Respiratory medicine最新文献_第4页

One-year lung function change and variability post allogeneic hematopoietic stem cell transplantation 同种异体造血干细胞移植后一年肺功能的变化和变异性

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-24 DOI: 10.1016/j.rmed.2026.108670

Kaj E.C. Blokland , Troy J. Cross , Fei Ni Hau , David Touma , David G. Chapman , G Kim Prisk , Sandra Rutting , Mark Barrios , Matthew Greenwood , Gregory G. King

Background and objective

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a well-established treatment for various haematologic and oncologic disorders, yet its clinical success is frequently compromised by complications such as pulmonary graft-versus-host disease (GvHD). Spirometry is the gold standard for monitoring and diagnosis, but it is insensitive to small airway changes. Oscillometry may complement spirometry as a way of detecting change in small airway function. This study assessed the longitudinal change and variability in spirometry and oscillometry following allo-HSCT and predictors of this change.

Methods

Longitudinal spirometry and oscillometry were retrospectively obtained from all patients (n = 374) who underwent allo-HSCT at Royal North Shore Hospital in Sydney, Australia, between January 2015 and December 2023.

Results

Baseline post allo-HSCT assessments showed significantly lower FEV₁ and FVC in the allo-HSCT group compared to controls. Over the follow-up period, oscillometric indices displayed significant worsening of Rrs₅ and Xrs₅, whereas FEV₁ did not significantly change. Severe cGvHD was associated with a modest decline in FEV₁/FVC and Xrs₅ trajectory. Notably, a subset of patients demonstrated discordant changes between spirometry and oscillometry, suggesting that oscillometry may capture early small airway dysfunction not evident on traditional spirometric measures.

Conclusion

These findings underscore the potential of oscillometry as a complementary tool in the routine monitoring of lung function post-allo-HSCT. By detecting subtle changes in small airway mechanics, oscillometry could facilitate earlier identification and intervention in patients at risk for developing pulmonary cGvHD, thereby improving long-term clinical outcomes.

背景和目的同种异体造血干细胞移植（allogeneic hematopoietic stem cell transplantation, alloo - hsct）是治疗多种血液学和肿瘤学疾病的一种行之有效的方法，但其临床成功常常受到诸如肺移植物抗宿主病（GvHD）等并发症的影响。肺活量测定法是监测和诊断的金标准，但它对微小的气道变化不敏感。振荡测量法可以作为肺活量测定法的补充，作为检测小气道功能变化的一种方法。本研究评估了同种异体造血干细胞移植后肺活量测定和振荡测量的纵向变化和可变性，以及这种变化的预测因素。方法回顾性分析2015年1月至2023年12月在澳大利亚悉尼皇家北岸医院接受同种异体造血干细胞移植的所有患者（n = 374）的纵向肺活量测定和振荡测量。结果：同种异体造血干细胞移植后基线评估显示，与对照组相比，同种异体造血干细胞移植组FEV1和FVC显著降低。在随访期间，振荡指标显示Rrs5和Xrs5显著恶化，而FEV1无显著变化。严重cGvHD与FEV1/FVC和Xrs5轨迹的适度下降相关。值得注意的是，一部分患者表现出肺活量测定法和振荡测量法之间的不一致变化，这表明振荡测量法可能捕捉到传统肺活量测量法不明显的早期小气道功能障碍。结论：这些发现强调了振荡测量法作为常规监测同种异体造血干细胞移植后肺功能的补充工具的潜力。通过检测小气道力学的细微变化，振荡测量法可以帮助早期识别和干预有发生肺部cGvHD风险的患者，从而改善长期临床结果。

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引用次数: 0

Effect of high-intensity interval training versus moderate intensity continuous training in heart failure patients on cardiorespiratory fitness and quality of life: a systematic review and meta-analysis 心力衰竭患者高强度间歇训练与中等强度连续训练对心肺功能和生活质量的影响：系统回顾和荟萃分析

