运动对慢性肾脏病患者炎症指标、最大摄氧量及生活质量影响的Meta分析

Effects of Exercise on Inflammatory Markers,VO2 Max and Quality of Life in Patients with Chronic Kidney Disease: A Meta Analysis

目的慢性肾脏病(Chronic kidney disease,CKD)是威胁人类健康的世界性难题,其发病率逐年升高,部分患者缓慢进展至ESRD,需依赖透析来维持生命,生活质量明显受影响。本文的目的是系统性评估物理运动对CKD患者炎症指标、最大摄氧量及生活质量的影响。方法系统检索Medline、Embase、Cochrane图书馆及临床试验注册中心,截止时间为2017年8月14日,检索词包括"exercise"、"chronic kidney disease"、"inflammatory factors"、"quality of life"、"maximal oxygen uptake"、"pulmonary function"和"randomized controlled trial"。使用JADAD量表对纳入文献进行方法学质量评价,提取有效数据后使用Revman5.3进行数据分析,主要结局指标包括高敏C反应蛋白、白细胞介素-6、最大摄氧量和SF-36量表指标。结果最终纳入25个随机对照试验包括1009名患者。Meta分析结果显示,运动可显著降低CKD患者hs CRP的水平(SMD=-0.23,95%CI:-0.45^-0.01,P=0.04),尤其是对于维持性血液透析患者,效果更佳(SMD=-0.58,95%CI:-0.94^-0.22,P=0.002),和CKD非透析患者相比,其差异具有统计学意义(P=0.01);降低CKD患者IL-6的水平0.75pg/m L;升高CKD患者Vo2max水平3.39m L/kg·min;并显著提升患者生活质量(WMD=46.34,95%CI:27.51~65.17,P<0.01)。结论运动疗法可显著降低慢性肾脏病患者炎症水平,提高患者最大摄氧量,改善心肺功能,并明显提升患者的生活质量,有助于患者身心健康。

Objective Chronic kidney disease(CKD)is a worldwide problem that threatens human health,and its incidence increases year by year.Some patients slowly life is obviously affected.The purpose of this study is to systematically assess the effects of physical exercise on inflammatory markers,VO2 max and quality of life in patients with CKD.Methods The Medline,Embase,Cochrane library and clinical trial registry were searched for the deadline of August 14,2017.The search term includes"exercise","chronic kidney disease","inflammatory factors","quality of life","maximal oxygen uptake","pulmonary function",and"randomized controlled trial".The JADAD scale was used to evaluate the methodological quality of the included literature,after extracting effective data,Revman5.3 was used to analyze the data,and the main outcome indexes included the high sensitive C reactive protein,interleukin-6,the maximum oxygen uptake and the SF-36 scale index.Results 25 randomized controlled trials were included,including 1009 patients.The results of Meta analysis showed that exercise significantly reduced the level of hsCRP in CKD patients(SMD=-0.23,95%CI:-0.45^-0.01,P=0.04),especially in maintenance hemodialysis patients(SMD=-0.58,95%CI:-0.94^-0.22,P=0.002),and the difference was statistically significant compared with those of non dialysis patients(P=0.01).It could reduce the IL-6 level 0.75pg/ml in CKD patients and increase Vo2max level 3.39mL/kg/min in CKD patients and significantly improve the quality of life(WMD=46.34,95%CI:27.51~65.17,P<0.01).Conclusion Exercise therapy can significantly reduce the level of inflammation in patients with chronic kidney disease,improve the maximum oxygen uptake,the cardiopulmonary function,the quality of life of the patients,and help the patients physical and mental health.