生理性缺血训练对冠心病患者循环血管内皮祖细胞的影响

Effects of physiological ischemia training on circulating endothelial progenitor cells in patients with coronary heart disease

目的:研究生理性缺血训练(PIT)对冠心病患者循环血管内皮祖细胞(EPCs)和血管内皮生长因子(VEGF)的影响。方法:冠心病患者分为训练组(n=10)和对照组(n=10),均应用3个月常规药物治疗,其中训练组患者同时进行3个月的PIT。PIT采用高强度静力性握拳诱导上肢肌肉最大等长收缩运动,造成短暂的骨骼肌生理性缺血;每次握拳持续1min,放松1min,重复10次为1组,每天4组,每周5d,训练3个月。3个月前、后分别抽取患者外周血,采用流式细胞术检测外周血EPCs的数量,ELISA法检测血清VEGF的浓度。结果:3个月前,两组患者外周血EPCs数量和VEGF浓度的差异均无显著性意义(P>0.05)。经过3个月PIT,训练组患者EPCs数量增加到(0.044±0.016)%,明显高于基线水平(P=0.015);VEGF浓度增加到(98.5±17.4)pg/ml,明显高于基线水平(P<0.01)。而对照组3个月前、后EPCs数量和VEGF浓度均没有显著改变(P>0.05)。对照组3个月后两指标均低于训练组3个月后的水平(P<0.05)。3个月后两组患者EPCs数量与VEGF浓度均呈正相关(P<0.05)。结论:PIT可以增加冠心病患者循环EPCs的数量和VEGF的浓度,从而可能促进远隔缺血心肌侧支循环的生成。

Objective： To investigate the effects of physiological ischemia training （PIT） on the amount of circulating endothelial progenitor cells （EPCs） and the level of vascular endothelial growth factor （VEGF） in patients with coronary artery disease（CAD）. Method： Twenty patients with CAD were divided into training group （n=10） and control group （n=10）. The patients in training group enrolled three-month PIT, while patients in control group remained sedentary. PIT was induced by isometric exercise （handgrip） with maximal voluntary contraction. Circulation EPCs were measured with flow cytometry at baseline and after training. Plasma concentration of VEGF was determined by ELISA. Result： EPCs increased significantly in training group to （0.044 ± 0.016） % after training （P=0.015）. VEGF levels in training patients also increased significantly after three-month PIT（P〈0.01）. A positive correlation was observed between the amount of EPCs and the level of VEGF in both groups after three-month PIT（P〈0.05）. Conclusion： PIT could increase the amount of circulating EPCs and the level of VEGF in CAD patients, which may contribute to collateral angiogenesis in the remote ischemia heart region.