运动改善慢性心力衰竭心肌损伤的临床研究

Study on the improvement of myocardial injury by exercise training in patients with chronic heart failure

目的:评价运动治疗对改善慢性心衰患者心肌损伤的价值。方法:采用酶联免疫吸附试验一步夹心法检测18名健康体检者(正常对照组)以及76名慢性心力衰竭患者(NYHA心功能Ⅱ级24例、Ⅲ级29例、Ⅳ级23例)治疗(三组分别给予常规治疗或运动治疗)前、后的血清心脏型脂肪酸结合蛋白(H-FABP)、心肌肌钙蛋白(cTn)I、肌酸激酶同工酶(CK-MB),并作比较。结果:(1)各组心衰患者的CK-MB、cTnI、H-FABP测值均显著高于正常对照组(P<0.05);随心衰程度加重,H-FABP、cTnI水平亦随之上升,在各组之间的差别均有显著性(P<0.05),而CK-MB仅在NYHAⅡ级与Ⅳ级患者之间差别有显著性(P<0.05);(2)常规治疗组与常规治疗+运动治疗组间的比较:两种治疗方案均可使各参数水平下降,但常规治疗+运动治疗组这种改变更明显(P<0.05)。结论:(1)慢性心力衰竭时存在心肌细胞的损伤,且随着病情的动态变化心肌损伤程度亦随之改变;(2)运动治疗可以显著改善慢性心衰患者的心肌损伤状态。

Objective： To study the value of exercise training in the amelioration of myocardial injury in patients with chronic heart failure （CHF）. Methods： Heart-type fatty acid binding protein （H- FABP） was measured in 18 healthy persons and 76 chronic heart failure patients （group NYHA Ⅱ, 24 cases; group NYHA Ⅲ, 29 cases; group NYHA Ⅳ , 23 cases） before and after exercise training by ELISA-one-step sandwich assay, at the same time, creatine kinase isoenzyme--MB （CK--MB） and cardiac troponin Ⅰ （cTnI） were determined. Results： （1） The serum levels of H--FABP, cTnI, CK--MB in each CHF group before therapy were all higher than those of control＇group （P〈0.05）; and these values increased as NYHA--class increased; there were significant differences of cTnI and H--FABP between the groups of exercise training and non-exercise training （P〈0.05） ; the significant difference of CK--MB was observed only between NYHAⅡ group and NYHA Ⅳ group （ P〈0.05）; （2） After being treated, the value of H--FABP, cTnI, CK--MB of routine therapy＋ exercise training group significantly reduced than those of routine therapy group （P〈0.05）. Conclusion： （1） There is myocardial injury in patients with heart failure, and the degree of myocardial injury has changed as the severity of chronic heart failure changed; （2） Exercise training may ameliorate myocardial injury process.