太极拳运动疗法改善心肌梗死患者心功能的Meta分析

Taijiquan exercise improving heart function in patients with myocardial infarction(MI):a Meta-analysis

目的系统评价有关太极拳对心肌梗死患者干预的随机对照试验,以评估太极拳对心肌梗死患者的疗效和安全性。方法检索PubMed、EMbase、Web of Science、Cochrane图书馆、CNKI、维普及万方数据库收集相关研究。检索时间范围从建库到2019年7月。使用Cochrane偏倚风险评价工具评估纳入文章的偏倚风险。结果共纳入7项RCT,包括591例患者(分为太极拳组和对照组)。Meta分析结果显示:与对照组相比,太极拳组的左室射血分数(LVEF)更高(MD=7.07,95%CI:2.54~11.60,P<0.05);峰值摄氧量(VO2Peak)更高(MD=4.00,95%CI:1.49~6.51,P<0.05);生活质量水平更高[生活质量评价量表(SF-36),MD=23.88,95%CI:16.49~31.27,P<0.05)、明尼苏达生活质量量表(MD=-12.88,95%CI:-17.51^-8.09,P<0.05),其差异有统计学意义。太极拳组在6分钟步行试验(6MWT)距离长短略有改善(MD=91.92,95%CI:1.55~182.28,P=0.05),但在N末端脑钠肽前体(NT-proBNP,MD=-380.84,95%CI:-815.38~53.71,P>0.05)方面,其差异不具有统计学意义。在有安全性报告的研究中,未发生不良事件。结论本研究的证据表明太极拳运动疗法改善心肌梗死患者心功能是有效的,但由于纳入研究的样本量小,研究间显著的异质性较大,上述结论尚需开展更多大规模、高质量的随即对照试验予以证实。

Objective To review systematically the randomized controlled trials(RCT)about the interventional effect of Taijiquan exercise on myocardial infarction(MI)in order to review the curative effect and safety of Taijiquan exercise in MI patients.Methods The databases of PubMed,EMbase,Web of Science,Cochrane Library,CNKI,VIP and WanFang Data were retrieved for collecting relevant studies.The time range of retrieving was from database establishment to July 2019.The risk of bias of included studies was reviewed by applying Cochrane evaluation tools.Results There were totally 7 RCT included involved 591 patients(divided into Taijiquan group and control group).The results of Meta-analysis showed that LVEF was higher(MD=7.07,95%CI:2.54~11.60,P<0.05),peak oxygen consumption(VO2 peak)was higher(MD=4.00,95%CI:1.49~6.51,P<0.05),quality of life(QOL)was higher(SF-36,MD=23.88,95%CI:16.49~31.27,P<0.05),and scores of Minnesota Table of Quality of Life were higher(MD=-12.88,95%CI:-17.51^-8.09,P<0.05)in Taijiquan group than those in control group.6MWT was improved a little(MD=91.92,95%CI:1.55~182.28,P=0.05),but NT pro-BNP did not show statistical significance(MD=-380.84,95%CI:-815.38~53.71,P>0.05).There were no adverse events observed in safety report studies.Conclusion The evidence from this study indicates that Taijiquan exercise therapy is effective in improving heart function in MI patients.However,due to the small sample size and significant heterogeneity among studies,the above conclusion needs to be confirmed by more RCT with larger scale and higher quality.