目的探讨肺康复训练对特发性肺纤维化 (IPF) 的益处, 评价肺康复的安全性.方法通过检索CEN-TRAL、PubMed和EMBase数据库中关于IPF肺康复干预的文献, 检索词采用"idiopathic pulmonary fibrosis和pulmonary rehabilitation".并检索文献中的参考文献, 进行定量分析.文献纳入标准为随机或者类随机对照试验, 采用肺康复训练 (PR干预组) 和非肺康复训练 (对照组) 治疗IPF.由两名研究者对文献进行阅读和筛选, 对文献中缺损数据通过联系作者获取.结果共有筛选出9项相关研究, 其中2篇为同一组数据的不同研究方向的分析, 3篇为同一组数据的不同随访时长的分析, 最终有6项临床试验纳入本次分析, 共纳入病例233例, 其中123例为对照组, 110例为干预组.未见肺康复训练的不良反应报道.5项临床试验描述了盲法, 1项未描述.6项研究均报道了6min步行测试, PM干预组与对照组相比差异有统计学意义 (RR=39.21, 95％CI:17.69～60.74, P<0.001) .3项描述了最大摄氧量 (VO2) , PM干预组与对照组相比差异有统计学意义 (RR=1.59, 95％CI:0.80～2.37, P<0.001) .5项描述了MRC呼吸困难, PM干预组与对照组相比差异无统计学意义 (RR=-0.35, 95％CI:-0.74～0.04, P=0.08) .5项研究通过不同的评价, PM干预组相比对照组生活质量短期有改善, 长期随访发现差异无统计学意义 (P>0.05) .仅有1项研究进行了长期随访 (30个月) , 对照组中3例死亡;干预组中1例死亡, 1例进行了肺移植.结论肺康复训练对于IPF患者的短期转归是有益的, 是否有利于长期转归还需进一步扩大样本量, 目前开展的临床试验病例数较少, 有必要行更大样本量的随机对照试验分析.%Objective To study and evaluated the safety of pulmonary rehabilitation by exploring the benefits of pulmonary rehabilitation training on idiopathic pulmonary fibrosis.Methods To search the terms"idiopathic pulmonary fibrosis and pulmonary rehabilitation"by the Cochrane central register of controlled trials (CENTRAL) , PubMed and EMBase databases for literature on IPF rehabilitation interventions, and retrieve references in the literature for quantitative analysis.Literature inclusion criteria were randomized or randomized controlled trials, using pulmonary rehabilitation training (PM intervention group) and non-pulmonary rehabilitation training (control group) treatment of IPF.Two researchers read and screened the literature, and the defect data in the literature was obtained by the contact author.Results Nine related studies were screened, two were for the same set of data in different directions, three for the same set of data for different follow-up analyzes, and finally six clinical trials were included in this analysis.Study was enrolling 233cases, 123cases for control group, 110cases for the intervention group.No adverse reactions reported in pulmonary rehabilitation training.Five clinical trials described blinding, one not described.All six studies reported 6-minute walk test.There was a statistically significant difference between the PM intervention group and the control group (RR=39.21, 95％CI:17.69～60.74, P<0.001) .The three items described the maximum oxygen uptake (VO2) .There was a significant difference between the PM intervention group and the control group (RR=1.59, 95％CI:0.80～2.37, P<0.001) .Five items described MRC dyspnea.There was no significant difference between PM intervention group and control group (RR=-0.35, 95％CI:-0.74～0.04, P=0.08) .Five studies through different evaluation, there was no e significant difference in quality of life improved in the short term, long-term follow-up found compared with control group (P>0.05) .Only one study was followed up for 30months, with 3deaths in the control group;1death in the intervention group and 1lung transplant.Conclusion Pulmonary rehabilitation training is beneficial for short-term outcome in patients with IPF.Whether it is conducive to long-term prognosis needs further expansion of the sample size.Currently, there are fewer clinical trials.It is necessary to conduct a larger sample size randomized controlled trial.
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