运动对改善中国老年冠心病人血脂、左心室功能水平的Meta分析

Country to Improve the Level of Clinical Coronary Heart Disease(CHD)People Blood Fat, Left Ventricular Function of Meta Study

目的:国内学者用有规律的运动,对提高临床无支架手术的冠心病患者的血脂、心脏功能水平的影响效果进行评价与诊断。方法:本文采用中国电子文献(万方、维普、知网、PUMBED、WebofScience、GoogleScholar,CochraneLibrary)数据资源库从1997年-2018年10月进行相关文章的检索,所有检索的文章筛选必须由临床冠心病临床医师进行质量评估是否纳入。本文采用循证医学中的系统评价方法进行研究,并用STATA软件进行meta统计学分析。结果:经筛选出24篇临床运动对冠心病人血脂及左心室功能(LEVF%指标)文献研究,研究样本共计1643人,其中实验组为823人,对照组820人。纳入研究中用较高等级方法学进行质量评估;其中高等级有12篇,中等研究有10篇,低质量研究1篇。Meta分析显示,运动相对实验组在稳定冠心病人的血脂水平SMD=-0.26(95%CL:-0.45,0.24,p=0.001)具有显著性差异;其中,高密度脂蛋白(HDL)含量提升效果明显SMD=0.64(95%CL:0.53,0.74,p=0.001);对提高左心室射血分数SMD=0.54(95%CL:0.41,0.67,p=0.001)具有显著性差异;但是异质性比较明显(I2血脂=88.2%、I2lvef%=76.6%)。通过meta回归分析可知,排除运动干预及相关因素的干预后,各组研究间异质性下降明显(I2血脂=60.32%、I2levf%=56.6%)。进一步亚组分析可知,运动强度对冠心病人提高血脂的稳定及心功能水平效果明显(SMD=0.114,95%CL:-0.123,0.362,p=0.00,随机效应模型)。在药物组中,相对其他药物阿司匹林对血脂的稳定和心功能水平的提高效果显著(SMD=0.006,95%CL:-0.361,0.112,p=0.00,随机效应模型)。结论:规律的运动对临床冠心病人的血脂指标稳定、左心室功能水平的提高具有显著性,尤其运动强度的选择对冠心病人的康复效果具有明显的提高,但由于各组间的异质性和发表偏倚的影响,什么样的强度的参照没有明确,因此,需要更多高质量的研究加以验证。

Objective:domestic scholars with regular exercise,to improve the clinical without stents the level of blood lipids,heart function in patients with coronary heart disease(CHD)effect evaluation and diagnosis.Methods:this article USES the Chinese electronic documents(ten thousand party)data repository from 1997-1997,October to retrieve related articles all retrieved articles screening must be conducted by clinical coronary heart disease clinical doctors quality assessment is included.In this paper,using evidence-based medicine system evaluation method in the study,using STATA software for Meta statistical analysis.Results:selected 24 clinical exercise on blood lipid and coronary heart disease left ventricular function(LEVF)%index literature research,research samples for a total of 1643 people,including the experimental group of 823 people,the control group of 820people.Integrated into the research with high grade quality assessment methodology;THE high grade 12,secondary research has 10,low quality study 1.Meta analysis showed that motion group relative experimental group in stable coronary heart disease,blood lipid level of SMD=0.26(95%CL:0.45,0.45,p=0.001)has a significant difference;Among them,the obvious effects of high-density lipoprotein(HDL)levels improve SMD=0.64(95%CL:0.53,0.74,p=0.001).To improve the left ventricular ejection fraction SMD=0.54(95%CL:0.41,0.67,p=0.001)has a significant difference;But evident heterogeneity of lipid(I2=88.2%,I2lvef%=76.6%).Excluded by a meta regression analysis shows that the movement after the intervention,intervention and the related factors between groups of research heterogeneity decreased obviously(I2ipid=60.32%,I2levf%=56.6%).Further subgroup analysis shows that the exercise intensity for coronary heart disease(CHD)improve the stability of blood lipid and heart function obviously(SMD=0.114,95%CL:0.114,0.362,p=0.00,random effects model).In the drug group,relative to other drugs aspirin effect on the stability of blood lipid and the improvement of heart function significantly(SMD=0.006,95%CL:0.006,0.112,p=0.00,random effects model).Conclusion:regular exercise for clinical coronary heart disease(CHD)of blood lipid index is stable,the improvement of left ventricular function is significant,especially the choice of intensity of the rehabilitation effect of person of coronary heart disease has obvious increase,but due to the heterogeneity and publication bias between the groups,the influence of the reference is not clear what kind of strength,therefore,need more high quality research verified.