目的通过Meta分析探究有氧运动对精神分裂症患者认知功能的改善效果。
方法检索PubMed、EMBASE、Cochrane Library和中国知网、万方、维普、中国生物医学文献数据库以及谷歌学术网，检索时限设定为建库至2020年9月14日。通过检索词搜集相关随机对照试验。提取文献中基本人口学特征、干预方案、结局指标，以及认知评估的平均改变值，对没有直接报道改变值的研究，通过提取基线、干预终点和随访终点的信息计算改变值。利用Stata 14分析软件，采用Q检验衡量异质性后进行固定效应模型的Meta分析，采用GRADE分级系统评价证据质量。
结果共纳入7篇文献，共355例患者。Meta分析结果显示：有氧运动可改善精神分裂症患者的言语学习与记忆（ SMD=0.42，95% CI 0.13~0.70， P<0.05）、工作记忆（ SMD=0.40，95% CI 0.19~0.61， P<0.05）、处理速度（ SMD=0.45，95% CI 0.10~0.80， P<0.05）、注意力/警觉（ SMD=0.40，95% CI 0.04~0.76， P<0.05）和推理与解决问题的能力（ SMD=0.43，95% CI 0.06~0.80， P<0.05），但对视觉空间记忆（ SMD=-0.18，95% CI -0.70~0.33， P>0.05）的改善效果不明显。随访终点相对基线的分析中，停止有氧运动干预后2~3个月，试验组言语学习与记忆（ SMD=0.52， P<0.05）、工作记忆（ SMD=0.39， P<0.05）、处理速度（ SMD=0.44， P<0.05）评分高于对照组，而2组注意力/警觉和推理与解决问题的能力评分差异无统计学意义。随访终点相对有氧运动干预终点的分析中，停止有氧运动干预后2~3个月，试验组与对照组的各认知功能评分差异均无统计学意义。GRADE评价结果显示，工作记忆的证据水平为高质量，言语学习与记忆、注意力/警觉的水平为中等，处理速度、推理与解决问题的能力、视觉空间记忆的水平为低质量。
结论有氧运动可改善精神分裂症患者的认知功能，但对视觉空间记忆的改善效果不明显，停止有氧运动后认知功能逐渐下降。
ObjectiveTo explore the efficacy of aerobic exercise (AE) on the cognitive function in patients with schizophrenia using meta-analysis.
MethodsA systematic online search was performed for eligible randomized controlled trials using the electronic databases of PubMed, EMBASE, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang data (Wanfang), VIP, China biology medicine disc (CBMdisc), and Google Scholar. The search was performed from database inception until September 14, 2020. The essential demographic characteristics, intervention programs, outcome indicators, and the average change values of cognitive scale were extracted from the included literatures. For the studies that did not directly report the change values, the change values were calculated by baseline, intervention endpoint, and follow-up endpoint. Stata 14 software was used for meta-analysis, and Q-test was used to measure heterogeneity. The GRADE quality of evidence system was used to evaluate the quality of evidence.
ResultsSeven studies involving 355 patients were included. Meta-analysis showed that AE could improve verbal learning ( SMD=0.42, 95% CI 0.13-0.70, P<0.05), working memory ( SMD=0.40, 95% CI 0.19-0.61, P<0.05), processing speed ( SMD=0.45, 95% CI 0.10-0.80, P<0.05), attention/vigilance( SMD=0.40, 95% CI 0.04-0.76, P<0.05), reasoning and problem solving ( SMD=0.43, 95% CI 0.06-0.80, P<0.05) of schizophrenia, but it may not improve visual learning ( SMD=-0.18, 95% CI -0.70-0.33, P>0.05). Besides, At 2-3 months after cessation of aerobic exercise intervention, compared with the baseline, the scores of verbal learning ( SMD=0.52, P<0.05), working memory ( SMD=0.39, P<0.05), and processing speed ( SMD=0.44, P<0.05) in the experimental group were higher than those in the control group at the endpoint of follow-up. Simultaneously, there was no significant difference in the scores of attention/vigilance and reasoning and problem solving between the two groups. Also, there was no significant difference in the cognitive function scores between the experimental and control groups at the endpoint of follow-up. The GRADE results showed that the evidence level of working memory was high, the level of verbal learning and attention/vigilance was moderate, and the level of processing speed, reasoning and problem-solving, visual learning were low.
ConclusionAerobic exercise help to improve the cognitive function in patients with schizophrenia, however, the improvement of visual-spatial memory is not significant. After stopping aerobic exercise, cognitive function tended to decrease gradually.
International Platform of Registered Systematic Review and Meta-analysis Protocols，INPLASY2020100075
杜健,郑月,刘薇. 有氧运动改善精神分裂症患者认知功能的Meta分析[J]. 中华精神科杂志,2021,54(03)：211-218.
DOI:10.3760/cma.j.cn113661-20200713-00333版权归中华医学会所有。
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杜健, 郑月, 刘薇. 有氧运动改善精神分裂症患者认知功能的Meta分析[J]. 中华精神科杂志, 2021, 54(3): 211-218. DOI: 10.3760/cma.j.cn113661-20200713-00333.
注册系统评价和Meta分析研究计划国际平台，注册号：INPLASY2020100075
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