2025年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读

doi:10.12114/j.issn.1007-9572.2024.0588

摘要/Abstract

摘要： 慢性阻塞性肺疾病全球倡议（GOLD）2025年修订版于2024-11-11发布，是GOLD 2023的第二次更新。总体来说其对于慢性阻塞性肺疾病（以下简称慢阻肺病）的定义、诊断、评估和治疗与GOLD 2024类似，但在12个方面修订/扩充了相应内容，包括增加有关肺功能变化轨迹的说明和参考文献、增加有关微生态失衡的内容、更新并扩充肺功能检查的内容、更新慢阻肺病患者的心血管病风险、更新慢阻肺病CT影像学检查、新增气候变化与慢阻肺病、更新慢阻肺病患者的推荐疫苗、更新随访期治疗药物、新增肺康复治疗的线上/线下及远程随访、修订有关长效β2受体激动剂（LABA）+吸入性糖皮质激素（ICS）患者停用ICS的说明、修订有关磷酸二酯酶（PDE）3 & PDE4抑制剂和其他减少急性加重药物的说明、新增肺动脉高压的内容。本文对更新内容进行简介和解读。

关键词: 肺疾病，慢性阻塞性, 肺功能, 肺动脉高压, 指南

Abstract:

The global initiative for chronic obstructive lung disease (GOLD) 2025 report, released on November 11th, 2024, marks the second update since GOLD 2023. Overall, this version maintains similar definition, diagnosis, assessment, and treatment for COPD as in GOLD 2024, but with revisions and expansions in 12 specific areas. These include: added explanations and references on lung function trajectories, expanded content on dysbiosis, updates and additions to spirometry, revised cardiovascular risk information for COPD patients, updated guidance on CT imaging for COPD, new insights into the impact of climate change on COPD, updated vaccination recommendations, updated follow-up pharmacological treatments, new guidance for delivery of pulmonary rehabilitation, revised recommendations on ICS withdrawal in patients on LABA+ICS therapy, updated information on PDE3 and PDE4 inhibitors and other exacerbation-reducing medications, and additional content on pulmonary hypertension. The article introduces and interprets the new contents.

Key words: Pulmonary disease, chronic obstructive, Pulmonary function, Pulmonary hypertension, Guidebooks

中图分类号:

R 563.9

陈典,隆寰宇,张丛溪,等. 2025年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J]. 中国全科医学, 2025, 28(16): 1937-1949. DOI: 10.12114/j.issn.1007-9572.2024.0588.
CHEN Dian,LONG Huanyu,ZHANG Congxi, et al. Interpretation of Global Strategy for the Diagnosis, Treatment, Management and Prevention of Chronic Obstructive Pulmonary Disease 2025 Report[J]. Chinese General Practice, 2025, 28(16): 1937-1949. DOI: 10.12114/j.issn.1007-9572.2024.0588.

图/表 5

图1 吸入支气管舒张剂前/后肺功能检查注：慢阻肺病=慢性阻塞性肺疾病；容积效应是指在吸入支气管舒张剂后，用力肺活量（FVC）显著增加；流量效应是指在吸入支气管舒张剂后，第1秒用力呼气容积（FEV1）显著增加。

Figure 1 Pre- and post- bronchodilator spirometry

图2 随访期药物治疗注：LABA=长效β2受体激动剂，LAMA=长效抗M-胆碱受体药物，eos=血嗜酸粒细胞；*表示使用单一吸入装置治疗可能比使用多种吸入装置治疗更便捷且更有效；单一吸入装置可提高治疗依从性。如果出现肺炎或其他明显的不良反应，应考虑减少ICS用量；当血eos≥300个/μL时，减少ICS用量更有可能与急性加重的发生相关。急性加重指的是每年发生急性加重的次数。

Figure 2 Follow-up pharmacological treatment

图3 当前使用LABA+ICS患者的管理注：ICS=吸入性糖皮质激素；*表示患者之前发生过急性加重且LABA+ICS治疗效果良好。

Figure 3 Management of patients currently on LABA+ICS

图4 降低慢阻肺病急性加重风险的措施

Figure 4 Interventions that reduce the frequency of COPD exacerbations

图5 慢阻肺病合并肺动脉高压患者的可治疗特质及管理建议注：ESC=欧洲心脏病学会，ERS=欧洲呼吸学会，PH=肺动脉高压。

Figure 5 Treatable traits in pulmonary hypertension-COPD(PH-COPD)and suggested management

