体力活动与运动训练对腹主动脉瘤发生风险及临床结局影响的Meta分析

Effects of physical activity and exercise training on the risk of abdominal aortic aneurysm and clinical outcomes: a Meta-analysis

摘要:

背景与目的 腹主动脉瘤（AAA）是一种常见且潜在致命的血管疾病，目前除手术治疗外，缺乏明确有效的非药物干预措施。体力活动和运动训练对心血管疾病具有明确获益，但其与AAA发生风险及临床结局之间的关系尚缺乏系统评价。本研究通过Meta分析探讨体力活动与AAA发生风险之间的剂量-反应关系，并评价运动训练对小AAA患者运动适能、疾病进展及围手术期结局的影响。方法 检索PubMed、Embase和Cochrane Library数据库中有关体力活动或运动训练与AAA关系的前瞻性队列研究及随机对照试验（RCT），检索时限截至2025年12月13日。采用稳健误差Meta回归（REMR）模型分析体力活动水平与AAA发生或筛查发现风险之间的剂量-反应关系；采用随机效应模型合并RCT研究结果，以标准化均数差（SMD）及95%置信区间（CI）评价运动训练对小AAA患者运动适能、生物标志物及围手术期结局的影响。结果 共纳入16项研究。剂量-反应Meta分析纳入4项前瞻性队列研究（94 109例受试者），结果显示体力活动水平与AAA发生或筛查发现风险呈显著线性负相关（非线性检验P=0.582），体力活动每增加20代谢当量-小时/周（MET-h/周），AAA风险降低约14%。6项RCT研究显示，运动训练未增加AAA直径（SMD=-0.03，95% CI=-0.29~0.24，P=0.85），但可显著提高患者3个月（SMD=0.49，95% CI=0.20~0.78，P<0.001）和12个月（SMD=0.71，95% CI=0.47~0.96，P<0.001）的MET水平。运动训练对血压、体质量指数及血清MMP-9水平的影响均无统计学意义。围手术期Meta分析显示，术前运动预康复可显著缩短患者住院时间（SMD=-0.75，95% CI=-1.08~-0.42，P<0.001）。结论 较高水平的日常体力活动与AAA发生风险降低相关。对于小AAA患者，长期规律运动训练具有良好的短期安全性，可显著改善运动适能而不增加瘤体扩张风险；对于拟行手术治疗的AAA患者，术前预康复运动有助于促进术后恢复并缩短住院时间。

Abstract:

Background and Aims Abdominal aortic aneurysm (AAA) is a common vascular disorder associated with substantial morbidity and mortality. Although physical activity and exercise training have well-established benefits in cardiovascular diseases, their associations with AAA risk and clinical outcomes remain incompletely understood. This study aimed to investigate the dose-response relationship between physical activity and AAA risk and to evaluate the effects of exercise training on exercise capacity, aneurysm progression, and perioperative outcomes in patients with AAA.Methods PubMed, Embase, and the Cochrane Library were searched for prospective cohort studies and randomized controlled trials (RCTs) investigating physical activity or exercise interventions in AAA up to December 13, 2025. Robust error Meta-regression (REMR) was used to assess the dose-response relationship between physical activity and AAA risk. Random-effects meta-analysis was performed for RCTs, and pooled effects were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI).Results Sixteen studies were included. Four prospective cohort studies involving 94 109 participants were eligible for dose-response analysis. Physical activity was linearly associated with a lower risk of AAA occurrence or screening detection (P for non-linearity=0.582), with a 14% reduction in risk for every 20 metabolic equivalent of task (MET)-hour/week increase in physical activity. Six RCTs demonstrated that exercise training did not increase aneurysm diameter (SMD=-0.03, 95% CI=-0.29-0.24, P=0.85), but significantly improved MET levels at both 3 months (SMD=0.49, 95% CI=0.20-0.78, P<0.001) and 12 months (SMD=0.71, 95% CI=0.47-0.96, P<0.001). No significant effects were observed on blood pressure, BMI, or serum MMP-9 levels. In perioperative patients, preoperative exercise-based prehabilitation significantly reduced the length of hospital stay (SMD=-0.75, 95% CI=-1.08- -0.42, P<0.001).Conclusion Higher levels of habitual physical activity are associated with a lower risk of AAA. In patients with small AAA, long-term exercise training appears safe and improves exercise capacity without accelerating aneurysm growth. In patients undergoing AAA repair, preoperative exercise-based prehabilitation may facilitate postoperative recovery and shorten the hospital stay.