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　　要津词：慢性阻塞性肺疾病；从不抽烟者；系统综述；东说念主口特征

　　一、

　　本系统综述的先容

　　刻下，慢性阻塞性肺疾病(COPD)已成为各人第三大死因。在COPD的诱因中，固然抽烟是一个要津的环境危秘密素，但当今如成心志到，天下上约30%的COPD病例发生在从不抽烟者 (NS) 中。然则，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认知。事实上，当今险些莫得任何专诚针对NS-COPD患者的策动。

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　　现存信息来自于对大型抽烟关系COPD队伍中NS-COPD患者亚组的分析。基于这些零碎的不雅察，总结合计NS-COPD多发于年青女性，呼吸系统症状较轻，呼吸策画同样，但鄙吝说念梗阻较严重，肺气肿较少，肺功能随时间的下落率较低，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，巨噬细胞吞并功能终点。

　　为进一步意志NS-COPD，在这里，咱们对关系文件进行了系统回来。

　　二、

　　检索战略、纳排尺度和质地评估

　　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。检索时间设定在2000年1月1日至2022年12月31日。

　　纳入尺度: (a) 安妥条目的策动瞎想包括队伍策动、病例对照策动和横断面策动; (b) 策动东说念主群年事必须在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) 放置未提供从不抽烟者效果分类的策动; (d) COPD的会诊必须基于临床症状和支气管推广剂后FEV1/FVC <0.70的客不雅肺活量测定确认。完成进一步筛查，剔除不安妥要求的文件后最终取得17篇论文，奉行经由如图1所示。

　　选定以下尺度进行评估:样本量;NS-COPD病例数;策动瞎想; COPD的会诊，每个技俩的得分从0到2，其中0为最低得分，8为总体最高得分 (如表1)。

　　图1 本策动纳入论文的采用经由 (PubMed, Embase, 2000-2022)

　　表1 对所纳入技俩进行的质地评定

　　COPD：慢性阻塞性肺疾病；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：诈欺支气管推广剂后

　　三、

　　效果及分析

　　纳入的17项安妥上述纳入/放置尺度的策动中：策动的质地从2分（最小值）到6分（最大值），平均值为3.4分，标明合座质地为中-低质地。从患病率、严重进程、性别、年事、症状等方面进行策动分析，不错发现不协策动间存在的彰着异质性。

　　从症状上讲，NS-COPD患者多数推崇为轻度至中度气流受限，对应于GOLD品级1级和2级；纳入策动中NS-COPD的性别关绑缚论异质性很强，皇冠集团有7项策动偏向于女性发病率大于男性，有5项策动合计男性发病率是女性的3倍以上；8项策动合计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贵增多，然则，在其他策动中，未不雅察到NS-COPD和S-COPD受试者之间存在彰着的年事关系各异；此外，一些策动一致合计，与S-COPD组比拟，NS-COPD组呼吸说念症状(慢性咳嗽、咳痰、呼吸清苦和喘气)的患病率较低，比拟之下三份策动论说了更多的症状 (使劲时呼吸清苦、慢性分娩性咳嗽和喘气)、更大的膂力活动死心、更差的疾病戒指、更低的氧足够度和更高的就诊次数。

　　四、

　　结  语

　　这是第一个分析NS-COPD会诊过头进展的临床特征的系统综述。本综述使用了专诚为分内析瞎想的质地量表，然则，必须承认仍然存在一些潜在的死心，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，并莫得笔据策动的质地专诚瞎想的病例对照策动来详情抽烟者与不抽烟者的病因或特征，也短少旨在不雅察COPD抽烟者与不抽烟者在其他临床效果方面是否存在各异的随访策动。

zh皇冠比分

　　笔者团队策动数据透露（中国全科医学，已罗致，待发表），策动纳入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策动），60岁以上NS-COPD患者47例，占89.4%，S-COPD与NS-COPD患者氧足够度并莫得显贵各异（P=0.565）；外洋策动中NS-COPD在不同性别散布策动效果各异较大，外洋策动与笔者数据均透露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的学问严重短少，本系统综述中纳入的不协策动具有高度的异质性，蹙迫需要瞎想精采的策动来打听其临床特征和疾病当然史，况且鉴于好多发达国度抽烟率下落的趋势，这少许尤其雄伟。

　　参考文件

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充值

　　44. World Health Organization. Regional Office for Europe. (2019). European tobacco use: trends report 2019. World Health Organization. Regional Office for Europe. https://apps.who.int//iris/handle/10665/346817

　　本 期 作 者

　　孟爱宏 主任大夫

　　医学博士/主任大夫/进修/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 硕士策动生

　　河北医科大学第二病院

　　本文仅代表作家个东说念主不雅点

　　仅供医务东说念主员参考

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