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.rmed.2026.108662

Lino Sergio Rocha Conceição , Mansueto Gomes-Neto , Camila Souza Gama Rocha , Acauã Oliveira Coelho , Vitor Oliveira Carvalho

Introduction

Heart failure is a major global health problem. High-intensity interval training (HIIT) is a form of aerobic exercise that involves repeated bouts of high-intensity effort interspersed with recovery periods. Previous meta-analyses have shown that HIIT has superior effects compared to moderate intensity continuous training (MICT) in terms of VO2peak improvements; however, discussions now focus on how exercise protocols may contribute to this superiority. Therefore, the aim of this study perform a systematic review of the eeffects of HIIT versus MICT on cardiorrespiratory fitness and health related quality of life (HRQoL) in individuals with heart failure.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a comprehensive search in the following databases: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials and PEDro up to April 2025.

Results

18 studies were included in this systematic review. HIIT improved VO2 peak by 1.49 mL/kg/min (95 % confidence interval [CI]: 0.74 to 2.24; I² = 61.2 %; N = 682) compared to the MICT group. However, our subanalysis of isocaloric exercise protocols according to the left ventricular ejection fraction (LVEF) showed no statistical significance between HIIT and MICT exercise training groups. No statistical difference was observed between HIIT and MICT for HRQoL.

Conclusion

This systematic review demonstrates that HIIT is superior to MICT in an overall context of HFrEF and HFpEF collectively. However, when comparing HIIT and MICT under isocaloric conditions, and considering LVEF, the superiority of HIIT over MICT in improving VO₂peak disappears.

心力衰竭是一个主要的全球性健康问题。高强度间歇训练（HIIT）是一种有氧运动的形式，它包括重复的高强度训练，穿插在恢复期。先前的荟萃分析表明，与中等强度连续训练（MICT）相比，HIIT在改善vo2峰值方面具有优越的效果；然而，现在的讨论集中在运动方案如何有助于这种优势。因此，本研究的目的是对HIIT与MICT对心力衰竭患者心肺健康和健康相关生活质量（HRQoL）的影响进行系统回顾。方法：我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。我们在以下数据库中进行了全面的检索：PubMed、EMBASE、Web of Science、Cochrane Central Register of Controlled Trials和PEDro，检索时间截止到2025年4月。结果：本系统综述纳入了18项研究。与MICT组相比，HIIT组的VO2峰值提高了1.49 mL/kg/min（95%可信区间[CI]: 0.74 ~ 2.24; I2 = 61.2%; N = 682）。然而，我们根据左心室射血分数（LVEF）对等热量运动方案进行的亚分析显示，HIIT和MICT运动训练组之间没有统计学意义。HIIT与MICT在HRQoL方面无统计学差异。结论：本系统综述表明，在HFrEF和HFpEF的整体背景下，HIIT优于MICT。然而，当在等热量条件下比较HIIT和MICT并考虑LVEF时，HIIT比MICT在提高VO2peak方面的优势消失了。

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引用次数: 0

Artificial intelligence and sleep medicine. 人工智能和睡眠医学。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.rmed.2026.108652

Ioanna Kouri, Sofia Konstantinopoulou

Artificial intelligence (AI) has become a significant part of everyday life. This is evident in features such as personalized product recommendations that rely on user data and the widespread use of virtual assistants. Over the past decade, AI has been implemented in the practice of medicine. This progress has been driven by the large amount of health data available, enhanced computational algorithms, and improved storage capabilities that support AI applications.

