康复运动对肌萎缩侧索硬化患者躯体功能影响的Meta分析

Effects of rehabilitation exercise training on somatic function in patients with amyotrophic lateral sclerosis:A Meta-analysis

目的:系统评价康复运动治疗肌萎缩侧索硬化(ALS)患者躯体功能障碍的临床疗效及安全性。方法:计算机检索相关中英文数据库有关康复运动治疗ALS的随机对照研究(RCT),使用柯克兰偏倚风险评估工具对纳入文献进行质量评价和偏倚风险评估,利用Cochrane RevMan软件5.4进行统计分析,使用合并率和95%置信区间(CI)评估结局指标。结果:共纳入11篇英文文献,包括481例ALS患者,其中试验组包括耐力训练、阻力训练、有氧运动、呼吸训练器,对照组为简单关节牵伸活动、无阻力呼吸训练器等。Meta分析结果显示:试验组1~3月的ALS功能评定量表(ALSFRS-R)评分优于对照组。试验组6月、10~12月ALSFRS-R、用力肺活量预计值(FVC%)、ALS生活质量评分(ALSSQOL-R)、0~3月疲劳严重程度评分(FSS)、6~10月(FSS)、四肢总体肌力评分、上肢总体肌力评分、下肢总体肌力评分与对照组相比差异无统计学意义。结论:1~3月短期内的康复运动能够改善早中期ALS患者ALSFRS-R量表中的整体功能,但长周期康复运动的临床获益仍需开展大样本高质量的临床研究来提供强有力的证据支撑。

Objective:To systematically evaluate the efficacy and safety of exercise in treatment of amyotrophic lateral sclerosis patients with physical dysfunction.Methods:Randomized controlled studies of exercise training in the treatment of ALS were included in the Chinese and English database.The quality of literature and the risk of bias were evaluated by Cochrane Risks of Bias.The outcome index data were evaluated by merger rate and 95%CI.Results:A total of 11 English articles were included,including 481 patients with ALS.Endurance training,resistance training,aerobic exercise and breathing training apparatus were carried out in experimental group,while simple joint traction and non-resistance breathing training apparatus were used in the control group.The results showed that the ALSFRS-R score in the experimental group from 1 to 3 months was better than that in the control group[MD=-0.68,95%CI(-2.01,3.40),Z=7.66,P<0.01].There was no significant difference in ALSFRS-R score,FVC% predicted value,ALSSQoL-R quality of life score,FSS score from 0 to 3 months,FSS score from 6 to 10 months,total muscle strength score of extremities,total muscle strength score of upper limb and total muscle strength score of lower limbs between two groups.Conclusion:The short-term rehabilitation exercise of 1-3 months can improve the overall function of ALSFRS-R scale in early and middle stage.However,the clinical benefits of long-term rehabilitation need to be supported by large-sample and high-quality clinical studies.