太极拳康复对慢性阻塞性肺疾病患者的影响

Effects of Tai Chi Quan rehabilitation in patients with chronic obstructive pulmonary disease

目的探讨太极拳康复对稳定期慢性阻塞性肺疾病(COPD)患者肺功能、运动能力以及炎症因子的影响。方法 2015年4月至2015年10月招募来自烟台社区稳定期COPD患者共40例,按1∶1随机分为太极拳康复辅以常规治疗组(太极组)以及常规治疗组(对照组)。24式简化太极拳训练3个月,每周3次,每次40min,评价康复前后两组患者的肺功能指标FEV1、FEV1%预计值、FEV1/FVC、6分钟步行距离(6MWD);酶联免疫吸附试验(ELISA)检测肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及白细胞介素8(IL-8)。结果康复治疗3个月后,太极组和对照组COPD患者的三项肺功能指标较康复前无明显改善(P>0.05),太极组康复前后差值与对照组康复前后差值的比较亦没有统计学意义(P>0.05);而康复后太极组6MWD较前显著增加70m(P=0.02),对照组康复前后比较无统计学差异(P=0.49),太极组康复前后差值与对照组康复前后差值的比较提示差异有统计学意义(P=0.03)。太极组COPD患者的炎症因子TNF-α、IL-6、IL-8较康复前明显降低,差异有统计学意义(P<0.05),而对照组康复后较康复前亦降低,差异无统计学意义(P>0.05);太极组康复前后差值与对照组康复前后差值的比较显示差异均有统计学意义(TNF-α:P=0.02;IL-6:P=0.005;IL-8:P=0.03)。结论太极拳康复有助于COPD稳定期患者肺功能及运动功能的恢复,可下调外周血促炎因子水平,有助于改善患者的全身炎症反应。

Objective To explore the effects of Tai Chi Quan rehabilitation with respect to lung function,exercise capacity and inflammatory cytokines in patients with chronic obstructive pulmonary disease（COPD）.Methods The patients with stable COPD will be recruited from Yantai community and randomly assigned to one of the two groups receiving Tai Chi Quan combined usual care（Tai Chi group）,or usual care（control group）in a 1∶1ratio from April 2015 to October 2015.Forty minutes supervised 24 simplified Tai Chi Quan 3times a week for 12 weeks will be performed.The outcomes,lung function（FEV1,FEV1%,FEV1/FVC）,6minute walk distance（6MWD）and inflammatory cytokines detected by enzyme-linked immunosorbent assay（ELISA）including tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）and interleukin-8（IL-8）,were evaluated at study entry and after 12 weeks.Results After 3 months,there was no statistical difference with respect to lung function（FEV1,FEV1% pred,FEV1/FVC）between the two groups（P〈0.05）.There was also no significant difference in terms of the changes from baseline to after 3months for these three outcomes between the two groups（P〈0.05）.However,Tai Chi Quan significantly increased 70 mof 6 MWD after 3months compared with the baseline in Tai Chi group（P=0.02）,but not in control group（P=0.49）.The changes from baseline to after 3months for 6MWD appeared to be significant difference between the two groups（P=0.03）.Importantly,Tai Chi Quan significantly decreased the levels of inflammatory cytokines（TNF-α,IL-6,IL-8）after 3 months compared with the baseline in Tai Chi group（P〈0.05）,but not in control group（P〈0.05）.The changes from baseline to after 3months for inflammatory cytokines appeared to be significant difference between the two groups（TNF-α：P=0.02,IL-6：P=0.005,IL-8：P=0.03）.Conclusion Tai Chi-based pulmonary rehabilitation achieved a clinically significant increase in COPD patient＇lung function and exercise capacity as well as lowering the levels of inflammatory cytokines and improving their systemic inflammatory response.