人工智能（AI）已经成为日常生活的重要组成部分。这在依赖用户数据的个性化产品推荐和虚拟助手的广泛使用等功能中表现得很明显。在过去的十年里，人工智能在医学实践中得到了应用。这一进展是由大量可用的健康数据、增强的计算算法和支持人工智能应用的改进的存储能力所推动的。

引用次数: 0

Biomarkers in trauma-induced acute lung injury: Diagnostic, prognostic, and therapeutic insights. A systematic review 创伤性急性肺损伤的生物标志物：诊断、预后和治疗见解。系统回顾

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.rmed.2026.108663

Katyayani Mishra , Manjaree Mishra , Prasoon Madhukar , Shashi Prakash Mishra

Background

Trauma-induced acute lung injury (TALI) is a hazardous illness that requires accurate diagnosis and prompt treatment due to its high rates of morbidity and fatality. Although the biomarkers are a promising tool to support therapeutic decision-making in TALI, little is known about their effectiveness and functionality. This systematic review aims to study and synthesize the available data on these regulators used in the assessment of trauma-induced ALI.

Method

To find relevant papers for this review, a thorough literature search was carried out across a number of databases, including PubMed, Scopus, and the Cochrane Library. The recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) were adhered to. This review exclusively included experimental animal studies; therefore, all biomarker interpretations pertain to findings from animal models.

Result

Including all available databases, the literature search yielded 3353 potentially relevant papers from PubMed (n = 3173), Scopus (n = 111), Cochrane library (n = 69). Following the exclusion of papers that did not meet the criteria, a shortlist of 16 studies was selected for the systematic review's purview.

Conclusion

The review determines how biomarker information influences the care of TALI patients in clinical practices. This study provides significant data on the utilization of biomarkers for improving the identification of TALI, assessing disease mechanisms, and understanding factors associated with severity and outcomes. These findings contribute to the broader knowledge that may support future translational efforts aimed at improving diagnostic and prognostic approaches for this fatal condition.

背景创伤性急性肺损伤（TALI）是一种危险的疾病，由于其高发病率和死亡率，需要准确诊断和及时治疗。尽管生物标志物是支持TALI治疗决策的有希望的工具，但对其有效性和功能知之甚少。本系统综述旨在研究和综合这些用于评估创伤性ALI的调节因子的现有数据。方法在PubMed、Scopus和Cochrane Library等数据库中进行全面的文献检索，寻找与本综述相关的论文。遵循系统评价和荟萃分析（PRISMA）首选报告项目的建议。本综述仅包括实验动物研究；因此，所有生物标志物的解释都与动物模型的发现有关。结果包括所有可用的数据库，检索到PubMed （n = 3173）、Scopus （n = 111）、Cochrane library （n = 69）中可能相关的论文3353篇。在排除了不符合标准的论文后，系统评价的范围选择了16项研究的入围名单。结论本综述确定了生物标志物信息在临床实践中如何影响TALI患者的护理。该研究为利用生物标志物提高TALI的识别、评估疾病机制以及了解与严重程度和结局相关的因素提供了重要数据。这些发现有助于提供更广泛的知识，可能支持未来旨在改善这种致命疾病的诊断和预后方法的转化工作。

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引用次数: 0

Image-guided shape-sensing robotic-assisted bronchoscopy for subaortic and paraaortic mediastinal lesion sampling 图像引导的形状传感机器人辅助支气管镜在主动脉下和主动脉旁纵隔病变取样中的应用

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.rmed.2026.108669

Vanessa E. Josef , David M. Wisa , Brie E. Kezlarian-Sachs , Bryan C. Husta , Robert P. Lee , Rami Naaman , Catherine L. Oberg , Matthew J. Bott , Rastko Rakočević , Mohit Chawla , Or Kalchiem-Dekel

Background

Mediastinal sampling of the subaortic - station 5 - and paraaortic - station 6 - lymph nodes and mediastinal lesions traditionally requires surgical access. Image-guided shape-sensing robotic-assisted bronchoscopy (ssRAB) extends endoscopic reach and may offer an alternative sampling approach. We evaluated the feasibility, diagnostic yield, and safety of ssRAB-guided sampling of these anatomically challenging lesions.

