Effects of pulmonary rehabilitation on systemic inflammation in chronic obstructive pulmonary disease: a meta-analysis.

IF 1.4 Q4 IMMUNOLOGY American journal of clinical and experimental immunology Pub Date : 2024-02-25 eCollection Date: 2024-01-01
Xiaotian Alex Yue, Yilan Sheng, Jianhua Li
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Abstract

Chronic obstructive pulmonary disease (COPD) is marked by both lung-related and systemic symptoms, notably chronic inflammation. Despite pulmonary rehabilitation (PR) being a critical treatment for COPD, its influence on systemic inflammation remains unclear. This meta-analysis was conducted to assess PR's effect on circulating inflammatory markers in COPD patients. We systematically reviewed databases like PubMed, EMBASE, and Web of Science to select randomized controlled trials and observational studies that investigated the impact of PR on systemic inflammation. We calculated the mean differences (MD) in inflammatory markers before and after PR using a random-effects model and assessed the risk of bias with established tools. Our study included six investigations (four RCTs, two observational) with 147 COPD patients. Our findings show notable increases in IL-6 (MD 0.44, 95% CI 0.17-0.70, P = 0.001), CRP (MD 0.56, 95% CI 0.31-0.81, P<0.00001), and TNF-alpha (MD 0.41, 95% CI 0.12-0.70, P = 0.005) following PR. However, sensitivity analysis pinpointed the study by El-Kader et al. as a key influence on these results. Excluding this study led to nonsignificant changes. Thus, our meta-analysis uncovers an unanticipated rise in inflammatory markers post-PR in COPD patients, questioning the assumed anti-inflammatory benefits of PR.

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肺康复对慢性阻塞性肺病全身炎症的影响:一项荟萃分析。
慢性阻塞性肺疾病(COPD)既有肺部相关症状,也有全身症状,尤其是慢性炎症。尽管肺康复(PR)是慢性阻塞性肺病的一种重要治疗方法,但其对全身炎症的影响仍不明确。本荟萃分析旨在评估肺康复对慢性阻塞性肺病患者循环炎症标志物的影响。我们系统地查阅了 PubMed、EMBASE 和 Web of Science 等数据库,选择了调查 PR 对全身炎症影响的随机对照试验和观察性研究。我们使用随机效应模型计算了 PR 前后炎症指标的平均差异 (MD),并使用既定工具评估了偏倚风险。我们的研究包括六项调查(四项 RCT,两项观察性研究),涉及 147 名慢性阻塞性肺病患者。
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