背景:慢性肾脏病(CKD)已成为越来越重要的公共卫生疾病,发病率和死亡率都很高。尽管已有多项研究探讨了抗阻运动对改善CKD患者预后的作用,研究的数量仍然有限,结果仍然存在争议。
目的:我们对随机对照试验(RCT)研究进行了荟萃分析,以评估抗阻运动对CKD患者的有效性。
方法:PubMed,Embase,从开始日期到2023年10月,搜索了Cochrane图书馆数据库。进行荟萃分析,评估12个主要指标,包括肾小球滤过率(GFR)(ml/(min•1.73m2)),C反应蛋白(CRP)(mg/L),血清肌酐(mg/dL),血红蛋白(g/dL),糖化血红蛋白,类型A1C(HBA1c)(%),高密度脂蛋白(HDL)(mg/dL),低密度脂蛋白(LDL)(mg/dL),步行6分钟(m),体重指数(BMI)(kg/m2),无脂质量(kg),脂肪质量(kg),握力(kgf)。
结果:16项RCT研究纳入本荟萃分析,来自875个记录。抗阻运动治疗的CKD患者GFR无明显变化(WMD1.82;95CI-0.59至4.23;P=0.139)。然而,步行6分钟(WMD89.93;95CI50.12至129.74;P=0.000),抗阻运动可显著改善无脂质量(WMD6.53;95CI1.14~11.93;P=0.018)和握力(WMD3.97;95CI1.89~6.05;P=0.000).抗阻运动治疗后,CRP(WMD-2.46;95CI-4.21至-0.72;P=0.006)和HBA1c(WMD-0.46;95CI-0.63至-0.29;P=0.000)水平明显下降。
结论:抗阻运动可以改善身体机能,代谢状况,CKD患者的炎症反应和心肺功能,具体反映在无脂肪质量指标的增加,握力,步行6分钟,以及HBA1c和CRP指标的下降。
BACKGROUND: Chronic kidney disease (CKD) has become an increasingly important public health disease with a high incidence rate and mortality. Although several studies have explored the effectiveness of resistance exercise in improving the prognosis of CKD patients, the number of studies is still limited and the results are still controversial.
OBJECTIVE: We conducted this meta-analysis of randomized controlled trials (RCT) studies to evaluate the effectiveness of resistance exercise on CKD patients.
METHODS: The PubMed, Embase, and Cochrane Library databases were searched from the inception date to October 2023. The meta-analysis was conducted to evaluate 12 main indicators, including glomerular filtration rate (GFR)(ml/(min•1.73m2)), C-reactive protein (CRP) (mg/L), serum creatinine (mg/dL), hemoglobin (g/dL), Glycosylated Hemoglobin, Type A1C (HBA1c) (%), high Density Lipoprotein (HDL) (mg/dL), low Density Lipoprotein (LDL) (mg/dL), 6-min walk(m), body mass index (BMI) (kg/m2), fat-free mass (kg), fat mass (kg), grip strength (kgf).
RESULTS: Sixteen RCT studies were included in this meta-analysis from 875 records. GFR exhibited no significant change in CKD patients treated with resistance exercise (WMD 1.82; 95%CI -0.59 to 4.23; P = 0.139). However, 6-min walk (WMD 89.93; 95%CI 50.12 to 129.74; P = 0.000), fat-free mass (WMD 6.53; 95%CI 1.14 to 11.93; P = 0.018) and grip strength (WMD 3.97; 95%CI 1.89 to 6.05; P = 0.000) were significantly improved with resistance exercise. The level of CRP (WMD - 2.46; 95%CI -4.21 to -0.72; P = 0.006) and HBA1c (WMD - 0.46; 95%CI -0.63 to -0.29; P = 0.000) dropped significantly after resistance exercise treatment.
CONCLUSIONS: Resistance exercise can improve physical function, metabolic condition, inflammatory response and cardiopulmonary function in CKD patients, specifically reflected in the increase of indicators fat-free mass, grip strength, 6-min walk, as well as the decrease of indicators HBA1c and CRP.