参考文献 78

[30]	CELLI B R, FABBRI L M, AARON S D, et al. Differential diagnosis of suspected chronic obstructive pulmonary disease exacerbations in the acute care setting：best practice[J]. Am J Respir Crit Care Med，2023，207(9)：1134-1144. DOI：10.1164/rccm.202209-1795ci.
[31]	张丛溪，陈亚红. 肺功能检查在慢性阻塞性肺疾病合并心血管疾病中的应用[J]. 中国医学前沿杂志（电子版），2024，16(6)：13-17. DOI：10.12037/YXQY.2024.06-03.
[32]	VESTBO J, EDWARDS L D, SCANLON P D, et al. Changes in forced expiratory volume in 1 second over time in COPD[J]. N Engl J Med，2011，365(13)：1184-1192.
[33]	MARTÍNEZ-GARCÍA M Á, DE LA ROSA-CARRILLO D, SOLER-CATALUÑA J J, et al. Bronchial infection and temporal evolution of bronchiectasis in patients with chronic obstructive pulmonary disease[J]. Clin Infect Dis，2021，72(3)：403-410. DOI：10.1093/cid/ciaa069.
[34]	DIAZ A A, OREJAS J L, GRUMLEY S, et al. Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease[J]. JAMA，2023，329(21)：1832. DOI：10.1001/jama.2023.2065.
[35]	EZPONDA A, CASANOVA C, DIVO M, et al. Chest CT-assessed comorbidities and all-cause mortality risk in COPD patients in the BODE cohort[J]. Respirology，2022，27(4)：286-293. DOI：10.1111/resp.14223.
[36]	DAVIE G S, BAKER M G, HALES S, et al. Trends and determinants of excess winter mortality in New Zealand：1980 to 2000[J]. BMC Public Health，2007，7：263.
[37]	BURKART K G, BRAUER M, ARAVKIN A Y, et al. Estimating the cause-specific relative risks of non-optimal temperature on daily mortality：a two-part modelling approach applied to the Global Burden of Disease Study[J]. Lancet，2021，398(10301)：685-697. DOI：10.1016/S0140-6736(21)01700-1.
[38]	TSENG C M, CHEN Y T, OU S M, et al. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease：a nationwide study[J]. PLoS One，2013，8(3)：e57066. DOI：10.1371/journal.pone.0057066.
[39]	SCHEERENS C, NURHUSSIEN L, AGLAN A, et al. The impact of personal and outdoor temperature exposure during cold and warm seasons on lung function and respiratory symptoms in COPD[J]. ERJ Open Res，2022，8(1)：00574-02021. DOI：10.1183/23120541.00574-2021.
[40]	MCCORMACK M C, PAULIN L M, GUMMERSON C E, et al. Colder temperature is associated with increased COPD morbidity[J]. Eur Respir J，2017，49(6)：1601501. DOI：10.1183/13993003.01501-2016.
[41]	MU Z, CHEN P L, GENG F H, et al. Synergistic effects of temperature and humidity on the symptoms of COPD patients[J]. Int J Biometeorol，2017，61(11)：1919-1925. DOI：10.1007/s00484-017-1379-0.
[42]	OSMAN L M, AYRES J G, GARDEN C, et al. Home warmth and health status of COPD patients[J]. Eur J Public Health，2008，18(4)：399-405. DOI：10.1093/eurpub/ckn015.
[43]	DE SARIO M, KATSOUYANNI K, MICHELOZZI P. Climate change，extreme weather events，air pollution and respiratory health in Europe[J]. Eur Respir J，2013，42(3)：826-843. DOI：10.1183/09031936.00074712.
[44]	ANENBERG S C, HAINES S, WANG E, et al. Synergistic health effects of air pollution，temperature，and pollen exposure：a systematic review of epidemiological evidence[J]. Environ Health，2020，19(1)：130.
[45]	QIU H, TAN K, LONG F Y, et al. The burden of COPD morbidity attributable to the interaction between ambient air pollution and temperature in Chengdu，China[J]. Int J Environ Res Public Health，2018，15(3)：492. DOI：10.3390/ijerph15030492.
