有氧运动对心肌梗死患者内皮祖细胞动员和功能的影响

Effect of aerobic exercise on mobilization and function of endothelial progenitor cells in patients with myocardial infarction

背景:运动康复是心肌梗死患者非药物治疗的重要手段,能够改善心肌灌注和心血管功能,其机制可能与血管内皮细胞介导的血管新生与修复有关,而内皮祖细胞是血管内皮细胞的前体细胞。目的:探讨12周有氧运动对心肌梗死患者内皮祖细胞动员和功能的影响。方法:(1)选择2022年1-10月在郑州大学第一附属医院接受经皮冠状动脉介入治疗后的急性心肌梗死患者66例,按照随机数字表法分为运动组(n=33)和对照组(n=33),对照组患者接受常规心脏康复治疗12周,运动组患者接受常规心脏康复+12周有氧运动干预。干预前及干预结束后72 h,检测患者心肺适能、纽约心脏协会分级、左心室射血分数、血清肌钙蛋白Ⅰ和脑钠肽水平及外周血内皮祖细胞数量。(2)干预前及干预结束后72 h,从两组患者外周血中分离提取内皮组细胞,检测内皮组细胞的增殖、黏附和迁移能力。结果与结论:(1)干预结束后72 h,运动组患者的纽约心脏协会分级、血清肌钙蛋白Ⅰ和脑钠肽水平均低于干预前、对照组(P<0.05),峰值摄氧量、最大功率、递增负荷试验完成时间、峰值运动时左心室射血分数高于干预前、对照组(P<0.05),平均心率和平均主观疲劳感觉评分低于干预前、对照组(P<0.05),外周血内皮组细胞数量多于干预前、对照组(P<0.05);(2)干预结束后72 h,运动组患者外周血内皮祖细胞的增殖、黏附与迁移能力均高于干预前、对照组(P<0.05);(3)结果表明,规律有氧运动能够促进内皮祖细胞动员并增强其增殖、黏附和迁移能力,进而改善心肌梗死患者临床病情、心功能和心肺适能。

BACKGROUND:Exercise rehabilitation is an important means of non-drug treatment for patients with myocardial infarction.It can improve myocardial perfusion and cardiovascular function.The mechanism may be related to angiogenesis and repair mediated by vascular endothelial cells,while endothelial progenitor cells are the precursors of vascular endothelial cells.OBJECTIVE:To explore the impact of 12-week aerobic exercise on mobilization and function of endothelial progenitor cells in patients with myocardial infarction.METHODS:(1)A total of 66 patients with acute myocardial infarction who received percutaneous coronary intervention in First Affiliated Hospital of Zhengzhou University from January to October 2022 were selected and divided into exercise group(n=33)and control group(n=33)according to random number table method.Patients in the control group received conventional cardiac rehabilitation treatment for 12 weeks.Patients in the exercise group received conventional cardiac rehabilitation+12 weeks of aerobic exercise intervention.Cardiopulmonary fitness,New York Heart Association classification,left ventricular ejection fraction,serum troponin I,brain natriuretic peptide levels,and peripheral blood endothelial progenitor cells were measured before and 72 hours after intervention.(2)Endothelial cells were isolated from peripheral blood of the two groups of patients before intervention and 72 hours after intervention,and the proliferation,adhesion,and migration ability of endothelial cells were detected.RESULTS AND CONCLUSION:(1)At 72 hours after the intervention,New York Heart Association classification,serum troponin I and serum brain natriuretic peptide decreased(P<0.05);peak oxygen uptake,maximum power,completion time of incremental load test,and left ventricular ejection fraction at peak exercise increased(P<0.05);average heart rate and average subjective fatigue sensation score decreased(P<0.05);peripheral blood endothelial cell count increased(P<0.05)in the exercise group compared with those before intervention and the control group.(2)At 72 hours after intervention,the cell proliferation,adhesion,and migration ability of peripheral blood endothelial cells in the exercise group were higher than those before intervention and control group(P<0.05).(3)Regular aerobic exercise can promote mobilization of endothelial progenitor cells and enhance ability of proliferation,adhesion,and migration,thereby improving clinical condition,cardiac function,and cardiopulmonary fitness of patients with myocardial infarction.