生理性缺血训练临床应用效果的Meta分析

Effects of the Clinical Applications of Physiological Ischemia Training:A Meta-analysis

目的：通过循证方法对生理性缺血训练（ PIT）临床应用效果进行系统评价。方法计算机检索Web of Science、PubMed、Cochrane Library、Clinical Science、中国生物医学文献数据库、中国知网、维普网、万方数据知识服务平台以及南通大学学位论文库，时间限定为数据库建库至2015年12月，根据纳入与排除标准进行文献筛选，提取文献主要信息，包括：基本特征（研究对象、样本量、年龄）、干预措施、对照方法、训练时间、结局指标。观察PIT临床应用效果，采用RevMan 5.0软件进行Meta分析。结果共纳入6篇文献，216例研究对象，其中干预组113例，对照组103例；Jadad评分为4~5分，提示纳入文献质量较高。Meta分析结果显示，干预组循环血血管内皮生长因子（VEGF）水平高于对照组〔标准化均数差（SMD）＝1.16，95％CI（0.73，1.60），P﹤0.01〕，循环血一氧化氮（NO）水平高于对照组〔均数差（MD）＝19.33，95％CI（12.25，26.41），P﹤0.01〕，收缩压降低程度高于对照组〔MD＝-6.34，95％ CI（-9.18，-3.49），P ﹤0.01〕，舒张压降低程度高于对照组〔MD ＝-3.66，95％ CI （-4.53，-2.79），P﹤0.01〕，左心室射血分数高于对照组〔MD＝3.88，95％CI（1.62，6.14），P﹤0.01〕。经去除样本量较大的文献或进行亚组分析，结果并未发生逆转且变化较小，证实Meta分析结果稳健。结论 PIT可以有效降低收缩压和舒张压，增加循环血中VEGF和NO水平，可能对远隔缺血部位的侧支循环生成有促进作用，从而改善心肌缺血。

Objective To systematically evaluate the effects of the clinical applications of physiological ischemia training（ PIT） through an evidence - based method. Methods Web of Science, PubMed, Cochrane Library, Clinical Science,China Biology Medicine Disc（CBMDisc）,CNKI,VIP Database,Wanfang Database,and the Dissertation Library of Nantong University were searched for related studies from the date of establishment to December 2015. Related studies were screened on the basis of our specified inclusion and exclusion criteria. The following information was extracted：basic features （ object of study, sample size, and age ）, intervention measures, comparison methods, training duration, and result indicators. The clinical effects of PIT were then observed. A meta-analysis was conducted by using RevMan 5. 0. Results Six papers were included. A total of 216 cases of research objects, with 113 cases in the intervention group and 103 cases in the control group,were considered. Jadad scores were 4 to 5 points,which indicated that the included studies were of relatively high quality. Meta-analysis revealed that VEGF〔SMD =1. 16,95%CI（0. 73,1. 60）,P ﹤0. 01〕and NO〔MD =19. 33, 95%CI（12. 25,26. 41）,P ﹤0. 01〕levels in the circulating blood in the intervention group were higher than those in the control group. Decreased degree of systolic blood pressure〔MD = -6. 34,95%CI（ -9. 18,-3. 49）,P ﹤0. 01〕and diastolic blood pressure〔MD= -3. 66,95%CI（ -4. 53,-2. 79）,P﹤0. 01〕were higher in the intervention group than those in the control group. Left ventricular ejection fraction was also higher in the intervention group than that in the control group〔MD=3. 88,95%CI（1. 62,6. 14）,P ﹤0. 01〕. After studies involving a large sample size were removed or subgroup analysis,results exhibited slight changes. This observation confirmed that the results of our meta - analysis were stable. Conclusion PIT can effectively reduce systolic blood pressure and diastolic blood pressure and increase VEGF and NO levels in the circulating blood. This approach may contribute to the formation of collateral circulation in remote ischemic area and thus alleviate myocardial ischemia.