[46]	MCCORMACK M C, BELLI A J, WAUGH D, et al. Respiratory effects of indoor heat and the interaction with air pollution in chronic obstructive pulmonary disease[J]. Ann Am Thorac Soc，2016，13(12)：2125-2131. DOI：10.1513/annalsats.201605-329oc.
[47]	PLATT H, OMOLE T, CARDONA J, et al. Safety，tolerability，and immunogenicity of a 21-valent pneumococcal conjugate vaccine，V116，in healthy adults：phase 1/2，randomised，double-blind，active comparator-controlled，multicentre，US-based trial[J]. Lancet Infect Dis，2023，23(2)：233-246.
[1]	Global strategy for prevention，diagnosis and management of COPD：2025[EB/OL].[2024-12-16].
[2]	陈典，隆寰宇，李姝润，等. 2024年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J]. 中国全科医学，2024，27(13)：1533-1543. DOI：10.12114/j.issn.1007-9572.2023.0867.
[3]	陈亚红. 2023年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略更新要点[J]. 中国医学前沿杂志（电子版），2023，15(2)：1-11. DOI：10.12037/YXQY.2023.02-01.
[4]	KOHANSAL R, MARTINEZ-CAMBLOR P, MARTINEZ-CAMBLOR P, et al. The natural history of chronic airflow obstruction revisited：an analysis of the Framingham offspring cohort[J]. Am J Respir Crit Care Med，2009，180(1)：3-10.
[5]	AGUSTI A, FANER R. Lung function trajectories in health and disease[J]. Lancet Respir Med，2019，7(4)：358-364. DOI：10.1016/s2213-2600(18)30529-0.
[6]	ÇOLAK Y, NORDESTGAARD B G, VESTBO J, et al. Relationship between supernormal lung function and long-term risk of hospitalisations and mortality：a population-based cohort study[J]. Eur Respir J，2021，57(4)：2004055. DOI：10.1183/13993003.04055-2020.
[7]	AGUSTI A, FABBRI L M, BARALDI E, et al. Spirometry：a practical lifespan predictor of global health and chronic respiratory and non-respiratory diseases[J]. Eur J Intern Med，2021，89：3-9. DOI：10.1016/j.ejim.2021.04.027.
[8]	MELÉN E, FANER R, ALLINSON J P, et al. Lung-function trajectories：relevance and implementation in clinical practice[J]. Lancet，2024，403(10435)：1494-1503. DOI：10.1016/s0140-6736(24)00016-3.
[9]	COLLABORATION E C. Lungtracker website：lung function tracker[EB/OL].[2024-12-16].
[10]	SONG Z, MENG Y F, FRICKER M, et al. The role of gut-lung axis in COPD：pathogenesis，immune response，and prospective treatment[J]. Heliyon，2024，10(9)：e30612. DOI：10.1016/j.heliyon.2024.e30612.
[11]	DICKER A J, HUANG J T J, LONERGAN M, et al. The sputum microbiome，airway inflammation，and mortality in chronic obstructive pulmonary disease[J]. J Allergy Clin Immunol，2021，147(1)：158-167. DOI：10.1016/j.jaci.2020.02.040.
[48]	WISEMAN D J, THWAITES R S, RITCHIE A I, et al. Respiratory syncytial virus-related community chronic obstructive pulmonary disease exacerbations and novel diagnostics：a binational prospective cohort study[J]. Am J Respir Crit Care Med，2024，210(8)：994-1001. DOI：10.1164/rccm.202308-1320oc.
[49]	THOMPSON M G, STENEHJEM E, GRANNIS S, et al. Effectiveness of covid-19 vaccines in ambulatory and inpatient care settings[J]. N Engl J Med，2021，385(15)：1355-1371. DOI：10.1056/nejmoa2110362.
[50]	KARNER C, CATES C J. Long-acting beta（2）-agonist in addition to tiotropium versus either tiotropium or long-acting beta（2）-agonist alone for chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev，2012，4(4)：CD008989. DOI：10.1002/14651858.CD008989.pub2.
[51]	LIPSON D A, BARNHART F, BREALEY N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD[J]. N Engl J Med，2018，378(18)：1671-1680.
