目的系统评价肥胖对急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）临床预后的影响。 方法通过计算机检索 Pubmed、EMBASE、Cochrane databases、Wiley、Ovid、Medline、CNKI、VIP、Wanfang 数据库中关于肥胖与 ARDS 及急性肺损伤（acute lung injury，ALI）临床预后的相关文献，运用 RevMan 5.0 及 Stata 10.0 软件进行统计学分析。 结果本 Meta 分析共纳入 9 篇文献，28 368 例患者。分析结果显示：肥胖显著降低 ARDS 的死亡率[ OR=0.63，95% 可信区间（95% CI）0.41～0.98， P=0.04]。亚组分析结果显示：与正常体重 ARDS 患者比较，肥胖患者在 28 d 死亡率未见明显差异（ OR=0.92，95% CI 0.55~1.54， P=0.76），但是在 60 d 及 90 d 死亡率均明显减低（60 d： OR=0.84，95% CI 0.75～0.94， P=0.002；90 d： OR=0.38，95% CI 0.22～0.66， P=0.000 5）。与正常体重 ARDS 患者比较，肥胖患者的住院时间及 ICU 时间延长，机械通气时间缩短，但无统计学意义[住院时间：加权均数差（weighted mean difference，WMD）=3.61，95% CI –0.36～7.57， P=0.07；重症监护病房（intensive care unit，ICU）时间：WMD=1.52，95% CI –0.22～3.26， P=0.09；机械通气时间：WMD=–0.50，95% CI –2.18～1.19， P=0.56]。此外，肥胖患者无需呼吸机辅助呼吸的时间延长（WMD=2.68，95% CI 0.86～4.51， P=0.004）。 结论肥胖对 ARDS 患者的住院时间、ICU 时间及机械通气时间无显著影响，但无需呼吸机辅助时间延长，60 d 和 90 d 死亡率显著降低。上述结论需要更多大样本临床随机对照试验加以证实
References
[1]
1. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. May 4; 2000 342(18): 1334-1349.
[2]
6. Newell MA, Bard MR, Goettler CE, et al. Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg. 2007 May; 204(5): 1056-61; discussion 1062-4.
[3]
16. Stapleton RD, Dixon AE, Parsons PE, et al. the NHLBI Acute Respiratory Distress Syndrome Network. The association between body mass index and plasma cytokine levels in patients with acute lung injury. Chest, 2010, 138(3): 568-577.
[4]
17. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med, 2008, 359（20）:2105-2120.
[5]
18. Mohamed-Ali V, Goodrick S, Bulmer K, et al. Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol, 1999, 277(期): E971-E975.
[6]
19. Li X, Handee W, Kuo MH. The slim, the fat and the obese: guess who lives the longest? Curr Genet. 2016 May 26.
[7]
20. Schenkeveld L, Magro M, Oemrawsingh RM, et al. The influence of optimal medical treatment on the ‘obesity paradox’, body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study. BMJ Open, 2012, 2(期): e000535.
[8]
2. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med. Oct 20; 2005 353(16): 1685-1693.
[9]
3. Raebel MA, Malone DC, Conner DA, et al. Health services use and health care costs of obese and nonobese individuals. Arch Intern Med. 2004; 164: 2135-40.
[10]
4. Gong MN, Bajwa EK, Thompson BT, et al. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax. 2010 Jan; 65(1): 44-50.
[11]
5. Karnatovskaia LV, Lee AS, Bender SP, et al. Obstructive Sleep Apnea, Obesity, and the Development of Acute Respiratory Distress Syndrome. J Clin Sleep Med. 2014 Jun 15; 10(6): 657-62.
[12]
7. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53: 1925-1932.
[13]
8. Kalantar-Zadeh K, Horwich TB, Oreopoulos A, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 2007; 10:433-442.
[14]
9. Memtsoudis SG, Bombardieri AM, Ma Y, et al. Mortaliy of patients with respiratory insufficiency and adult respiratory distress syndrome after surgery: the obesity paradox. J Intensive Care Med. 2012 Sep-Oct; 27(5): 306-11.
[15]
10. O’Brien JM Jr, Welsh CH, Fish RH, et al. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004 Mar 2; 140(5): 338-45.
[16]
11. Morris AE, Stapleton RD, Rubenfeld GD, et al. The association between body mass index and clinical outcomes in acute lung injury. Chest. 2007 Feb; 131(2): 342-8.
[17]
12. De Jong A, Molinari N, Sebbane M, et al. Feasibility and effectiveness of position in morbidly obese patients with ARDS: a case-control clinical study. Chest. 2013 Jun; 143(6): 1554-61.
[18]
13. Soubani AO, Chen W, Jang H.The outcome of acute respiratory distress syndrome in relation to body mass index and diabetes mellitus. Heart Lung, 2015, 44(5): 441-447.
[19]
14. Soto GJ, Frank AJ, Christiani DC, et al. Body mass index and acute kidney injury in the acute kidney injury in the acute respiratory distress syndrome. Crit Care Med, 2012, 40(9): 2601-2608.
[20]
15. O’Brien JM Jr, Phillips GS, Ali NA, et al. Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med, 2006, 34(3): 738-744.
