有氧运动对类风湿关节炎患者自评健康状况影响的荟萃分析

Effects of aerobic exercise on self-reported health status in rheumatoid arthritis patients:A meta-analysis

目的:探索有氧运动对类风湿关节炎(rheumatoid arthritis,RA)患者自评健康状况的影响。方法:采用计算机检索Pub Med、Cochrane Library、EMbase、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库、中国期刊全文数据库,自建库以来至2015年7月公开发表的,关于有氧运动对RA患者干预效果的中、英文随机和半随机对照试验,并辅以手工检索,追踪纳文献和相关综述的参考文献。按照纳入排除标准选择并评价文献质量,采用Rev Man 5.3软件进行荟萃分析。结果:最终纳入7篇英文文献,共644例RA患者,其中包括有氧运动组(干预组)327例,常规治疗组(对照组)317例。荟萃分析结果显示,干预组的健康评估问卷-残疾指数量表(Health Assessment Questionnaire-Disability Index,HAQ-DI)评分高于对照组[加权均数差(mean difference,MD)=-0.14,95%CI为-0.23^-0.05,P=0.001]。亚组分析显示,短期干预(≤16周)效果(MD=-0.35,95%CI为-0.52^-0.19,P<0.001)优于长期干预(≥24周)效果(MD=-0.08,95%CI为-0.16~0.00,P=0.04);干预组的疲乏评分高于对照组[标准化均数差(standardized mean difference,SMD)=-0.16,95%CI为-0.31^-0.01,P=0.04],而短期干预对RA患者疲乏的改善效果(SMD=-0.16,95%CI为-0.31^-0.01,P=0.04)优于长期干预(SMD=-0.09,95%CI为-0.30~0.12),P=0.41);疼痛评分在2组间差异无统计学意义(SMD=-0.13,95%CI为-0.32~0.05,P=0.16)。结论 :有氧运动可明显改善RA患者的躯体功能,对缓解疲乏症状具有一定的积极作用,但仍需行更多高质量的随机对照研究以验证。

Objective： To assess the effects of aerobic exercise on self-reported health status in rheumatoid arthritis patients. Methods： PubMed, Cochrane Library, EMbase, CBM, VIP, Wangfang data, CNKI were screened to search randomized controlled trial （RCT） and quasi-randomized control trial involving RA patients who received aerobic exercise as treatment. All the relevant studies published in Chinese or English before July 2015 were included. The meta-analysis was conducted using Review Manager Version 5.3. Results： Seven RCTs published in English including 644 RA patients were included, of them 327 patients had aerobic exercise as treatment （intervention group）, and 317 patients without aerobic exercise were served as control group. Health Assessment Questionnaire-Disability Index （HAQ-DI） score of intervention group were higher than that of control group [MD=-0.14, 95%CI （-0.23, -0.05）, P=0.001], as well as fatigue score [SMD=-0.16, 95%CI（-0.31,-0,01）, P=0.04]. Subgroup analysis indicated that short-term intervention （≤ 16 weeks） of aerobic exercise was more effective than long-term intervention （〉124 weeks） for both HAQ-DI score and fatigue score. There was no significant difference in pain score between the two groups. Conclusions： Aerobic exercise could significantly improve the body function and may have a positive effect on fatigue score in RA, but further high-quality, randomized controlled trials are needed to evaluate its long-term effect.