中国循证医学杂志

中国循证医学杂志

6 分钟步行试验在慢性心力衰竭临床评估中的应用价值

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目的分析 6 分钟步行试验(6MWT)在慢性心力衰竭(CHF)临床评估中的应用价值。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、VIP、WanFang Data 和 CNKI 数据库,搜集以 6 分钟步行距离(6MWD)为 CHF 评价指标的随机对照试验(RCT),检索时限均从建库至 2017 年 8 月。由 2 名研究者独立筛选文献、提取资料,采用 SPSS 17.0 统计软件进行分析。运用 Kappa 一致性检验分析 6MWD 与 CHF 症状、生活质量、运动耐量(ETT)、左室射血分数(LVEF)、峰值耗氧量(pVO2)改善的一致性;运用 Logistic 回归方法分析可能改善患者 6MWD 的因素。结果共纳入 158 个 RCT,包括 17 853 例患者。统计分析结果显示:6MWD 与 CHF 症状、生活质量、ETT、LVEF、pVO2 的改善具有一致性(Kappa 值>0.4);基线 6MWD[OR=2.91,95%CI(1.278,6.634),P=0.011]和 NYHA 分级Ⅲ~Ⅳ级患者比例[OR=2.59,95%CI(1.091,6.138),P=0.031]是 6MWD 改善的独立影响因素。结论6MWT 可作为 CHF 临床便捷可靠的评价指标之一。

ObjectivesTo analyze the application value of 6-minute walking test (6MWT) in the clinical evaluation of chronic heart failure (CHF).MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were searched online to collect randomized controlled trials (RCTs) of 6-minute walking distance (6MWD) as the CHF evaluation index. Two reviewers independently screened literature, extracted data, and then analyzed data by using SPSS 17.0 statistical software. The 6MWD with symptom, quality of life, exercise tolerance (ETT), left ventricular ejection fraction (LVEF), peak oxygen consumption (pVO2) were analyzed by Kappa consistency test, and the possible influencing factors of 6MWD were analyzed by logistic regression.ResultsA total of 158 RCTs involving 17 853 patients were included. The results of statistical analysis showed that: 6MWD was consistent with the improvement of symptoms, quality of life, ETT, LVEF and pVO2 (Kappa>0.4). Baseline 6MWD (OR=2.91, 95%CI 1.278 to 6.634,P=0.011) and NYHA Ⅲ-Ⅳ ratio (OR=2.59, 95%CI 1.091 to 6.138, P=0.031) were the independent influencing factors for 6MWD improvement separately.ConclusionsThe 6MWT is an objective and reliable indicator of CHF evaluation.

关键词: 6分钟步行试验; 6分钟步行距离; 慢性心力衰竭; 一致性; 影响因素; 随机对照试验

Key words: 6-minute walking test; 6-minute walking distance; Chronic heart failure; Consistency; Influencing factor; Randomized controlled trial

引用本文: 侯雅竹, 闫玲燕, 毛静远, 王贤良, 李玲, 钟成梁, 刘瀚文, 赵志强. 6 分钟步行试验在慢性心力衰竭临床评估中的应用价值. 中国循证医学杂志, 2018, 18(9): 907-917. doi: 10.7507/1672-2531.201804092 复制

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