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　　谬误词：慢性抑制性肺疾病；从不抽烟者；系统综述；东谈主口特征

　　一、

　　本系统综述的先容

　　现时，慢性抑制性肺疾病(COPD)已成为环球第三大死因。在COPD的诱因中，诚然抽烟是一个谬误的环境危阴私素，但当今还是意志到，天下上约30%的COPD病例发生在从不抽烟者 (NS) 中。关系词，对于NS-COPD（从不抽烟者中的COPD）的流行病学、当然病史和临床特征尚不了了。事实上，当今险些莫得任何独特针对NS-COPD患者的斟酌。

　　现存信息来自于对大型抽烟有关COPD队伍中NS-COPD患者亚组的分析。基于这些败落的不雅察，总结觉得NS-COPD多发于年青女性，呼吸系统症状较轻，呼吸认识不异，但爱惜谈梗阻较严重，肺气肿较少，肺功能随时期的下落率较低，合并症发生率较低。从生物学角度看，NS-COPD患者痰中中性粒细胞减少，嗜酸性粒细胞增多，巨噬细胞吞并功能相当。

　　为进一步意志NS-COPD，在这里，咱们对有关文件进行了系统回来。

　　二、

　　检索战略、纳排门径和质料评估

　　在PubMed (Medline) 和Embase数据库中进行文件检索，使用了以下目田文本的不同组合；MeSH术语和布尔运算符: chronic obstructive pulmonary disease; chronic airflowobstruction; chronic airflow limitation; AND non-smokers OR never-smokers。检索时期设定在2000年1月1日至2022年12月31日。

　　纳初学径: (a) 合适条款的斟酌野心包括队伍斟酌、病例对照斟酌和横断面斟酌; (b) 斟酌东谈主群年事必须在18岁或以上，包括男性和女性，最小样本量为100名参与者，其中至少有20名患有COPD且从不抽烟; (c) 排斥未提供从不抽烟者后果分类的斟酌; (d) COPD的会诊必须基于临床症状和支气管膨胀剂后FEV1/FVC <0.70的客不雅肺活量测定说明。完成进一步筛查，剔除不合适要求的文件后最终获取17篇论文，奉行历程如图1所示。

　　遴选以下门径进行评估:样本量;NS-COPD病例数;斟酌野心; COPD的会诊，每个步地的得分从0到2，其中0为最低得分，8为总体最高得分 (如表1)。

　　图1 本斟酌纳入论文的选拔历程 (PubMed, Embase, 2000-2022)

　　表1 对所纳入步地进行的质料评定

　　COPD：慢性抑制性肺疾病；NS-COPD:从不抽烟者中的COPD；FEV1：第一秒使劲呼气容积；FVC：使劲肺活量；PBD：诈欺支气管膨胀剂后

　　三、

　　后果及分析

　　纳入的17项合适上述纳入/排斥门径的斟酌中：斟酌的质料从2分（最小值）到6分（最大值），平均值为3.4分，标明全体质料为中-低质料。从患病率、严重进度、性别、年事、症状等方面进行询查分析，不错发现不同斟酌间存在的显明异质性。

　　从症状上讲，NS-COPD患者大王人推崇为轻度至中度气流受限，对应于GOLD品级1级和2级；纳入斟酌中NS-COPD的性别有关论断异质性很强，有7项斟酌偏向于女性发病率大于男性，有5项斟酌觉得男性发病率是女性的3倍以上；8项斟酌觉得NS-COPD倾向于年事较大，中重度NS-COPD患病率跟着年事的增长而显赫加多，关系词，在其他斟酌中，未不雅察到NS-COPD和S-COPD受试者之间存在显明的年事有关互异；此外，一些斟酌一致觉得，与S-COPD组比拟，NS-COPD组呼吸谈症状(慢性咳嗽、咳痰、呼吸困难和喘气)的患病率较低，比拟之下三份斟酌诠释注解了更多的症状 (使劲时呼吸困难、慢性出产性咳嗽和喘气)、更大的膂力步履甩手、更差的疾病适度、更低的氧裕如度和更高的就诊次数。

　　四、

　　结  语

　　这是第一个分析NS-COPD会诊十分进展的临床特征的系统综述。本综述使用了独特为分内析野心的质料量表，关系词，必须承认仍然存在一些潜在的甩手，NS-COPD患者的样本量时常较小，时常来自于较大的COPD患者队伍的一部分，并莫得把柄斟酌的质料独特野心的病例对照斟酌来笃定抽烟者与不抽烟者的病因或特征，也短缺旨在不雅察COPD抽烟者与不抽烟者在其他临床后果方面是否存在互异的随访斟酌。

　　笔者团队斟酌数据清楚（中国全科医学，还是受，待发表），斟酌纳入NS-COPD患者中，女性42例，占80.8%（样本量较小，可扩大样本量后进一步斟酌），60岁以上NS-COPD患者47例，占89.4%，S-COPD与NS-COPD患者氧裕如度并莫得显赫互异（P=0.565）；国际斟酌中NS-COPD在不同性别散布斟酌后果互异较大，国际斟酌与笔者数据均清楚NS-COPD中支气管炎型COPD多于肺气肿型COPD。

　　而当今咱们对于NS-COPD的学问严重短缺，本系统综述中纳入的不同斟酌具有高度的异质性，费事需要野心精致的斟酌来访谒其临床特征和疾病当然史，而且鉴于好多发达国度抽烟率下落的趋势，这少许尤其要紧。

　　参考文件

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皇冠体育

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　　本 期 作 者

　　孟爱宏 主任大夫

　　医学博士/主任大夫/教师/博士生导师

　　河北医科大学第二病院北院区呼吸与危重症医学科主任

　　张智伟 硕士斟酌生

　　河北医科大学第二病院

　　本文仅代表作家个东谈主不雅点

　　仅供医务东谈主员参考

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