目的 评价不同抗阻训练方案对2型糖尿病患者血脂代谢及胰岛素抵抗的改善作用.方法 检索PubMed、ProQuest、Embase、Web of Science、中国知网、万方和维普数据库中关于抗阻运动改善2型糖尿病患者血脂和胰岛素抵抗相关的随机对照试验,检索区间为建库至2023年5月.由2位评审员通过物理治疗证据数据库量表评估纳人文献的偏倚风险,并使用Stata 16.0软件对提取的数据进行网状Meta分析.结果 最终纳入24篇文献,总计983例受试者.网状Meta分析结果显示:高频-中等强度抗阻运动对胰岛素抵抗[标准化均数差=-1.71,95％置信区间(confidence interval,CI)(-2.75,-0.67)]、甘油三酯[加权均数差(weighted mean difference,WMD)=-0.27 mmol/L,95％CI(-0.51,-0.04)mmol/L]、总胆固醇[WMD=-0.16 mmol/L,95％CI(-0.20,-0.12)mmol/L]水平的改善效果有统计学意义,在改善高密度脂蛋白[WMD=0.05 mmol/L,95％CI(-0.02,0.11)mmol/L]和低密度脂蛋白[WMD=-0.20 mmol/L,95％CI(-0.42,0.03)mmol/L]水平方面效果无统计学意义.累积概率排序结果显示:高频-中等强度抗阻运动在改善胰岛素抵抗、甘油三酯、高密度脂蛋白和低密度脂蛋白水平方面均最优.结论 基于当前证据,高频-中等强度抗阻运动可能是改善2型糖尿病患者胰岛素抵抗和血脂代谢的最佳抗阻运动方案.
Improvement of different resistance training regimens on blood lipids and insulin resistance in patients with type 2 diabetes mellitus:a network meta-analysis
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus(T2DM).Methods PubMed,ProQuest,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang,and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM.The search time range was from the establishment of the databases to May 2023.Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale,and performed a network meta-analysis of the extracted data using Stata 16.0 software.Results In the end,24 articles were included,and a total of 983 participants were enrolled.The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance[standardized mean difference=-1.71,95％confidence interval(CI)(-2.75,-0.67)],triglycerides[weighted mean difference(WMD)=-0.27 mmol/L,95％CI(-0.51,-0.04)mmol/L],and total cholesterol[WMD=-0.16 mmol/L,95％CI(-0.20,-0.12)mmol/L],but had no significant effect on improving the level of high-density lipoprotein[WMD=0.05 mmol/L,95％CI(-0.02,0.11)mmol/L]or low-density lipoprotein[WMD=-0.20 mmol/L,95％CI(-0.42,0.03)mmol/L].The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance,triglycerides,high-density lipoprotein and low-density lipoprotein levels.Conclusion Based on current evidence,high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
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