Methods

All ssRAB procedures performed from October 2019 to September 2025 were reviewed retrospectively. Procedures in which a subaortic or paraaortic mediastinal lesion was targeted were included in the final analysis. Abstracted variables included patient data, pre-operative imaging, procedural details, peri-operative complications, and sampling results. The primary endpoint was conservative diagnostic yield, defined as the rate of procedures establishing a specific diagnosis.

Results

A total of 16 procedures targeting a subaortic or paraaortic mediastinal lesion were identified for the final analysis. The conservative diagnostic yield rate was 69 %. After elimination in one case in which sampling was planned but not pursued, the lenient diagnostic yield rate was 73 %. The conservative diagnostic yield rate was 75 % and 62 % for the subaortic and paraaortic samplings, respectively. One instance of grade 1 pneumothorax was documented. No additional complications were observed.

Conclusion

This single-center retrospective case series demonstrated that image-guided ssRAB may represent a feasible, safe, and minimally invasive approach for sampling subaortic and paraaortic mediastinal lymph nodes and lesions, potentially obviating the need for surgical procedures.

背景：传统上，对5号主动脉下站和6号主动脉旁站的淋巴结和纵隔病变进行纵隔取样需要手术。图像引导的形状感应机器人辅助支气管镜检查（ssRAB）扩展了内窥镜检查的范围，并可能提供另一种采样方法。我们评估了ssrab引导下对这些解剖学上具有挑战性的病变取样的可行性、诊断率和安全性。方法回顾性分析2019年10月至2025年9月所有ssRAB手术。以主动脉下或主动脉旁纵隔病变为目标的手术纳入最终分析。抽象变量包括患者资料、术前影像、手术细节、围手术期并发症和采样结果。主要终点是保守诊断率，定义为确定特定诊断的手术率。结果共有16例手术针对主动脉下或主动脉旁纵隔病变进行最终分析。保守诊断率为69%。在一个计划抽样但没有进行的病例中，排除后，宽松诊断率为73%。主动脉下和主动脉旁取样的保守诊断率分别为75%和62%。1例1级气胸被记录。无其他并发症。结论：该单中心回顾性病例系列表明，图像引导下的ssRAB可能是主动脉下和主动脉旁纵隔淋巴结和病变取样的一种可行、安全、微创的方法，可能避免手术治疗的需要。

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引用次数: 0

Ultra-short term Heart Rate Variability in moderate and severe Obstructive Sleep Apnea 中度和重度阻塞性睡眠呼吸暂停的超短期心率变异性。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.rmed.2026.108654

Karthik Nagaraju , Kavitha Venkatnarayan , Rahul Venugopal , Ravindra P. Nagendra , Chitra Veluthat , Priya Ramachandran , Uma Devaraj , Uma Maheswari Krishnaswamy

Introduction

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia and recurrent arousals, leading to sympathetic overactivity and adverse cardiometabolic consequences. Heart rate variability (HRV), which reflects beat-to-beat fluctuations in heart rate, serves as a non-invasive marker of cardiac autonomic regulation. Although reduced long-term HRV has been described in OSA, literature on short- and ultra-short-term HRV (uST-HRV) is sparse.

Methodology

In this cross-sectional study, adults with moderate and severe OSA were included. Stable, artifact-free 30-s electrocardiographic segments were extracted using a dedicated algorithm during rapid eye movement (REM) and non-REM (NREM) sleep, as well as during respiratory events (apneas and hypopneas). These segments were assessed for ultra-short term HRV comprising time domain and nonlinear indices.

Results

A total of 88 patients (44 moderate and 44 severe OSA) were studied. The mean (SD) age was 49.7 (14) years, with a male predominance (64.7 %). Mean (SD) AHI was 16.8 (4.3) in moderate and 61.5 (23.1) in severe OSA respectively. HRV indices were significantly lower in female participants and among diabetics and hypertensives compared to their non-diabetic and non-hypertensive counterparts. Time-domain and non-linear HRV indices were also lower in severe OSA, NREM sleep and during hypopneic events compared to moderate OSA, REM sleep and apneic events respectively.

