运动对高血压心力衰竭患者血清肌钙蛋白I的影响

The effects of exercise on level of cardiac troponin I in patients with hypertensive heart failure

目的观察症状限制性运动试验和运动训练对高血压心力衰竭患者心肌肌钙蛋白I（cTnI）的影响。方法30例高血压中度心力衰竭患者[NYHA分级Ⅱ～Ⅲ级，射血分数（1．7±9.3）％]与15例轻度心力衰竭患者及10例无心力衰竭受试者进行对比观察。患者均进行症状限制性运动试验和单期运动训练（达最大心率的80％以上，持续时间30min），分别测定基础cTnI值、症状限制性试验后和运动训练后1～6h时的cTnI值。结果症状限制性运动试验后，中度心力衰竭患者cTM值由（37±21）pg／ml增加到（77±24）pg／d，其中9例中度心力衰竭患者和4例轻度心力衰竭患者的cTnI值升高到100pg／ml以上。无心力衰竭的受试者无论是静息时或是运动后，cTnI值均较低（P〈0．05）。结论高血压心力衰竭患者在症状限制性运动试验后cTnI值增加，其水平达到轻微的心肌损伤水平。这一现象对患者预后的影响值得进一步研究。

Objective To study whether an increase of cardiac troponin I can be observed after symptom-limited exercise and an exercise training session in patients of hypertension with moderate heart failure. Methods 30 patients with hypertension and moderate heart failure [New York Heart Association Ⅱ-Ⅲ ,ejection fraction （31.7±9.3）%] were compared with 15 patients with mild heart failure and 10 subjects without heart failure. All subjects underwent a symptom-limited test and a exercise training session at 〉80% of maximal heart rate over time 30 minutes. The plasma cTnI level was measured at baseline, after symptom-limited exercise hourly for 6 hours, and lto 6 hours after training. Results Patients with moderate heart failure showed an increase of cTnI from （37±21）pg/rnl to（77±24）pg/ml（P〈0.01 ） after symptom-limited exercise. Nine patients with moderate and four patients with mild heart failure showed the increase of cTnI above 100 pg/ml after acute exercise but not after training. Subjects without heart failure had lower cTnI levels at rest and significantly lower values after symptomlimited exercise and training （P〈0.05 for each）. ConcLusion Patients with hypertension and symptomatic heart faiLure show an increase of cTnI after symptom-limited exercise that indicate minor myocardial damage. The prognostic impact of this finding should, be further investigated.