慢性阻塞性肺病不同治疗措施疾病负担的系统评价与网状Meta分析  

Disease burden of different treatment measures for chronic obstructive pulmonary disease:a systematic review and network meta-analysis

作　　者：王汉彬 吴亚楠 黄家艺 崔璐 梁翠 胡晓晔 李秀霞 张瑜[5,6] WANG Hanbin;WU Yanan;HUANG Jiayi;CUI Lu;LIANG Cui;HU Xiaoye;LI Xiuxia;ZHANG Yu(Health Technology Assessment Center/Evidence Based Social Science Research Center,School of Public Health,Lanzhou University,Lanzhou 730000,P.R.China;Evidence Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,P.R.China;Key Laboratory of Evidence Based Medicine of Gansu Province,Lanzhou University,Lanzhou 730000,P.R.China;Research Center for Medical Device Regalotory Science,Lanzhou University,Lanzhou 730000,P.R.China;Gansu Health Vocational College,Lanzhou 730000,P.R.China;Health Vocational Education Transformation Base of Evidence Based Medicine Center,Lanzhou University,Lanzhou 730000,P.R.China)

机构地区：[1]兰州大学卫生技术评估中心/循证社会科学研究中心,兰州大学公共卫生学院,兰州730000 [2]兰州大学循证医学中心,兰州大学基础医学院,兰州730000 [3]甘肃省循证医学重点实验室,兰州730000 [4]兰州大学医疗器械临管研究中心,兰州730000 [5]甘肃卫生职业学院,兰州730000 [6]兰州大学循证医学中心卫生职业教育转化基地,兰州730000

出　　处：《中国循证医学杂志》2025年第1期64-73,共10页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价不同干预措施对慢性阻塞性肺病(以下简称“慢阻肺”)的疾病负担情况。方法计算机检索CNKI、VIP、WanFang Data、PubMed、Web of Science和Cochrane Library等数据库,搜集慢阻肺疾病负担相关的随机对照试验(RCT),检索时限均从建库至2023年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16软件和R语言进行网状Meta分析。结果最终纳入69个RCT,包括6689例患者,涉及常规治疗、无创正压通气治疗、有创通气治疗、营养支持方案等26项干预措施,偏倚风险评估均为“风险未知”。网状Meta分析结果显示,和有创通气治疗相比,无创正压通气治疗[SMD=−3.84,95%CI(−5.16,−2.52)]和二陈止咳清肺颗粒[SMD=−3.04,95%CI(−5.89,−0.20)]能够降低慢阻肺患者的住院经济费用,差异有统计学意义(P<0.05)。健脾益肺冲剂、咪达唑仑、目标氧疗、无创正压通气治疗和营养支持方案对降低慢阻肺患者死亡率的效果优于常规治疗[RR=4.50,95%CI(1.02,19.79);RR=4.81,95%CI(1.25,18.52);RR=6.92,95%CI(3.34,14.32);RR=3.56,95%CI(1.14,11.08);RR=2.70,95%CI(1.86,3.92);RR=3.60,95%CI(2.01,6.45)],差异有统计学意义(P<0.05)。最佳概率排序显示,氧疗处方成为降低慢阻肺患者死亡率最佳措施的概率(75.2%)最高,无创正压通气治疗成为降低慢阻肺患者住院经济费用最佳措施的概率(87.4%)最高。结论氧疗处方可能是降低慢阻肺患者死亡率的最佳措施,无创正压通气治疗可能是降低慢阻肺患者住院经济费用的最佳措施。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。Objective To assess the impact of different interventions on the disease burden of chronic obstructive pulmonary disease(COPD).Methods The CNKI,VIP,WanFang Data,PubMed,Web of Science,Cochrane Library were electronically searched to collect randomized controlled trials(RCTs)on the disease burden of COPD from inception to October,2023.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of the included studies;then,network meta-analysis was performed by using Stata 16 software and R programming language.Results A total of 69 RCTs involving 26 interventions were included.The results of the network meta-analysis showed that compared with invasive ventilation therapy,non-invasive positive pressure ventilation treatment(SMD=−3.84,95%CI−5.16 to−2.52)and Erchenzhikeqingfei granules(SMD=−3.04,95%CI−5.89 to−0.20)were reducing the hospitalization cost of COPD patients(P<0.05).The effects of Jianpi Yifei granules,midazolam,targeted oxygen therapy,non-invasive positive pressure ventilation,and nutritional support protocol on reducing mortality in patients with COPD were superior to conventional treatments(RR=4.50,95%CI 1.02 to 19.79;RR=4.81,95%CI 1.25 to 18.52;RR=6.92,95%CI 3.34 to 14.32;RR=3.56,95%CI 1.14 to 11.08;RR=2.70,95%CI 1.86 to 3.92;RR=3.60,95%CI 2.01 to 6.45).Surface under the cumulative ranking(SUCRA)showed that oxygen therapy prescription had the highest probability of becoming the best measure(75.2%)to reduce mortality in patients with chronic obstructive pulmonary disease,the non-invasive positive pressure ventilation treatment was the most effective intervention(87.4%)to reduce the hospitalization cost of COPD patients.Conclusion Oxygen therapy prescription might be the best measure to reduce mortality and the noninvasive positive pressure ventilation treatment might be the best measure to reduce the hospitalization cost of COPD patients.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify the above

关 键 词：慢性阻塞性肺疾病 疾病负担 系统评价 网状Meta分析 

分 类 号：R563.9[医药卫生—呼吸系统]