Conclusions

Ultra-short-term HRV varies with OSA severity, sleep stage, and type of respiratory event, with reduced HRV observed in severe OSA, NREM sleep, and during hypopneic events. The exclusion of mild OSA and the focus on 30-s respiratory events limit the generalisability of these findings.

梗阻性睡眠呼吸暂停（OSA）以间歇性缺氧和反复觉醒为特征，导致交感神经过度活跃和不良的心脏代谢后果。心率变异性（HRV），反映心率的搏动波动，是心脏自主调节的非侵入性标志。虽然长期HRV降低在OSA中有报道，但关于短期和超短期HRV （uST-HRV）的文献很少。方法：在这项横断面研究中，纳入了中度和重度OSA的成年人。在快速眼动（REM）和非快速眼动（NREM）睡眠期间以及呼吸事件（呼吸暂停和呼吸不足）期间，使用专用算法提取稳定，无伪影的30秒心电图片段。对这些部分进行超短期HRV评估，包括时域和非线性指标。结果：共纳入88例OSA患者，其中中度OSA 44例，重度OSA 44例。平均（SD）年龄为49.7（14）岁，男性居多（64.7%）。中度OSA患者的平均AHI为16.8(4.3)，重度OSA患者的平均AHI为61.5（23.1）。与非糖尿病和非高血压患者相比，女性参与者、糖尿病患者和高血压患者的HRV指数明显较低。重度OSA、非快速眼动睡眠和低睡眠事件期间的时域和非线性HRV指数也分别低于中度OSA、快速眼动睡眠和呼吸暂停事件。结论：超短期HRV随OSA严重程度、睡眠阶段和呼吸事件类型而变化，在严重OSA、非快速眼动睡眠和低氧事件期间观察到HRV降低。排除轻度OSA和关注30秒呼吸事件限制了这些发现的普遍性。

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引用次数: 0

Safety and efficacy of performing medical thoracoscopy on a “dry space” using an optical trocar 使用光学套管针在“干燥空间”进行医用胸腔镜检查的安全性和有效性。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.rmed.2026.108667

Kimia G. Ganjaei , Diana Mihalache , Sung H. Choi , Abhinav Agrawal , Udit Chaddha

Introduction

Medical thoracoscopy (MT) to obtain pleural biopsies ideally requires a pleural effusion to safely access the pleural space. In the absence of an effusion (“dry space”), accessing the pleural space is more challenging, with variably reported success.

Methods

A retrospective review was performed of all MTs at a single center in New York City from January 2023 to November 2025. Documented dry spaces were selected for analysis. An optical trocar was used for direct visualization of the parietal pleura in addition to obtaining tactile feedback, to induce an ex-vacuo pneumothorax and access the pleural space. We also performed a literature review of MT performed on patients with absent or minimal pleural effusion.

Results

A total of 226 MTs were performed, of which 54 were dry spaces. The parietal pleura was accessed and pleural biopsies were successfully performed in all cases. Some degree of adhesiolysis was required in 62 % of cases to optimize a thorough inspection of the space. Common diagnoses obtained included acute or chronic organizing pleuritis (59.3 %), followed by malignancy (24.1 %). The diagnostic sensitivity for malignancy was 100 %. There were no significant intra-procedural complications.

Conclusion

Dry space MT, using an optical trocar to access the pleural space, can be safely and effectively performed.

