老年人衰弱表型干预效果分析

摘要

Objective To synthesise evidences from randomised controlled trials (RCTs)to evaluate the effectiveness of exercise and nutrition interventions on functioning,muscle strength and body composition in older people with frailty.Methods A systematic review and meta analysis was performed.The electronic databases of Pubmed,Ovid,Web of Science EMBASE and Cochrane were consulted.We included RCT trials of exercise and nutrition interventions for older people with frailty identified through a validated frailty scale of Fried phenotype.The related articles were extracted and cross-checked independently by two reviewers.Methodological quality of trials was evaluated according to Cochrane Handbook criteria.Meta analysis was conducted using RevMan software.The outcomes of performance-based physical function such as gait speed,timed up and go(TUG),muscle strength(knee extension strength or leg extension strength)and body lean mass,fat mass,appendicular lean mass (ALM)were assessed.Results We included 13 articles reporting on 9 trials of exercise interventions (total n=1 034 participants)and included 5 trials of nutrition interventions(n=423 participants).Overall,exercise interventions had a significant beneficial effect on knee extension strength post-intervention compared to usual care control[standardised mean differences (SMD) =1.20,95 ％ CI:0.32-2.08,Z =2.67,P =0.008,I2 =62.0％].We found no effects upon gait speed or TUG time (both P＞0.05).Exercise and nutrition interventions had some effects on ALM,but no significant different(SMD 0.45,95％CI:-0.18-1.09,Z=1.40,P =0.163,I2 =82.2％)compared to control.There were no differences in gait speed or leg extension strength after nutrition interventions (both P＞0.05).The effects of exercise and nutrition interventions on body composition index were inconsistent.Conclusions Exercise interventions had some positive effects on functioning for older people with frailty,but these were based on small,low quality studies.Further large scale and high quality studies of rigorously RCT interventions are needed.%目的 系统分析运动和(或)营养干预对老年人衰弱表型的身体功能、肌肉力量和身体成分的影响. 方法 通过检索Pubmed、Ovid、Web of Science、EMBASE数据库、Cochrane图书馆和Cochrane临床试验中心注册库,检索运动和(或)营养干预对老年人衰弱表型影响的随机对照英文研究.由2名评价人员按照Cochrane系统评价手册独立筛选文献、提取资料和评价纳入的文献质量并交叉核对后,使用RevMan软件对数据进行Meta分析.分析结局指标包括步速、计时起立行走测试(TUG)、肌肉力量和身体成分如四肢肌肉量(ALM)、瘦体重、脂肪量等. 结果 最终纳入符合条件的13篇随机对照研究(14项研究),其中9项运动干预(1 034例),5项运动加营养干预(423例).与对照组比较,运动干预对对衰弱老年人的步速和TUG无影响(均P＞0.05),但运动提高衰弱老年人的膝关节伸展力量[标准均数差(SMD)=1.20,95％CI:0.32～2.08,Z=2.67,P=0.008,I2=62.0％].运动加营养干预衰弱后,与对照组比较对衰弱老年人的步速和肌肉力量无影响(均P＞0.05),干预组和对照组四肢肌肉量差异也无统计学意义(SMD=0.45,95％CI:-0.18～1.09,Z=1.40,P=0.163,I2=82.2％).运动和(或)营养对身体成分的影响不一. 结论 运动对衰弱老年人的膝关节伸展力量有改善作用,但运动和营养对步速和TUG可能无明显影响;由于样本量少、存在偏倚,仍需要样本量大、质量高的随机对照研究.