血尿酸在慢性阻塞性肺疾病患者中临床意义的Meta分析

目的系统评价血尿酸(sUA)在慢性阻塞性肺疾病(COPD)患者中的临床意义。方法计算机检索Web of Science、Pub Med、Cochrane Library、Ovid、CNKI、CBM、VIP、万方、Springer Link、Embase、Wiley Online Library等数据库,全面收集sUA与COPD的相关文献,按照Cochrane系统评价手册推荐的方法对纳入研究的文献进行评价,对符合纳入标准的病例对照研究应用RevMan 5. 3软件进行Meta分析。结果共纳入15个病例对照研究,1 983例[主要为AECOPD(含肺功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级),少部分为入组时COPD稳定期或治疗后进入稳定期]患者及782例健康人。Meta分析结果显示:(1) AECOPD组患者sUA高于健康对照组(SMD=2. 05,95%CI=1. 55~2. 55,P <0. 01);(2) AECOPD患者治疗前sUA高于治疗后(SMD=1. 03,95%CI=0. 72~1. 34,P <0. 01);(3) AECOPD治疗未好转患者治疗前后sUA比较,差异无统计学意义(MD=-11. 23,95%CI=-53. 63~31. 17,P> 0. 05);(4) AECOPD治疗好转患者治疗后sUA低于治疗前(SMD=1. 30,95%CI=0. 79~1. 80,P <0. 01);(5) AECOPD组患者sUA高于COPD稳定期组患者(SMD=2. 54,95%CI=0. 46~4. 62,P <0. 05);(6) COPD稳定期组患者sUA高于健康对照组(SMD=0. 82,95%CI=0. 39~1. 25,P <0. 01);(7)从COPDⅠ级到Ⅳ级患者,sUA水平呈逐级升高趋势,差异均有统计学意义(P <0. 01)。结论随着COPD患者病情的加重,尤其在急性加重期时,sUA水平逐渐升高,可以作为判断COPD患者病情严重程度、病情急缓以及评估治疗效果的重要指标。

Meta-analysis of the clinical significance of serum uric acid in patients with chronic obstructive pulmonary disease

Objective To systematically evaluate the clinical significance of serum uric acid( s UA) in patients with stable chronic obstructive pulmonary disease( COPD). Methods Cochrane Library,Ovid,CNKI,CBM,VIP,Wanfang,Springer Link,Embase and Wiley Online Library were searched,and the relevant literature of s UA and COPD was comprehensively collected. According to the method recommended by Cochrane system evaluation manual,the literature in the study was evaluated,and the case-controll study meeting the inclusion criteria were meta analyzed with RevMan 5. 3. Results A total of 15 case-controll study were included,including 1 983 [mainly AECOPD( including pulmonary function grades Ⅰ,Ⅱ,Ⅲ,Ⅳ),and a few of them are stable phase of COPD when entering the group or entering stable stage after treatment]patients and 782 healthy people. The Meta-analysis showed that:( 1) The s UA of AECOPD group was significantly higher than that of healthy control group( SMD = 2. 05,95% CI: 1. 55-2. 55,P < 0. 01).( 2) s UA of patients with AECOPD before treatment was significantly higher than that after treatment( SMD = 1. 03,95% CI: 0. 72-1. 34,P < 0. 01).( 3) There was no significant difference in s UA before and after treatment in patients with AECOPD( MD =-11. 23,95% CI:-53. 63-31. 17,P > 0. 05).( 4) The s UA of patients with improved AECOPD after treatment was significantly lower than that before treatment( SMD = 1. 30,95% CI: 0. 79-1. 80,P < 0. 01).( 5) s UA in AECOPD group was significantly higher than that in COPD stable period group( SMD =2. 54,95% CI: 0. 46-4. 62,P < 0. 05).( 6) s UA of COPD patients in stable stage was significantly higher than that of healthy control group( SMD = 0. 82,95% CI: 0. 39-1. 25,P < 0. 01).( 7) From the stable COPD patients with grade Ⅰ to the grade Ⅳ the level of s UA increased gradually( P < 0. 01). Conclusion With the exacerbation of COPD patients,especially in the acute exacerbation stage,the level of s UA gradually increased,which can be used as an important indicator to judge the severity of COPD patients,the urgency of the disease and evaluate the treatment effect.