医学胸腔镜（MT）理想的胸膜活检需要胸膜积液来安全进入胸膜间隙。在没有积液（“干腔”）的情况下，进入胸膜腔更具挑战性，成功的报道各不相同。方法：对2023年1月至2025年11月在纽约市单一中心的所有MTs进行回顾性分析。选择有文件记录的干空间进行分析。除了获得触觉反馈外，还使用光学套管针直接显示胸膜壁层，以诱导出空气胸并进入胸膜间隙。我们也进行了文献回顾，在没有或很少胸腔积液的患者中进行MT。结果：共行226例MTs，其中54例为干腔。所有病例均成功进入胸膜壁层并行胸膜活检。62%的病例需要一定程度的粘连溶解，以优化对空间的彻底检查。常见的诊断包括急性或慢性组织性胸膜炎（59.3%），其次是恶性肿瘤（24.1%）。对恶性肿瘤的诊断敏感性为100%。无明显术中并发症。结论：采用光学套管针进入胸膜腔，可安全有效地完成干腔MT手术。

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引用次数: 0

Correlation between obstructive sleep apnea and pituitary function in pituitary adenomas patients 垂体腺瘤患者阻塞性睡眠呼吸暂停与垂体功能的关系

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108660

Zitong Wang , Qi Li , Junjie Zhao , Hai Yu , Jiayi Du , Tingqin Huang , Yushan Xie , Zine Cao , Chendi Lu , Xinru Lv , Simin Zhu , Yanuo Zhou , Wei Hou , Yani Feng , Haiqin Liu , Xiaoyong Ren , Yewen Shi

Purpose

The aim of this study was to analyze the correlation between pituitary function and obstructive sleep apnea (OSA) in pituitary adenomas (PA) patients, and to investigate the effect of related hormone levels on the severity of OSA.

Methods

The clinical data of 82 patients with PA aged 18–70 years admitted to the Department of Neurosurgery, Xi'an Jiaotong University Affiliated Hospital from March 2023 to February 2025 were retrospectively collected and divided into functional and non-functional PA group.

Results

Functional PA patients were younger and had a higher platelet-lymphocyte ratio (all p < 0.05). Among the PSG related parameters, Patients with functional PA showed higher apnea-hypopnea index (AHI), total sleep time spent with arterial oxygen saturation<90 % and longest apnea duration and oxygen desaturation index with >3 % desaturation (all p < 0.01). In terms of pituitary function parameters, free triiodothyronine (FT3) and insulin-like growth factor-1 (IGF-1) were significantly increased in OSA group, while the levels of cortisol, estradiol and progesterone were all lower (all p < 0.05). Correlation analysis showed that AHI was positively correlated with FT3 and IGF-1. After adjusting for confounding factors, mediation analysis based on regression revealed that FT3 and IGF-1 mediated the association between PA and OSA severity.

Conclusion

OSA was more severe in functional PA patients compared with non-functional PA patients. FT3 and IGF-1 are reliable predictors of AHI in PA patients, and may become important indicators for early clinical diagnosis of OSA in PA patients. Larger prospective studies are needed to further clarify the relationship between PA and OSA in the future.

目的分析垂体腺瘤（PA）患者垂体功能与阻塞性睡眠呼吸暂停（OSA）的相关性，并探讨相关激素水平对OSA严重程度的影响。方法回顾性收集2023年3月~ 2025年2月西安交通大学附属医院神经外科收治的82例18 ~ 70岁PA患者的临床资料，分为功能性PA组和非功能性PA组。结果功能性PA患者年龄较轻，血小板淋巴细胞比较高（p < 0.05）。在PSG相关参数中，功能性PA患者的呼吸暂停低通气指数（AHI）、动脉氧饱和度≥90%的总睡眠时间、最长的呼吸暂停持续时间和氧去饱和指数≥3% （p < 0.01）。在垂体功能参数方面，OSA组游离三碘甲状腺原氨酸（FT3）、胰岛素样生长因子-1 （IGF-1）显著升高，皮质醇、雌二醇、孕酮水平均降低（p < 0.05）。相关分析显示AHI与FT3、IGF-1呈正相关。在调整混杂因素后，基于回归的中介分析显示，FT3和IGF-1介导了PA与OSA严重程度的关联。结论功能性PA患者的osa较非功能性PA患者更为严重。FT3和IGF-1是PA患者AHI的可靠预测因子，可能成为PA患者OSA早期临床诊断的重要指标。未来需要更大规模的前瞻性研究来进一步阐明PA与OSA之间的关系。

