透析中有氧运动对患者透析充分性、微炎症状态及白蛋白水平影响的Meta分析
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摘要
目的评价透析中有氧运动对维持性血液透析(MHD)患者透析充分性、微炎症状态及白蛋白水平的影响。方法检索PubMed、Embase、Cochrane图书馆、中国知网、万方、维普等数据库,筛选建库至2018年1月31日的文献,最终纳入19篇文献(均为随机对照试验),采用RevMan 5.1统计软件进行Meta分析。结果 Meta分析结果显示,透析中有氧运动在改善MHD患者透析充分性(MD=0.07,95%CI:0.02～0.12)、微炎症状态(SMD=-1.56,95%CI:-3.03～-0.10)、血清白蛋白(MD=-1.27,95%CI:-2.22～-0.32)、抑郁状态(SMD=-1.27,95%CI:-2.30～-0.24)、疲乏(MD=-2.38,95%CI:-2.72～-2.03)、睡眠情况(SMD=-0.79,95%CI:-1.52～-0.07)等方面有优势,差异均有统计学意义(均P<0.05);但在Hb、TC方面,实验组与对照组比较差异均无统计学意义(均P>0.05)。结论透析中有氧运动能显著改善MHD患者透析充分性、微炎症状态、血清白蛋白水平及抑郁、疲乏、睡眠状况,但在Hb、TC等方面的优势不明显。
Objective To evaluate the effect of intradialytic aerobic exercise on the dialysis efficacy, inflammation status and albumin in patients on maintenance hemodialysis. Methods Randomized controlled trials(RCT) of intradialytic aerobic exercise intervention in patients on maintenance hemodialysis were collected by searching PubMed, Embase and Cochrane library, CNKI,Wanfang, and VIP databases from the inception to January 2018. Nineteen randomized controlled trials were included.Rev-Man 5.1 software was used for meta-analysis. Results Meta-analysis showed that compared with the control group, the intradialytic aerobic exercise significantly improved the dialysis efficacy(MD=0.07, 95%CI:0.02～0.12), inflammation status(SMD=-1.56, 95%CI:-3.03～-0.10),serum albumin(MD=-1.27, 95%CI:-2.22～-0.32), the depression level(SMD=-1.27, 95%CI:-2.30～-0.24), the fatigue level(MD=-2.38, 95%CI:-2.72～-2.03) and the sleep quality(SMD=-0.79, 95%CI:-1.52～-0.07) of the patients on maintenance hemodialysis(all P<0.05). However, in the levels of Hb and TC, there was no significant difference between two groups(both P >0.05). Conclusion Intradialytic aerobic exercise can significantly improve dialysis efficacy, inflammation status, serum albumin, depression, fatigueand sleep quality in patientson maintenance hemodialysis, but not change of the Hb and TC in patients.
Objective To evaluate the effect of intradialytic aerobic exercise on the dialysis efficacy, inflammation status and albumin in patients on maintenance hemodialysis. Methods Randomized controlled trials(RCT) of intradialytic aerobic exercise intervention in patients on maintenance hemodialysis were collected by searching PubMed, Embase and Cochrane library, CNKI,Wanfang, and VIP databases from the inception to January 2018. Nineteen randomized controlled trials were included.Rev-Man 5.1 software was used for meta-analysis. Results Meta-analysis showed that compared with the control group, the intradialytic aerobic exercise significantly improved the dialysis efficacy(MD=0.07, 95%CI:0.02～0.12), inflammation status(SMD=-1.56, 95%CI:-3.03～-0.10),serum albumin(MD=-1.27, 95%CI:-2.22～-0.32), the depression level(SMD=-1.27, 95%CI:-2.30～-0.24), the fatigue level(MD=-2.38, 95%CI:-2.72～-2.03) and the sleep quality(SMD=-0.79, 95%CI:-1.52～-0.07) of the patients on maintenance hemodialysis(all P<0.05). However, in the levels of Hb and TC, there was no significant difference between two groups(both P >0.05). Conclusion Intradialytic aerobic exercise can significantly improve dialysis efficacy, inflammation status, serum albumin, depression, fatigueand sleep quality in patientson maintenance hemodialysis, but not change of the Hb and TC in patients.
引文
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[3]黄柳,黄燕林,李建英,等.有氧运动对维持性血液透析患者营养状况的影响[J].广东医学, 2015,36(5):814-816.
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[8]van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands:results of a randomized clinical trial[J]. Nephrol Dial Transplant, 2005, 20(1):141-146. DOI:10.1093/ndt/gfh560.
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[11]Reboredo MM, Pinheiro BV, Neder JA, et al. Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients[J]. J Bras Nefrol, 2010,32(4):367-373. DOI:10.1590/S0101-28002010000400006.
[12]Wilund KR, Tomayko EJ, Wu PT, et al. Intradialytic exercise training reduces oxidative stress and epicardial fat:a pilot study[J]. Nephrol Dial Transplant,2010,25(8):2695-2701.DOI:10.1093/ndt/gfq106.
