4种中国传统健身运动疗法对中老年人骨质疏松症的网状Meta分析

Network Meta-analysis of Four Kinds of Traditional Chinese Fitness Exercises in the Treatment of Osteoporosis in the Elderly

目的:比较八段锦、太极拳、五禽戏、易筋经4种中国传统健身功法治疗中老年人骨质疏松症的临床疗效性。方法:全面检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统等中文数据库及The Cochrane Library、PubMed、EMBASE、Web of Science外文数据库,搜索公开发表此4种中国传统健身功法治疗骨质疏松症的临床随机对照试验(RCTS),检索时间均为自建库至2020年1月31日,筛选出符合纳入标准的研究,按照Cochrane 5.1手册标准对所纳入的研究进行文献质量评价与偏倚风险评估,采用ADDIS与R软件进行数据合并及网状Meta分析。结果:纳入35项RCT共计2281例患者,网状Meta分析结果显示,太极拳在增加患者骨密度总评分上的差异具有统计学意义[MD=0.64(0.83,2.03),P<0.05];针对增强患者Ward’s三角区、股骨大转子部位的骨密度方面,以太极拳治疗效果最显著,且差异具有统计学意义[MD=0.07(0.04,0.11),P<0.05;MD=0.06(0.01,0.14),P<0.05];针对增强患者腰椎L2-4、股骨颈部位的骨密度以及改善血清碱性磷酸酶(ALP)的骨代谢生化指标方面,皆以易筋经健身功法治疗效果最佳,差异具有统计学意义[MD=0.11(0.03,0.19),P<0.05;MD=0.09(0.01,0.17),P<0.05;MD=-1.62(-2.40,-0.84),P<0.05]。结论:4种中国传统健身功法治疗骨质疏松时的作用机制各有优势,皆具有较好的临床治疗表现,尽管研究表明太极拳为临床首选推荐的传统健身功法,对中老年人骨质疏松症患者具有很好的改善与防治作用,但明确的结论仍需要更多高质量随机对照文献予以验证,临床中可根据病人的具体特征进行准确选择应用。

Objective:To evaluate the clinical efficacy of four traditional Chinese fitness exercises(Baduanjin,Taijiquan,Wuqinxi and Yijinjing)in treatment of osteoporosis in middle-aged and elderly people.Methods:Searched the Chinese database including CNKI,CQVIP,WANFANG Data,CBM and the English database including the Cochrane Library,PubMed,EMBASE and Web of Science from inception to January 31st,2020,to collect randomized controlled trials(RCTs)about four traditional Chinese fitness exercises of clinical research.The review on quality and bias risk of included study were assessed by 5.1 standards in Cochrane Handbook.R and ADDIS software was used for statistical analysis and the results were compared by the network meta-analysis(NMA).Results:A total of thirty-five studies involving 2281 patients were included.The results of NMA showed that Taijiquan had statistical significance in increasing the total score of Bone Mineral Density(BMD)of patients[MD=0.64(0.83,2.03),P<0.05];Taijiquan had the most significant effect in enhancing the BMD of Ward’s triangle and greater trochanter of femur,and the difference was statistically significant[MD=0.07(0.04,0.11),P<0.05;MD=0.06(0.01,0.14),P<0.05].Regarding enhancing the BMD of lumbar L2-4,femoral neck and improving the biochemical index of bone metabolism of ALP in patients,the best of therapeutic effect of fitness skills was Yijinjing[MD=0.11(0.03,0.19),P<0.05;MD=0.09(0.01,0.17),P<0.05;MD=-1.62(-2.40,-0.84),P<0.05],and the difference was statistically significant.Conclusions:Four kinds of traditional Chinese physical exercises have their own advantages in the treatment of osteoporosis,and they all have better clinical treatment performance.Although this study concludes that Taijiquan may be the first recommended traditional Chinese physical exercise in clinical practice,which has good improvement,prevention and treatment effect on the middle-aged and elderly patients with osteoporosis,this conclusion is still immaturity and still needs further verification by high-quality randomized controlled trials.The clinical application can be accurately selected according to the specific characteristics of patients.