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引用次数: 0

Risk factors of sepsis-associated encephalopathy in sepsis patients with pulmonary infection: from the secondary analysis of a cluster‐randomized controlled trial 脓毒症合并肺部感染患者脓毒症相关脑病的危险因素：来自一项聚类随机对照试验的二次分析

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108658

Lijun Meng , Jialing Liu , Panpan Wang , Ling Yin , Xingjie Ma , Xingxing Yang , Yucheng Li , Kaizheng Gong , Weili Liu

Background & aims

The risk factors for sepsis-associated encephalopathy (SAE) secondary to pulmonary infection remain unclear. This study aimed to determine the prevalence and identify the risk factors of SAE in this specific sepsis population.

Methods

In this secondary analysis of the cluster-randomized controlled trial. We screened 603 sepsis patients with pulmonary infection. Least absolute shrinkage and selection operator (LASSO) regression was used for potential variables selection. Selected variables were then included in a multivariable logistic regression model to identify the potential independent risk factors for SAE. Cox proportional hazard models were used to assess its impact on 28‐day mortality.

Results

A total of 603 sepsis patients with pulmonary infection at ICU admission, of whom 411 (68 %) had SAE, were included in this study. LASSO regression identified 19 potential variables, and the following factors remained independently associated with SAE: acute gastrointestinal injury (AGI)-II (OR = 1.86, 95 % CI: 1.18–2.98, P = 0.008), elevated serum lactate (OR = 1.25, 95 % CI: 1.10–1.44, P = 0.001), hypernatremia (OR = 1.93, 95 % CI: 1.07–3.62, P = 0.034), and BUN (OR = 1.03, 95 %CI:1.0–1.05, P = 0.025). SAE was associated with higher mortality, with an adjusted HR of 1.61 (95 % CI: 1.04–2.47, P = 0.031).

Conclusion

These findings indicate that SAE is closely associated with prognosis in sepsis induced by pulmonary infection. The primary independent risk factors identified were acute gastrointestinal injury (AGI) severity, elevated serum lactate, hypernatremia, and increased blood urea nitrogen (BUN).

背景和目的继发于肺部感染的脓毒症相关脑病（SAE）的危险因素尚不清楚。本研究旨在确定SAE在这一特定脓毒症人群中的患病率和危险因素。方法采用聚类随机对照试验进行二次分析。我们筛选了603例脓毒症合并肺部感染的患者。最小绝对收缩和选择算子（LASSO）回归用于潜在变量的选择。然后将选定的变量纳入多变量逻辑回归模型，以确定SAE的潜在独立危险因素。采用Cox比例风险模型评估其对28天死亡率的影响。结果本研究共纳入603例ICU入院脓毒症合并肺部感染患者，其中411例（68%）发生SAE。LASSO回归确定了19个潜在变量，以下因素仍然与SAE独立相关：急性胃肠道损伤(AGI)-II （OR = 1.86, 95% CI: 1.18-2.98, P = 0.008）、血清乳酸升高（OR = 1.25, 95% CI: 1.10-1.44, P = 0.001）、高钠血症（OR = 1.93, 95% CI: 1.07-3.62, P = 0.034）和BUN （OR = 1.03, 95% CI: 1.0-1.05, P = 0.025）。SAE与较高的死亡率相关，校正后的风险比为1.61 （95% CI: 1.04-2.47, P = 0.031）。结论SAE与肺部感染脓毒症的预后密切相关。确定的主要独立危险因素是急性胃肠道损伤（AGI）严重程度、血清乳酸升高、高钠血症和血尿素氮（BUN）升高。

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引用次数: 0

High-flow nasal cannula versus CPAP for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review with meta-analysis and trial sequential analysis 高流量鼻插管与CPAP预防早产儿支气管肺发育不良：荟萃分析和试验序贯分析的系统综述

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108651

Janneth Milena Avendaño-Vanegas , Henry Mauricio Parada-Gereda , Luis Alexander Peña-López , Leonardo Arzayus-Patiño

Background

Bronchopulmonary dysplasia (BPD) is common in preterm infants and is associated with invasive ventilation and prolonged oxygen therapy. Continuous positive airway pressure (CPAP) has been the standard non-invasive respiratory support for decades, but it may cause nasal trauma and poor tolerance. High-flow nasal cannula (HFNC) could improve comfort; however, its effectiveness in preventing BPD remains unconfirmed, and the available evidence is heterogeneous.

