要道词：慢性艰涩性肺疾病；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，慢性艰涩性肺疾病(COPD)已成为寰球第三大死因。在COPD的诱因中，天然抽烟是一个要道的环境危急身分，但现在依然意识到，宇宙上约30%的COPD病例发生在从不抽烟者 (NS) 中。但是，对于NS-COPD（从不抽烟者中的COPD）的流行病学、天然病史和临床特征尚不透露。事实上，现在确凿莫得任何稀奇针对NS-COPD患者的筹商。

　　现存信息来自于对大型抽烟筹商COPD队伍中NS-COPD患者亚组的分析。基于这些衰退的不雅察，总结觉得NS-COPD多发于年青女性，呼吸系统症状较轻，呼吸主义相同，但吝惜说念梗阻较严重，肺气肿较少，肺功能随技术的下跌率较低，吞并症发生率较低。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，巨噬细胞吞吃功能相等。

　　为进一步意识NS-COPD，在这里，咱们对筹商文件进行了系统回来。

　　二、

　　检索计谋、纳排圭臬和质地评估

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

　　纳入圭臬: (a) 顺应条款的筹商打算包括队伍筹商、病例对照筹商和横断面筹商; (b) 筹商东说念主群年齿必须在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) 摒除未提供从不抽烟者效果分类的筹商; (d) COPD的会诊必须基于临床症状和支气管延迟剂后FEV1/FVC <0.70的客不雅肺活量测定说明。完成进一步筛查，剔除不顺应要求的文件后最终获取17篇论文，履行经由如图1所示。

　　接纳以下圭臬进行评估:样本量;NS-COPD病例数;筹商打算; 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 本筹商纳入论文的礼聘经由 (PubMed, Embase, 2000-2022)

　　表1 对所纳入步地进行的质地评定

　　COPD：慢性艰涩性肺疾病；NS-COPD:从不抽烟者中的COPD；FEV1：第一秒用劲呼气容积；FVC：用劲肺活量；PBD：愚弄支气管延迟剂后

　　三、

　　效果及分析

　　纳入的17项顺应上述纳入/摒除圭臬的筹商中：筹商的质地从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、严重进度、性别、年齿、症状等方面进行筹商分析，不错发现不同筹商间存在的彰着异质性。

　　从症状上讲，NS-COPD患者大都进展为轻度至中度气流受限，对应于GOLD品级1级和2级；纳入筹商中NS-COPD的性别筹商论断异质性很强，有7项筹商偏向于女性发病率大于男性，有5项筹商觉得男性发病率是女性的3倍以上；8项筹商觉得NS-COPD倾向于年齿较大，中重度NS-COPD患病率跟着年齿的增长而显耀加多，但是，在其他筹商中，未不雅察到NS-COPD和S-COPD受试者之间存在彰着的年齿筹商互异；此外，一些筹商一致觉得，与S-COPD组比较，NS-COPD组呼吸说念症状(慢性咳嗽、咳痰、呼吸勤苦和喘气)的患病率较低，比较之下三份筹商论说了更多的症状 (用劲时呼吸勤苦、慢性分娩性咳嗽和喘气)、更大的膂力当作截止、更差的疾病适度、更低的氧满盈度和更高的就诊次数。

　　四、

　　结  语

　　这是第一个分析NS-COPD会诊过甚进展的临床特征的系统综述。本综述使用了稀奇为天职析打算的质地量表，但是，必须承认仍然存在一些潜在的截止，NS-COPD患者的样本量频繁较小，频繁来自于较大的COPD患者队伍的一部分，并莫得凭证筹商的质地稀奇打算的病例对照筹商来细目抽烟者与不抽烟者的病因或特征，也枯竭旨在不雅察COPD抽烟者与不抽烟者在其他临床效果方面是否存在互异的随访筹商。

北京时间10月1日凌晨，2023-24赛季西甲联赛第8轮，皇马客场3-0战胜赫罗纳，比赛第90+3分钟，纳乔铲伤对方球员波图被红牌罚下。据记者Alberto Pereiro的报道，安切洛蒂和纳乔两人均已打电话给波图向他道歉。

　　笔者团队筹商数据解析（中国全科医学，已吸收，待发表），筹商纳入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筹商），60岁以上NS-COPD患者47例，占89.4%，S-COPD与NS-COPD患者氧满盈度并莫得显耀互异（P=0.565）；海外筹商中NS-COPD在不同性别散播筹商效果互异较大，海外筹商与笔者数据均解析NS-COPD中支气管炎型COPD多于肺气肿型COPD。

　　而现在咱们对于NS-COPD的常识严重枯竭，本系统综述中纳入的不同筹商具有高度的异质性，蹙迫需要打算精采的筹商来走访其临床特征和疾病天然史，而况鉴于好多发达国度抽烟率下跌的趋势，这极少尤其渊博。

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　　本 期 作 者

　　孟爱宏 主任医生

　　医学博士/主任医生/解说/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 硕士筹商生

　　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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