Xiong Xingjiang, Wang Pengqian, Li Xiaoke, Zhang Yuqing
From the Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences (XX); Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA, USA (XL); Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences (PW), Beijing, China; Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (YZ).
Medicine (Baltimore). 2015 Jan;94(1):e352. doi: 10.1097/MD.0000000000000352.
The purpose of this review was to evaluate the efficacy and safety of qigong for hypertension.A systematic literature search was performed in 7 databases from their respective inceptions until April 2014, including the Cochrane Library, EMBASE, PubMed, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang database, and Chinese National Knowledge Infrastructure. Randomized controlled trials of qigong as either monotherapy or adjunctive therapy with antihypertensive drugs versus no intervention, exercise, or antihypertensive drugs for hypertension were identified. The risk of bias was assessed using the tool described in Cochrane Handbook for Systematic Review of Interventions, version 5.1.0.Twenty trials containing 2349 hypertensive patients were included in the meta-analysis. The risk of bias was generally high. Compared with no intervention, qigong significantly reduced systolic blood pressure (SBP) (weighted mean difference [WMD] = -17.40 mm Hg, 95% confidence interval [CI] -21.06 to -13.74, P < 0.00001) and diastolic blood pressure (DBP) (WMD = -10.15 mm Hg, 95% CI -13.99 to -6.30, P < 0.00001). Qigong was inferior to exercise in decreasing SBP (WMD = 6.51 mm Hg, 95% CI 2.81 to 10.21, P = 0.0006), but no significant difference between the effects of qigong and exercise on DBP (WMD = 0.67 mm Hg, 95% CI -1.39 to 2.73, P = 0.52) was identified. Compared with antihypertensive drugs, qigong produced a clinically meaningful but not statistically significant reduction in SBP (WMD = -7.91 mm Hg, 95% CI -16.81 to 1.00, P = 0.08), but appeared to be more effective in lowering DBP (WMD = -6.08 mm Hg, 95% CI -9.58 to -2.58, P = 0.0007). Qigong plus antihypertensive drugs significantly lowered both SBP (WMD = -11.99 mm Hg, 95% CI -15.59 to -8.39, P < 0.00001) and DBP (WMD = -5.28 mm Hg, 95% CI, -8.13 to -2.42, P = 0.0003) compared with antihypertensive drugs alone. No serious adverse events were reported.The meta-analysis suggests that qigong is an effective therapy for hypertension. However, more rigorously designed randomized controlled trials with long-term follow-up focusing on hard clinical outcomes are required to confirm the results.
本综述的目的是评估气功治疗高血压的疗效和安全性。从各数据库建库起至2014年4月,对7个数据库进行了系统的文献检索,包括考克兰图书馆、EMBASE、PubMed、中国科学期刊数据库、中国生物医学文献数据库、万方数据库和中国知网。纳入了关于气功作为单一疗法或与降压药联合治疗高血压,对比无干预、运动或单纯降压药治疗的随机对照试验。使用《考克兰系统评价干预措施手册》第5.1.0版中描述的工具评估偏倚风险。荟萃分析纳入了20项试验,共2349例高血压患者。偏倚风险总体较高。与无干预相比,气功显著降低收缩压(加权均数差[WMD] = -17.40 mmHg,95%置信区间[CI] -21.06至-13.74,P < 0.00001)和舒张压(WMD = -10.15 mmHg,95% CI -13.99至-6.30,P < 0.00001)。在降低收缩压方面,气功不如运动有效(WMD = 6.51 mmHg,95% CI 2.81至10.21,P = 0.0006),但在降低舒张压方面,气功与运动的效果无显著差异(WMD = 0.67 mmHg,95% CI -1.39至2.73,P = 0.52)。与降压药相比,气功使收缩压有临床意义的降低,但无统计学显著性(WMD = -7.91 mmHg,95% CI -16.81至1.00,P = 0.08),但在降低舒张压方面似乎更有效(WMD = -6.08 mmHg,95% CI -9.58至-2.58,P = 0.0007)。与单纯降压药相比,气功联合降压药显著降低收缩压(WMD = -11.99 mmHg,95% CI -15.59至-8.39,P < 0.00001)和舒张压(WMD = -5.28 mmHg,95% CI -8.13至-2.42,P = 0.0003)。未报告严重不良事件。荟萃分析表明,气功是治疗高血压的有效疗法。然而,需要更严格设计、长期随访并关注硬临床结局的随机对照试验来证实这些结果。