An Qin-Yan, Wang Lan, Yuan Ping, Zhao Qin-Hua, Gong Su-Gang, Zhang Rui, He Jing, Luo Ci-Jun, Qiu Hong-Ling, Li Hui-Ting, Liu Jin-Ming, Wang Jing-Jing, Cheng Kuan, Jiang Rong
Department of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Palliat Med. 2021 Jul;10(7):8134-8146. doi: 10.21037/apm-21-1758.
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) still have impaired exercise training and quality of life (QoL) despite pulmonary arterial hypertension (PAH)-targeted drugs. Exercise training is considered to improve exercise capacity and QoL in patients with pulmonary hypertension (PH), but this has not been fully studied in CTEPH patients. We conducted the meta-analysis and systematic review to evaluate the effectiveness and safety of exercise training in patients with CTEPH.
The relevant literature was retrieved for the meta-analysis using the PubMed, EMBASE, and Cochrane Library databases published before December 2020. The primary outcome was a change in six-minute walk distance (6MWD). We also assessed the effect of exercise training on peak oxygen uptake per kilogram (peak VO2/kg), mean pulmonary artery pressure (mPAP) assessed by right heart catheterization (RHC), N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and QoL.
A total of 6 studies with 234 exercise training patients were included. In the pooled analysis, 6MWD significantly improved by 70.14 m (WMD: 58.33 to 81.95, I2=0) after 3-week exercise training. After 12 or 15-week exercise training, 6MWD and peak VO2/kg significantly improved (WMD: 106.22 m, 95% CI: 65.90 to 146.55, I2=87.4%, P<0.0001; 1.84 mL/min/kg, 95% CI: 0.72 to 2.96, P=0.001, respectively). Furthermore, the mPAP decreased by 12.17 mmHg after 12-week exercise training (95% CI: -14.53 to -9.82, P<0.001, I2=99%). The subscales of QoL such as physical function, general health perception, and mental health improved in varying degrees. NT-proBNP did not improve significantly in the pooled analysis. In addition, exercise training was well tolerated without major adverse events occurred during training, and the dropout rate was low.
Exercise training may improve exercise capacity, mPAP, and QoL, and was well tolerated among patients with CTEPH. However, more large-scale multicenter studies are needed to confirm the effectiveness and safety of exercise training in patients with CTEPH.
尽管使用了肺动脉高压（PAH）靶向药物，但慢性血栓栓塞性肺动脉高压（CTEPH）患者的运动训练和生活质量（QoL）仍受损。运动训练被认为可改善肺动脉高压（PH）患者的运动能力和生活质量，但在CTEPH患者中尚未对此进行充分研究。我们进行了荟萃分析和系统评价，以评估运动训练对CTEPH患者的有效性和安全性。
使用2020年12月之前发表的PubMed、EMBASE和Cochrane图书馆数据库检索相关文献进行荟萃分析。主要结局是六分钟步行距离（6MWD）的变化。我们还评估了运动训练对每千克峰值摄氧量（peak VO2/kg）、通过右心导管检查（RHC）评估的平均肺动脉压（mPAP）、N末端脑钠肽前体（NT-proBNP）和生活质量的影响。
共纳入6项研究，涉及234例接受运动训练的患者。在汇总分析中，3周运动训练后6MWD显著改善70.14米（加权均数差：58.33至81.95，I2 = 0）。12周或15周运动训练后，6MWD和peak VO2/kg显著改善（加权均数差：106.22米，95%可信区间：65.90至146.55，I2 = 87.4%，P < 0.0001；1.84毫升/分钟/千克，95%可信区间：0.72至2.96，P = 0.001）。此外，12周运动训练后mPAP下降12.17毫米汞柱（95%可信区间：-14.53至-9.82，P < 0.001，I2 = 99%）。生活质量的各个子量表，如身体功能、总体健康感知和心理健康，均有不同程度的改善。在汇总分析中，NT-proBNP没有显著改善。此外，运动训练耐受性良好，训练期间未发生重大不良事件，退出率较低。
运动训练可能改善CTEPH患者的运动能力、mPAP和生活质量，且耐受性良好。然而，需要更多大规模多中心研究来证实运动训练对CTEPH患者的有效性和安全性。
