太极拳锻炼防治骨质疏松症的Meta分析

Tai Chi Chuan exercises for prevention and treatment of osteoporosis:a meta analysis

目的:评价太极拳锻炼防治骨质疏松症的有效性。方法:计算机检索PubMed、Web of science、The Cochrane Library、Embase、中国生物医学文献数据库、维普网、万方数据库、中国知网收录的太极拳锻炼防治骨质疏松症的随机对照试验文献,检索时限为建库至2020年7月15日。对照组不干预或口服常规抗骨质疏松药物,试验组在对照组的基础上联合太极拳锻炼干预。由2名研究人员独立检索、筛选文献,提取资料并评价纳入研究的偏倚风险。采用Revman5.3软件进行Meta分析。结果:共纳入18篇文献。Meta分析结果显示,试验组腰椎骨密度改善程度优于对照组[I^(2)=0%,P=0.960;SMD=0.17,95%CI(0.01,0.33),P=0.030],股骨颈骨密度改善程度优于对照组[I^(2)=0%,P=0.910;SMD=0.24,95%CI(0.09,0.38),P=0.001],Ward三角骨密度改善程度优于对照组[I^(2)=0%,P=0.730;SMD=0.21,95%CI(-0.00,0.43),P=0.050],2组患者股骨大转子骨密度改善程度的差异无统计学意义[I^(2)=0%,P=0.720;SMD=0.14,95%CI(-0.08,0.36),P=0.210];2组患者的跟骨超声振幅衰减改善程度、跟骨骨质指数改善程度比较,组间差异均无统计学意义[I^(2)=0%,P=0.980;SMD=0.13,95%CI(-0.24,0.50),P=0.490;I^(2)=0%,P=0.940;SMD=0.11,95%CI(-0.26,0.47),P=0.570];试验组跟骨超声传播速度改善程度优于对照组[I^(2)=0%,P=0.980;SMD=0.50,95%CI(-0.13,0.87),P=0.009];试验组血清钙浓度改善程度优于对照组[I^(2)=0%,P=0.860;SMD=-0.33,95%CI(-0.58,-0.07),P=0.010];2组患者的血清磷浓度和血清碱性磷酸酶浓度改善程度比较,组间差异均无统计学意义[I^(2)=0%,P=0.980;SMD=0.09,95%CI(-0.16,0.34),P=0.480;I^(2)=0%,P=0.610;SMD=-0.01,95%CI(-0.27,0.24),P=0.930];试验组的治疗有效率高于对照组[I^(2)=0%,P=0.680;RR=11.74,95%CI(3.71,37.17),P=0.000]。利用股骨颈骨密度作发表偏倚分析,结果显示漏斗图上各研究点分布基本对称,提示存在发表偏倚的可能性较小。结论:现有的证据表明,太极拳锻炼可以有效提高锻炼者的骨密度,改善骨代谢,对骨质疏松症有较好的防治作用。

Objective:To review the clinical efficacy of Tai Chi Chuan(TCC)exercises in prevention and treatment of osteoporosis(OP).Methods:All randomized controlled trial(RCT)articles about TCC exercises for prevention and treatment of OP included from database establishing to July 15,2020 were retrieved from PubMed, Web of science, The Cochrane Library, Embase, Chinese biomedical literature database, VIP Database, WanFang Database and China national knowledge internet through computer.All patients in the 2 groups were treated with oral application of conventional anti-osteoporosis drugs or not given any intervention;moreover, the patients in experimental group were treated with TCC exercises.The articles were retrieved and screened and the information was extracted independently by two searchers.The risk of bias of included researches in the articles was assessed and a Meta-analysis was conducted by using Revman5.3 software.Results:Eighteen articles were included in the final analysis.The results of Meta-analysis demonstrated that the degree of improvement in bone mineral density(BMD)of lumbar vertebrae, femoral neck and Ward’s triangle were better in experimental group compared to control group(I2=0%,P=0.960;SMD=0.17,95%CI(0.01,0.33),P=0.030;I2=0%,P=0.910;SMD=0.24,95%CI(0.09,0.38),P=0.001;I2=0%,P=0.730;SMD=0.21,95%CI(-0.00,0.43),P=0.050).There was no statistical difference in the degree of improvement in BMD of greater trochanter of femur between the 2 groups(I2=0%,P=0.720;SMD=0.14,95%CI(-0.08,0.36),P=0.210).There was no statistical difference in the degree of improvement in broadband ultrasound attenuation(BUA)and bone quality index(BQI) of calcaneus between the 2 groups(I2= 0%,P = 0. 980;SMD = 0. 13,95% CI(-0. 24,0. 50),P = 0. 490;I^2= 0%,P = 0. 940;SMD = 0. 11,95% CI(-0. 26,0. 47),P = 0. 570). The degree of improvement in speed of ultrasound(SOU) in calcaneus was better in experimental group compared to control group(I2= 0%,P = 0. 980;SMD = 0. 50,95% CI(-0. 13,0. 87),P = 0. 009). The degree of improvement in serum concentration of calcium was better in experimental group compared to control group(I^2= 0%,P = 0. 860;SMD =-0. 33,95% CI(-0. 58,-0. 07),P = 0. 010). There was no statistical difference in the degree of improvement in serum concentrations of Phosphorus and alkaline phosphatase(ALP) between the 2 groups(I2= 0%,P = 0. 980;SMD = 0. 09,95% CI(-0. 16,0. 34),P = 0. 480;I^2= 0%,P = 0. 610;SMD =-0. 01,95% CI(-0. 27,0. 24),P = 0. 930). The clinical curative effective rate was higher in experimental group compared to control group(I^2= 0%,P = 0. 680;RR = 11. 74,95% CI(3. 71,37. 17),P = 0. 000). Publication bias was analyzed according to femoral neck BMD,and the basically symmetrical funnel plot demonstrated that publication bias was a remote possibility. Conclusion: Available evidences suggest that TCC exercises can effectively increase BMD and improve bone metabolism in exercisers,and it has good preventive and therapeutic effects on OP.