慢性阻塞性肺疾病急性加重后早期心血管易损性：一项时间窗系统评价和证据图谱。
完整摘要 · 中文译文
背景：心血管事件似乎在慢性阻塞性肺疾病（COPD）急性加重后聚集发生，但其发生时机、严重程度梯度及对呼吸科随访的意义仍未被系统整理。 方法：检索PubMed、Embase、Scopus和Web of Science，时间从建库至2026年5月1日。纳入评估COPD、哮喘或支气管扩张急性加重期间或之后临床诊断的心血管事件的成人观察性研究和试验后分析。COPD被视为主要证据基础。由于研究设计、终点、严重程度定义、对照组和风险窗口存在显著差异，结果以时间窗证据图而非合并荟萃分析的形式进行综合。 结果：检索识别出8027条记录；筛选了4866条去重记录，评估了55篇全文，最终保留34篇文献进行定量、敏感性或叙述性评价。提取的矩阵包含110项效应估计值，其中101项与COPD相关，在时间窗统一后有57项落在30天窗口内。早期风险始终高于晚期风险，尤其是在重度或住院治疗的COPD急性加重后。观察到冠状动脉事件、缺血性卒中、心力衰竭、心房颤动或心律失常、心血管死亡及复合严重心血管结局的信号。哮喘和支气管扩张的证据稀少且属于探索性。 结论：重度或住院治疗的COPD急性加重识别出一个短期心血管脆弱窗口，该窗口最一致地持续…… 在第一个月内。其实践贡献并非单一的合并风险估计值，而是一张具有临床可解读性的图谱，显示何时应将呼吸恢复视为心肺照护交接点。
完整摘要 · 英文原文
BACKGROUND: Cardiovascular events appear to cluster after acute exacerbation of chronic obstructive pulmonary disease (COPD), but the timing, severity gradient, and implications for respiratory follow-up remain incompletely organized. METHODS: PubMed, Embase, Scopus, and Web of Science were searched from inception to 1 May 2026. Adult observational studies and post hoc trial analyses were eligible when they evaluated clinically diagnosed cardiovascular events during or after exacerbations of COPD, asthma, or bronchiectasis. COPD was treated as the primary evidence base. Because designs, endpoints, severity definitions, comparators, and risk windows differed materially, results were synthesized as a time-windowed evidence map rather than as a pooled meta-analysis. RESULTS: The search identified 8027 records; 4866 unique records were screened, 55 full texts were assessed, and 34 records were retained for quantitative, sensitivity, or narrative evaluation. The extracted matrix contained 110 effect estimates, of which 101 related to COPD and 57 fell within 30-day windows after time-window harmonization. Early risk was consistently higher than later risk, especially after severe or hospitalized COPD exacerbations. Signals were observed for coronary events, ischemic stroke, heart failure, atrial fibrillation or arrhythmia, cardiovascular death, and composite severe cardiovascular outcomes. Asthma and bronchiectasis evidence was sparse and exploratory. CONCLUSIONS: Severe or hospitalized COPD exacerbation identifies a short cardiovascular vulnerability window, most consistently during the first month. The practical contribution is not a single pooled risk estimate, but a clinically interpretable map showing when respiratory recovery should be treated as cardiopulmonary transition-of-care.