[52]	Azithromycin for prevention of exacerbations of COPD[J]. N Engl J Med，2011，365(23)：2234-2237. DOI：10.1056/nejmc1111248.
[53]	HAN M K, TAYOB N, MURRAY S, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy[J]. Am J Respir Crit Care Med，2014，189(12)：1503-1508.
[54]	MARTINEZ F J, CALVERLEY P M, GOEHRING U M, et al. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy（REACT）：a multicentre randomised controlled trial[J]. Lancet，2015，385(9971)：857-866.
[55]	BHATT S P, RABE K F, HANANIA N A, et al. Dupilumab for COPD with blood eosinophil evidence of type 2 inflammation[J]. N Engl J Med，2024，390(24)：2274-2283. DOI：10.1056/nejmoa2401304.
[56]	CHAPMAN K R, HURST J R, FRENT S M, et al. Long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with chronic obstructive pulmonary disease（SUNSET）：a randomized，double-blind，triple-dummy clinical trial[J]. Am J Respir Crit Care Med，2018，198(3)：329-339. DOI：10.1164/rccm.201803-0405oc.
[12]	KAYONGO A, ROBERTSON N M, SIDDHARTHAN T, et al. Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease[J]. Front Immunol，2022，13：1085551.
[13]	SULAIMAN I, WU B G, CHUNG M, et al. Lower airway dysbiosis augments lung inflammatory injury in mild-to-moderate chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med，2023，208(10)：1101-1114. DOI：10.1164/rccm.202210-1865oc.
[14]	LEA S, HIGHAM A, BEECH A, et al. How inhaled corticosteroids target inflammation in COPD[J]. Eur Respir Rev，2023，32(170)：230084. DOI：10.1183/16000617.0084-2023.
[15]	WANG Z, BAFADHEL M, HALDAR K, et al. Lung microbiome dynamics in COPD exacerbations[J]. Eur Respir J，2016，47(4)：1082-1092. DOI：10.1183/13993003.01406-2015.
[16]	WANG Z, LOCANTORE N, HALDAR K, et al. Inflammatory endotype-associated airway microbiome in chronic obstructive pulmonary disease clinical stability and exacerbations：a multicohort longitudinal analysis[J]. Am J Respir Crit Care Med，2021，203(12)：1488-1502. DOI：10.1164/rccm.202009-3448oc.
[17]	OPRON K, BEGLEY L A, ERB-DOWNWARD J R, et al. Loss of airway phylogenetic diversity is associated with clinical and pathobiological markers of disease development in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med，2024，210(2)：186-200. DOI：10.1164/rccm.202303-0489oc.
[18]	BUHR R G, BARJAKTAREVIC I Z, QUIBRERA P M, et al. Reversible airflow obstruction predicts future chronic obstructive pulmonary disease development in the SPIROMICS cohort：an observational cohort study[J]. Am J Respir Crit Care Med，2022，206(5)：554-562. DOI：10.1164/rccm.202201-0094oc.
[19]	AARON S D, TAN W C, BOURBEAU J, et al. Diagnostic instability and reversals of chronic obstructive pulmonary disease diagnosis in individuals with mild to moderate airflow obstruction[J]. Am J Respir Crit Care Med，2017，196(3)：306-314.
[20]	GÜDER G, BRENNER S, ANGERMANN C E, et al. GOLD or lower limit of normal definition? A comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study[J]. Respir Res，2012，13(1)：13.
[57]	ROCHESTER C L, ALISON J A, CARLIN B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease：an official American thoracic society clinical practice guideline[J]. Am J Respir Crit Care Med，2023，208(4)：e7-26. DOI：10.1164/rccm.202306-1066ST.
[58]	SCHRIJVER J, LENFERINK A, BRUSSE-KEIZER M, et al. Self-management interventions for people with chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev，2022，1(1)：CD002990. DOI：10.1002/14651858.CD002990.pub4.
