太极拳运动对慢性阻塞性肺疾病患者生存质量和BODE指数的影响

摘要 目的：评价太极拳运动对我国农村慢性阻塞性肺疾病（COPD）患者稳定期康复治疗的作用。 方法：纳入24例我国农村地区中重度COPD患者,随机分为太极拳组和对照组,每组12例。太极拳组患者进行为期8周的太极拳康复训练,每天1h,对照组患者给予沙美特罗/氟替卡松50μg/500μg吸入。在基线时和8周时分别进行以下测量：肺功能、6min步行距离、生存质量、BODE指数,并进行两组之间的比较。 结果：在24例患者中,有22例完成了测试。每组均有1例患者因COPD急性加重退出研究。结果显示太极拳组患者在8周后圣乔治呼吸问卷（SGRQ）评分下降了11.78±1.68,而对照组患者仅下降了3.00±1.57,两组之间差异具有显著性意义。太极拳组患者6min步行距离显著改善,由基线时的（420.15±35.78）m,改善为8周时的（479.12±34.32）m,对照组患者没有出现显著性改善（P=0.09）。8周时,太极拳组BODE指数下降了0.73分,对照组下降了0.82分,两组均较干预前明显改善,两组之间相比差异不具有显著性意义。 结论：8周的太极拳康复训练显著地改善了COPD患者的生存质量、运动能力和呼吸困难。减小的BODE指数预示着可能降低的死亡风险。     

丹参致肝功能异常1例

丹参, 性苦, 味微寒, 归心、心包、肝经. 一般用量是9～15 g/贴. 主要功效: 活血化瘀、活血清心、养血安神. 现代研究表明: 丹参主要含有丹参酮、丹参醇、维生素E、丹参素等, 通过肝肾代谢排泄. 临床上使用丹参致肝功能异常的报道少见. 据笔者检索到的文献仅3例[1～3], 而造成肝功能损害的是复方片剂或丹参注射液. 我们在临床上发现服用丹参汤剂致使肝功能异常1例, 现予报道.     

Effects of Tai Chi on Lower-Limb Myodynamia in the Elderly People: A Meta-Analysis

Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), Cochrane Library (from 1991), Elsevier sciences database (from 1990), OVID full text database (from 1997), Springer-link database (from 1997), The National Research Register database, ISI Web of knowledge (from 1963), Chinese Medical Citation Index/Chinese Medical Current Contents (CMCI/CMCC, from 1989), China Knowledge Resource Integrated Database (CNKI, from 1915),VIP database (from 1989), and Wanfang database (from 1977) have been searched only for the English and Chinese literatures updated to 10-30-2010. Two researchers independently assessed the methodological quality of studies, extracted and checked the data one another according to the include/exclude standards. Disagreement was resolved by discussions or with the third person. The Review Manage Software 5.0 was used for Meta-analysis. Results: Eventually, 2 randomized controled studies and 2 non-randomized controled studies met the inclusion criteria, with 163 subjects involved in the present meta-analysis. The meta-analysis demonstrated that Tai Chi exercise could improve the ankle flexor/extensor muscle strength and the knee extensor/flexor muscle strength, tested with an isokinetic dynamometer. The limb muscle strength increased significantly after Tai Chi exercise (P<0.01). Conclusion: The meta-analysis favours Tai Chi exercise for improving the lower-limb muscle strength in the older people.     

BODE指数在我国农村慢性阻塞性肺疾病患者中的应用价值

目的 探讨我国农村地区慢性阻塞性肺疾病(COPD)患者BODE指数与生活质量的相关性及其应用价值.方法 选择广东省英德市九龙镇COPD稳定期患者26例.测定并计算其BODE指数各项目的评分.采用St George呼吸问卷(SGRQ)评价患者的生活质量.结果 患者BODE指数分级与SGRQ总分、症状分、活动分、影响分均具有相关性(r值分别为0.674、0.430、0.460、0.495,P均＜0.05);GOLD分级仅与SGRQ总分和活动分具有相关性(r值分别为0.447、0.418,P均＜0.05).多元线性逐步回归分析发现BODE指数中影响SGRQ总分的因素是6 min步行距离(t=-2.397,P=0.025)和呼吸困难(t=2.257,P=0.034).结论 农村COPD患者BODE指数和生活质量密切相关,BODE指数中6 min步行距离和呼吸困难对生活质量的影响最大.

Abstract：

Objective To evaluate the application value of BODE and the relationship between BODE index and life quality in patients with chronic obstructive pulmonary disease (COPD) in rural China. Methods A total of 26 rural patients with stable COPD were enrolled. BODE index and it's four components including body mass index ( BMI ), airflow obstruction ( FEV1 % ), dyspnea ( MMRC ) and exercise capacity ( 6MWD ) were calculated. St. Georgeps Respiratory Questionnaire (SGRQ) were used to evaluate health-related quality of life of these patients. Results The BODE index was significantly correlated with the SGRQ total score , symptom ,activity and impact score ( r = 0. 674,0. 430,0. 460,0. 495 respectively, Ps ＜ 0. 05 ). GOLD grade was only significantly correlated with the SGRQ total score and active score( r =0. 447,0. 418 ,Ps ＜0. 05 ). Stepwise liner multiple regression analysis showed that activity score of SGRRQ was an influence factor of BODE index. 6MWD of BODE index( t = - 2. 397, P = 0. 025 ) and MMRC ( t = 2. 257, P = 0. 034 ) were independently correlated with activity scores of SGRQ . Conclusion BODE index and life quality had significant relationship. 6MWD and MMRC of BODE index were the most powerful influence factors of life quality in rural COPD patients.