肺结核后肺病中的肺康复：一项系统评价

摘要(中文译文)

结核病（TB）仍然是一个重大的全球健康问题，导致数百万人的疾病和死亡。尽管存在有效的治疗方案，仍有大量患者持续遭受被称为结核后肺病（PTLD）的长期肺部后遗症。PTLD可能伴随运动能力下降、呼吸功能受损和生活质量降低。肺康复（PR）是一种结合运动和教育以改善肺功能和整体健康的干预措施，可能提供一种解决方案。本系统综述旨在梳理关于PTLD肺康复干预的现有证据，识别文献中的空白，并综合关于运动能力、生活质量、肺功能和症状结局的研究结果，以指导临床实践和未来研究。我们系统检索了Scopus、PubMed（MEDLINE）、ProQuest和EBSCO四个电子数据库，检索2000年至2026年间发表的研究。总体检索共获得1,085篇文章。在审阅标题和摘要后，我们移除了163篇重复文献并排除了905篇文章。共有17篇文章符合纳入标准，被纳入本系统综述。17项研究符合纳入标准，涵盖随机对照试验（RCT）和观察性研究设计，涉及多个国家。肺康复持续改善了运动能力，6分钟步行距离（6MWD）增加了36-189米（440.6 ± 70.8米至574.6 ± 168.9米；399 ± 62米至467 ± 65米，< 0.01），生活质量也显著改善，圣乔治呼吸问卷（SGRQ）评分降低多达13分（< 0.05），部分研究中组间差异显著（< 0.0001）。症状结局也有所改善，包括呼吸困难和胸痛的减少（44.8%至24.1%）。肺功能研究结果异质性较大；一些研究报告FEV显著改善（2.94 ± 0.68 L至3.18 ± 0.54 L，< 0.001），而其他研究则显示无显著变化。尽管存在一定局限性，所有纳入的研究均显示至少一个关键结局领域有所改善。这些研究共同表明，肺康复可能是PTLD管理的重要组成部分，但仍需要进一步的高质量试验来确定最佳方案并确认疗效。肺康复有潜力改善结核后并发症患者的生活质量、运动能力和肺功能。

Abstract

Tuberculosis (TB) remains a significant global health concern, resulting in illness and death for millions of individuals. Despite the availability of effective treatment options, a substantial number of people continue to suffer from long-term lung consequences known as post-tuberculosis lung disease (PTLD). PTLD may be associated with reduced exercise capacity, respiratory impairment, and diminished quality of life. Pulmonary rehabilitation (PR), an intervention that combines exercise and education to enhance pulmonary function and overall wellbeing, may offer a solution. The aim of this systematic review was to map the available evidence on PR interventions for PTLD, identify gaps in the literature, and synthesize findings on exercise capacity, quality of life, pulmonary function, and symptom outcomes to inform clinical practice and future research. A systematic search was conducted across four electronic databases, Scopus, PubMed (MEDLINE), ProQuest, and EBSCO, for studies published between 2000 and 2026. The overall search yielded 1,085 articles. After reviewing titles and abstracts, we removed 163 duplicates and excluded 905 articles. A total of 17 articles met the inclusion criteria and were included in this systematic review. Seventeen studies met the inclusion criteria, encompassing randomized controlled trials (RCTs) and observational study designs across multiple countries. PR consistently improved exercise capacity, with a 6 min walk distance (6MWD) increasing by 36-189 m (440.6 ± 70.8 m to 574.6 ± 168.9 m; 399 ± 62 m to 467 ± 65 m, < 0.01) and a significant improvement in quality of life, as evidenced by reductions in St Georges Respiratory Questionnaire (SGRQ) scores of up to 13 points ( < 0.05) and significant between-group differences in some studies ( < 0.0001). Symptom outcomes also improved, including reductions in dyspnea and chest pain (44.8% to 24.1%). Pulmonary function findings were heterogeneous; some studies reported significant improvements in FEV (2.94 ± 0.68 L to 3.18 ± 0.54 L, < 0.001), whereas others showed no significant changes. Despite certain limitations, all included studies demonstrated improvement in at least one key outcome domain. They collectively suggest that PR may be a valuable component of PTLD management, though further high-quality trials are needed to establish optimal protocols and confirm efficacy. PR has the potential to enhance the quality of life, exercise capacity, and lung function in patients with post-TB complications.

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