[59]	OSHAGBEMI O A, FRANSSEN F M E, VAN KRAAIJ S, et al. Blood eosinophil counts，withdrawal of inhaled corticosteroids and risk of COPD exacerbations and mortality in the clinical practice research datalink（CPRD）[J]. COPD，2019，16(2)：152-159. DOI：10.1080/15412555.2019.1608172.
[60]	SUISSA S, DELL’ANIELLO S, ERNST P. Discontinuation of inhaled corticosteroids from triple therapy in COPD：effects on major outcomes in real world clinical practice[J]. COPD，2022，19(1)：133-141. DOI：10.1080/15412555.2022.2045265.
[61]	VOGELMEIER C F, WORTH H, BUHL R, et al. Impact of switching from triple therapy to dual bronchodilation in COPD：the DACCORD 'real world’ study[J]. Respir Res，2022，23(1)：109. DOI：10.1186/s12931-022-02037-2.
[62]	NECHES GARCÍA V, VALLEJO-APARICIO L A, ISMAILA A S, et al. Clinical and economic impact of long-term inhaled corticosteroid withdrawal in patients with chronic obstructive pulmonary disease treated with triple therapy in Spain[J]. Int J Chron Obstruct Pulmon Dis，2022，17：2161-2174. DOI：10.2147/COPD.S367708.
[63]	ANZUETO A, BARJAKTAREVIC I Z, SILER T M, et al. Ensifentrine，a novel phosphodiesterase 3 and 4 inhibitor for the treatment of chronic obstructive pulmonary disease：randomized，double-blind，placebo-controlled，multicenter phase III trials（the ENHANCE trials）[J]. Am J Respir Crit Care Med，2023，208(4)：406-416. DOI：10.1164/rccm.202306-0944oc.
[64]	SINGH D, AGUSTI A, MARTINEZ F J, et al. Blood eosinophils and chronic obstructive pulmonary disease：a global initiative for chronic obstructive lung disease science committee 2022 review[J]. Am J Respir Crit Care Med，2022，206(1)：17-24. DOI：10.1164/rccm.202201-0209pp.
[21]	VAZ FRAGOSO C A, MCAVAY G, VAN NESS P H, et al. Phenotype of spirometric impairment in an aging population[J]. Am J Respir Crit Care Med，2016，193(7)：727-735. DOI：10.1164/rccm.201508-1603oc.
[22]	MALINOVSCHI A, ZHOU X, ANDERSSON A, et al. Consequences of using post- or prebronchodilator reference values in interpreting spirometry[J]. Am J Respir Crit Care Med，2023，208(4)：461-471. DOI：10.1164/rccm.202212-2341oc.
[23]	DUONG M, ISLAM S, RANGARAJAN S, et al. Global differences in lung function by region（PURE）：an international，community-based prospective study[J]. Lancet Respir Med，2013，1(8)：599-609. DOI：10.1016/s2213-2600(13)70164-4.
[24]	DIAO J A, HE Y, KHAZANCHI R, et al. Implications of race adjustment in lung-function equations[J]. N Engl J Med，2024，390(22)：2083-2097. DOI：10.1056/nejmsa2311809.
[25]	BACKMAN H, BLOMBERG A, LUNDQUIST A, et al. Lung function trajectories and associated mortality among adults with and without airway obstruction[J]. Am J Respir Crit Care Med，2023，208(10)：1063-1074.
[26]	SIN D D, ANTHONISEN N R, SORIANO J B, et al. Mortality in COPD：role of comorbidities[J]. Eur Respir J，2006，28(6)：1245-1257. DOI：10.1183/09031936.00133805.
[27]	AGUSTÍ A, EDWARDS L D, RENNARD S I, et al. Persistent systemic inflammation is associated with poor clinical outcomes in COPD：a novel phenotype[J]. PLoS One，2012，7(5)：e37483. DOI：10.1371/journal.pone.0037483.
[28]	HURST J R, GALE C P, Global Working Group on Cardiopulmonary Risk. MACE in COPD：addressing cardiopulmonary risk[J]. Lancet Respir Med，2024，12(5)：345-348. DOI：10.1016/s2213-2600(24)00038-9.