[13]Afshar R, Emany A, Saremi A, et al. Effects of intradialytic aerobic training on sleep quality in hemodialysis patients[J]. Iran J Kidney Dis, 2011,5(2):119-123.
[14]Makhlough A, Ilali E, Mohseni R, et al. Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients[J]. Iran J Kidney Dis, 2012,6(2):119-123.
[15]de Lima MC, Cicotoste CL, Cardoso KS, et al. Effect of exercise performed during hemodialysis:strength versus aerobic[J]. Ren Fail,2013,35(5):697-704. DOI:10.3109/0886022X.2013.780977.
[16]Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome[J].NephrolDialTransplant,2013,28(11):2834-2840. DOI:10.1093/ndt/gft288.
[17]Giannaki CD, Sakkas GK, Christina K, et al. Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome:a six-month randomized, partially double-blind,placebo-controlled comparative study[J]. BMC Nephrol, 2013,14(1):194. DOI:10.1186/1471-2369-14-194.
[18]Mohseni R, Emami ZA, Ilali E, et al. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients:a randomized controlled trial[J]. Oman Med J, 2013, 28(5):345-349. DOI:10.5001/omj.2013.99.
[19]Momeni A, Nematolahi A, Nasr M. Effect of intradialytic exercise on echocardiographic findings in hemodialysis patients[J]. Iran J Kidney Dis, 2014,8(3):207-211.
[20]王新美,朱小玲,许敏,等.有氧运动对终末期肾病血液透析患者微炎症状态及透析相关性疲乏影响研究[J].交通医学, 2015, 29(4):360-362.
[21]尹诗,万芳.透析过程运动对维持性血液透析患者微炎症状态的影响[J].现代临床护理, 2016,15(8):54-58. DOI:10.3969/j.issn.1671-8283.2016.07.013.
[22]陶海燕,陆燕,陈怡.低强度有氧康复运动对慢性肾功能不全血液透析患者脂代谢透析效果及透析相关疲乏感的影响[J].山西医药杂志, 2017,46(7):857-859. DOI:10.3969/j.issn.0253-9926.2017.07.049.
[23]As'Habi A, Tabibi H, Hedayati M, et al. Association of malnutrition-inflammation score, dialysis-malnutrition score and serum albumin with novel risk factors for cardiovascular diseases in hemodialysis patients[J]. Ren Fail, 2015,37(1):113-116. DOI:10.3109/0886022X.2014.967615.
[24]尹丽霞,胡晓艳,张海林,等.透析中运动对维持性血液透析患者透析充分性及睡眠质量的影响[J].中国护理管理, 2017, 17(11):1478-1481. DOI:10.3969/j.issn.1672-1756.2017.11.008.
[25]焦占峰.维持性血液透析患者微炎症状态研究的意义及进展[J].中国血液净化,2010,9(12):675-677.DOI:10.3969/j.issn.1671-4091.2010.12.013.
[26]王梦平,曾炎,王明初,等.维持性血液透析患者贫血治疗效果的影响因素分析[J].山东医药, 2017(47):56-59. DOI:10.3969/j.issn.1002-266X.2017.47.017.
[27]Najafi A, Keihani S, Bagheri N, et al. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis[J]. Iran J Psychiatry Behav Sci, 2016, 10(2):e4962. DOI:10.17795/ijpbs-4962.
[28]范汝艳,张红梅,常立阳.太极拳运动对血液透析患者焦虑抑郁状态和睡眠质量的影响[J].中国血液净化, 2016, 15(4):241-243. DOI:10.3969/j.issn.1671-4091.2016.04.012.
[29]梁燕萍,肖翠艳,侯永梅.运动疗法对维持性血液透析患者睡眠质量的影响[J].广东医学院学报, 2011, 29(6):618-620. DOI:10.3969/j.issn.1005-4057.2011.06.010.
[2]刘文琴,曹灵.血小板反应蛋白-1与维持性血液透析患者微炎症状态的相关性[J].实用医学杂志, 2017, 33(5):774-777. DOI:10.3969/j.issn.1006.5725.2017.05.027.
[3]黄柳,黄燕林,李建英,等.有氧运动对维持性血液透析患者营养状况的影响[J].广东医学, 2015,36(5):814-816.
[4]Workgroup KD. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients[J]. Am J Kidney Dis,2005,45(3):1-153. DOI:10.1053/j.ajkd.2005.01.019.
[5]Koufaki P, Mercer TH, Naish PF. Effects of exercise training on aerobic and functional capacity of end-stage renal disease patients[J]. Clin Physiol Funct Imaging, 2002,22(2):115-124. DOI:10.1046/j.1365-2281.2002.00405.x.
[6]Painter P, Moore G, Carlson L, et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life[J]. Am J Kidney Dis, 2002,39(2):257-265. DOI:10.1053/ajkd.2002.30544.
[7]Parsons TL, Toffelmire EB, Kingvanvlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease(ESRD)patients[J]. Clin Nephrol, 2004,61(4):261-274.
