better ways to develop and validate high-quality predictive models.Future research should refine the study design and study report,and continue to update and validate existing models.Secondly medical staff should develop and implement risk stratification strategies for acute exacerbations of COPD based on predicted risk classification results in order to reduce the frequency of acute exacerbations and to facilitate the rational allocation of medical resources.

关 键 词：慢性阻塞性肺疾病 急性加重 风险预测 模型 

分 类 号：R563.9[医药卫生—呼吸系统]