Methods

We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomised controlled trials comparing HFNC with CPAP for the prevention of BPD in preterm infants. Searches were performed in PubMed, Scopus, Cochrane Library, LILACS, and Science Direct up to June 2025, with no language restrictions. The primary outcome was the incidence of BPD; secondary outcomes included air leak and nasal injury. Methodological quality was assessed using the Cochrane RoB 2.0 tool, certainty of evidence with GRADE, and publication bias with funnel plots and Egger's and Begg's tests. The protocol was registered in PROSPERO (CRD420251076520).

Results

Twenty trials were included (n = 2871 preterm infants). No significant differences were found in the incidence of BPD between HFNC and CPAP (RR: 0.86; 95 % CI: 0.73–1.02; p = 0.08; I² = 0 %). Similarly, no differences were observed for air leak (RR: 0.76; 95 % CI: 0.45–1.27; p = 0.29). However, HFNC significantly reduced the risk of nasal injury (RR: 0.40; 95 % CI: 0.33–0.49; p < 0.00001). TSA indicated insufficient evidence to confirm a 20 % reduction in BPD. Most studies were at low risk of bias; certainty of the evidence was rated as low for BPD and air leak, and high for nasal injury.

Conclusions

HFNC showed no significant differences compared with CPAP in preventing BPD or air leak in preterm infants, although it reduced the risk of nasal injury. TSA suggests that current evidence is insufficient to confirm or refute a 20 % relative risk reduction in BPD, highlighting the need for further high-quality trials to establish definitive conclusions.

背景：支气管肺发育不良（BPD）在早产儿中很常见，与有创通气和长时间氧疗有关。数十年来，持续气道正压通气（CPAP）一直是标准的无创呼吸支持，但它可能导致鼻外伤和耐受性差。高流量鼻插管（HFNC）可提高舒适度；然而，它在预防BPD方面的有效性仍未得到证实，现有证据也各不相同。方法采用试验序贯分析（TSA）对比较HFNC和CPAP预防早产儿BPD的随机对照试验进行系统评价和荟萃分析。检索在PubMed， Scopus, Cochrane Library， LILACS和Science Direct中进行，截止到2025年6月，没有语言限制。主要结局是BPD的发病率；次要结局包括漏气和鼻腔损伤。方法学质量评价采用Cochrane RoB 2.0工具，证据确定性采用GRADE，发表偏倚采用漏斗图和Egger’s和Begg’s检验。该协议在PROSPERO中注册（CRD420251076520）。结果纳入20项试验（n = 2871例早产儿）。HFNC组与CPAP组BPD发生率无显著差异（RR: 0.86; 95% CI: 0.73-1.02; p = 0.08; I2 = 0%）。同样，在空气泄漏方面也没有观察到差异（RR: 0.76; 95% CI: 0.45-1.27; p = 0.29）。然而，HFNC显著降低了鼻部损伤的风险（RR: 0.40; 95% CI: 0.33-0.49; p < 0.00001）。TSA没有足够的证据证实BPD降低了20%。大多数研究偏倚风险较低；证据的确定性在BPD和漏气中被评为低，在鼻损伤中被评为高。结论shfnc在预防早产儿BPD或漏气方面与CPAP相比无显著差异，但可降低鼻部损伤的风险。TSA表示，目前的证据不足以证实或反驳BPD相对风险降低20%的说法，强调需要进一步的高质量试验来建立明确的结论。

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