[8]van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands:results of a randomized clinical trial[J]. Nephrol Dial Transplant, 2005, 20(1):141-146. DOI:10.1093/ndt/gfh560.
[9]Petraki M, Kouidi E, Grekas D, et al. Effects of exercise training during hemodialysis on cardiac baroreflex sensitivity[J]. Clin Nephrol, 2008,70(3):210-219. DOI:10.5414/CNP70210.
[10]Afshar R, Shegarfy L, Shavandi N, et al. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis[J]. Indian J Nephrol, 2010,20(4):185-189. DOI:10.4103/0971-4065.73442.
[11]Reboredo MM, Pinheiro BV, Neder JA, et al. Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients[J]. J Bras Nefrol, 2010,32(4):367-373. DOI:10.1590/S0101-28002010000400006.
[12]Wilund KR, Tomayko EJ, Wu PT, et al. Intradialytic exercise training reduces oxidative stress and epicardial fat:a pilot study[J]. Nephrol Dial Transplant,2010,25(8):2695-2701.DOI:10.1093/ndt/gfq106.
[13]Afshar R, Emany A, Saremi A, et al. Effects of intradialytic aerobic training on sleep quality in hemodialysis patients[J]. Iran J Kidney Dis, 2011,5(2):119-123.
[14]Makhlough A, Ilali E, Mohseni R, et al. Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients[J]. Iran J Kidney Dis, 2012,6(2):119-123.
[15]de Lima MC, Cicotoste CL, Cardoso KS, et al. Effect of exercise performed during hemodialysis:strength versus aerobic[J]. Ren Fail,2013,35(5):697-704. DOI:10.3109/0886022X.2013.780977.
[16]Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome[J].NephrolDialTransplant,2013,28(11):2834-2840. DOI:10.1093/ndt/gft288.
[17]Giannaki CD, Sakkas GK, Christina K, et al. Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome:a six-month randomized, partially double-blind,placebo-controlled comparative study[J]. BMC Nephrol, 2013,14(1):194. DOI:10.1186/1471-2369-14-194.
[18]Mohseni R, Emami ZA, Ilali E, et al. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients:a randomized controlled trial[J]. Oman Med J, 2013, 28(5):345-349. DOI:10.5001/omj.2013.99.
[19]Momeni A, Nematolahi A, Nasr M. Effect of intradialytic exercise on echocardiographic findings in hemodialysis patients[J]. Iran J Kidney Dis, 2014,8(3):207-211.
[20]王新美,朱小玲,许敏,等.有氧运动对终末期肾病血液透析患者微炎症状态及透析相关性疲乏影响研究[J].交通医学, 2015, 29(4):360-362.
[21]尹诗,万芳.透析过程运动对维持性血液透析患者微炎症状态的影响[J].现代临床护理, 2016,15(8):54-58. DOI:10.3969/j.issn.1671-8283.2016.07.013.
[22]陶海燕,陆燕,陈怡.低强度有氧康复运动对慢性肾功能不全血液透析患者脂代谢透析效果及透析相关疲乏感的影响[J].山西医药杂志, 2017,46(7):857-859. DOI:10.3969/j.issn.0253-9926.2017.07.049.
[23]As'Habi A, Tabibi H, Hedayati M, et al. Association of malnutrition-inflammation score, dialysis-malnutrition score and serum albumin with novel risk factors for cardiovascular diseases in hemodialysis patients[J]. Ren Fail, 2015,37(1):113-116. DOI:10.3109/0886022X.2014.967615.
[24]尹丽霞,胡晓艳,张海林,等.透析中运动对维持性血液透析患者透析充分性及睡眠质量的影响[J].中国护理管理, 2017, 17(11):1478-1481. DOI:10.3969/j.issn.1672-1756.2017.11.008.
[25]焦占峰.维持性血液透析患者微炎症状态研究的意义及进展[J].中国血液净化,2010,9(12):675-677.DOI:10.3969/j.issn.1671-4091.2010.12.013.
[26]王梦平,曾炎,王明初,等.维持性血液透析患者贫血治疗效果的影响因素分析[J].山东医药, 2017(47):56-59. DOI:10.3969/j.issn.1002-266X.2017.47.017.
[27]Najafi A, Keihani S, Bagheri N, et al. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis[J]. Iran J Psychiatry Behav Sci, 2016, 10(2):e4962. DOI:10.17795/ijpbs-4962.
[28]范汝艳,张红梅,常立阳.太极拳运动对血液透析患者焦虑抑郁状态和睡眠质量的影响[J].中国血液净化, 2016, 15(4):241-243. DOI:10.3969/j.issn.1671-4091.2016.04.012.
[29]梁燕萍,肖翠艳,侯永梅.运动疗法对维持性血液透析患者睡眠质量的影响[J].广东医学院学报, 2011, 29(6):618-620. DOI:10.3969/j.issn.1005-4057.2011.06.010.