[29]	GRAUL E L, NORDON C, RHODES K, et al. Temporal risk of nonfatal cardiovascular events after chronic obstructive pulmonary disease exacerbation：a population-based study[J]. Am J Respir Crit Care Med，2024，209(8)：960-972. DOI：10.1164/rccm.202307-1122oc.
[65]	SINGH D, LEA S, MATHIOUDAKIS A G. Inhaled phosphodiesterase inhibitors for the treatment of chronic obstructive pulmonary disease[J]. Drugs，2021，81(16)：1821-1830. DOI：10.1007/s40265-021-01616-9.
[66]	BHATT S P, RABE K F, HANANIA N A, et al. Dupilumab for COPD with type 2 inflammation indicated by eosinophil counts[J]. N Engl J Med，2023，389(3)：205-214. DOI：10.1056/nejmoa2303951.
[67]	KOVACS G, AGUSTI A, BARBERÀ J A, et al. Pulmonary vascular involvement in chronic obstructive pulmonary disease. is there a pulmonary vascular phenotype?[J]. Am J Respir Crit Care Med，2018，198(8)：1000-1011. DOI：10.1164/rccm.201801-0095pp.
[68]	PEPKE-ZABA J, DELCROIX M, LANG I, et al. Chronic thromboembolic pulmonary hypertension（CTEPH）：results from an international prospective registry[J]. Circulation，2011，124(18)：1973-1981. DOI：10.1161/CIRCULATIONAHA.110.015008.
[69]	KOVACS G, AVIAN A, BACHMAIER G, et al. Severe pulmonary hypertension in COPD impact on survival and diagnostic approach[J]. Chest，2022，162(1)：202-212. DOI：10.1016/j.chest.2022.01.031.
[70]	HUMBERT M, KOVACS G, HOEPER M M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Heart J，2022，43(38)：3618-3731. DOI：10.1093/eurheartj/ehac237.
[71]	DAURIAT G, REYNAUD-GAUBERT M, COTTIN V, et al. Severe pulmonary hypertension associated with chronic obstructive pulmonary disease：a prospective French multicenter cohort[J]. J Heart Lung Transplant，2021，40(9)：1009-1018. DOI：10.1016/j.healun.2021.04.021.
[72]	DOCHERTY A B, HARRISON E M, GREEN C A, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol：prospective observational cohort study[J]. BMJ，2020，369：m1985. DOI：10.1136/bmj.m1985.
[73]	TAL-SINGER R, CRAPO J D. COPD at the time of COVID-19：a COPD foundation perspective[J]. Chronic Obstr Pulm Dis，2020，7(2)：73-75. DOI：10.15326/jcopdf.7.2.2020.0149.
[74]	CHEN X, ZHOU C W, FU Y Y, et al. Global，regional，and national burden of chronic respiratory diseases and associated risk factors，1990-2019：Results from the Global Burden of Disease Study 2019[J]. Front Med，2023，10：1066804. DOI：10.3389/fmed.2023.1066804.
[75]	YU Y, XIAO W, DU L Y, et al. Acupuncture for dyspnea and breathing physiology in chronic respiratory diseases：a systematic review and meta-analysis of randomized controlled trials[J]. Heliyon，2024，10(10)：e31176. DOI：10.1016/j.heliyon.2024.e31176.
[76]	ZHOU L, YANG H, ZHANG Y, et al. Predictive value of lung function measures for cardiovascular risk：a large prospective cohort study[J]. Thorax，2024，79(3)：250-258. DOI：10.1136/thorax-2023-220703.
[77]	BAI J J, CUI J X, YU C H. Burden of chronic obstructive pulmonary disease attributable to non-optimal temperature from 1990 to 2019：a systematic analysis from the Global Burden of Disease Study 2019[J]. Environ Sci Pollut Res，2023，30(26)：68836-68847. DOI：10.1007/s11356-023-27325-2.
[78]	FANG Y C, CHENG W H, LU H I, et al. Double lung transplantation is better than single lung transplantation for end-stage chronic obstructive pulmonary disease：a meta-analysis[J]. J Cardiothorac Surg，2024，19(1)：162. DOI：10.1186/s13019-024-02654-6.