Shu Chenjie, Feng Shuo, Cui Qingyu, Cheng Sifan, Wang Yun
School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China; Beijing Institute of Traditional Chinese Medicine, Beijing, China.
Ann Palliat Med. 2021 Jul;10(7):7468-7478. doi: 10.21037/apm-21-640.
Previous studies have reported that C reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) in Coronavirus disease 2019 (COVID-19) patients are significantly increased, and their progressive increases are clinical warning indicators of severe and critical severity. The purpose of this meta-analysis is to evaluate the efficacy of Tai Chi on CRP, TNF-alpha and IL-6, and provide a basis for complementary treatment of COVID-19.
Five English databases (PubMed, Web of Science, Physiotherapy Evidence Database, Cochrane Library and Embase) and four Chinese electronic databases (CNKI, Wanfang, China Science and Technology Journal Database and SinoMed) were searched from inception to April 1st, 2020. Combination MeSH and free text terms were used to make up search strategy. Interventions in RCTs were Tai Chi with or without comparison (usual care, health education, drug therapy, psychosocial therapy). Revman version 5.3 was used to analyze the extracted data. Continuous outcomes were described by SMD, and the I2 test was used to assess heterogeneity. Revised Physiotherapy Evidence Database scale was used to assess methodological quality.
Nine RCTs involving 571 participants met the inclusion criteria, and the sample size ranged from 19 to 100 per study. Tai Chi can significantly reduce TNF-alpha (Tai Chi intervention: SMD =-0.92, 95% CI: -1.32 to -0.53; Tai Chi plus drug treatment intervention: SMD =-0.63, 95% CI: -1.15 to -0.11), moreover, it could reduce the amount of IL-6 (Tai Chi intervention: SMD =-0.62, 95% CI: -1.00 to -0.23; Tai Chi plus drug treatment intervention: SMD =-2.17, 95% CI: -3.69 to -0.64) and CRP (Tai Chi plus drug treatment intervention: SMD =-1.98, 95% CI: -2.47 to -1.50) while with a high exercise amount. A low exercise amount of Tai Chi showed poor efficacy on CRP (Tai Chi intervention: SMD =-0.18, 95% CI: -0.61 to 0.25; Tai Chi plus drug treatment intervention: SMD =-0.15, 95% CI: -0.47 to 0.16) and IL-6 (Tai Chi intervention: SMD =0.15, 95% CI: -0.24 to 0.55).
The strength of evidence might be limited due to relatively low methodological quality, heterogeneity and indirectness. The overall results elucidate that Tai Chi could significantly reduce TNF-alpha while it did not show the same effects in IL-6 and CRP. After subgroup analysis, Tai Chi with a high exercise amount can reduce IL-6 and CRP. Tai Chi with a high exercise amount could be suggested as a complementary intervention for people with COVID-19.
PROSPERO CRD42020177655.
既往研究报道，2019冠状病毒病（COVID-19）患者的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）显著升高，其进行性升高是重症和危重症的临床警示指标。本荟萃分析的目的是评估太极拳对CRP、TNF-α和IL-6的疗效，为COVID-19的辅助治疗提供依据。
检索5个英文数据库（PubMed、Web of Science、物理治疗证据数据库、Cochrane图书馆和Embase）和4个中文电子数据库（中国知网、万方、中国科技期刊数据库和中国生物医学文献数据库），检索时间从建库至2020年4月1日。采用主题词与自由词相结合的方式制定检索策略。随机对照试验（RCT）中的干预措施为太极拳，有或无对照（常规护理、健康教育、药物治疗、心理社会治疗）。采用Revman 5.3软件对提取的数据进行分析。连续变量结果用标准化均数差（SMD）描述，I²检验用于评估异质性。采用修订的物理治疗证据数据库量表评估方法学质量。
9项RCT共571例参与者符合纳入标准，每项研究的样本量为19至100例。太极拳能显著降低TNF-α（太极拳干预：SMD=-0.92，95%CI：-1.32至-0.53；太极拳加药物治疗干预：SMD=-0.63，95%CI：-1.15至-0.11），此外，在运动量较大时，它还能降低IL-6（太极拳干预：SMD=-0.62，95%CI：-1.00至-0.23；太极拳加药物治疗干预：SMD=-2.17，95%CI：-3.69至-0.64）和CRP（太极拳加药物治疗干预：SMD=-1.98，95%CI：-2.47至-1.50）。低运动量的太极拳对CRP（太极拳干预：SMD=-0.18，95%CI：-0.61至0.25；太极拳加药物治疗干预：SMD=-0.15，95%CI：-0.47至0.16）和IL-6（太极拳干预：SMD=0.15，95%CI：-0.24至0.55）的疗效较差。
由于方法学质量相对较低以及存在异质性和间接性，证据强度可能有限。总体结果表明，太极拳能显著降低TNF-α，但对IL-6和CRP未显示出相同效果。亚组分析后发现，高运动量的太极拳可降低IL-6和CRP。对于COVID-19患者，建议将高运动量的太极拳作为一种辅助干预措施。
PROSPERO CRD42020177655。
