有氧运动对血液透析患者6分钟步行距离及血网膜素-1的影响

Effects of aerobic exercise on 6-minute walk distance and serum level of omentin-1 in hemodialysis patients

目的探讨有氧运动对维持性血液透析(MHD)患者6分钟步行距离及血网膜素-1的影响。方法选取2013年12月—2014年11月天津市第五中心医院MHD(MHD组)患者89例,随机分为常规治疗组(常规组,43例)和有氧运动治疗组(有氧运动组,46例),选取50例健康体检者作为正常对照组(对照组)。有氧运动组在常规治疗基础上进行6个月的透析间期有氧运动,常规组避免任何运动干预。2组MHD患者治疗前及治疗6个月后行6分钟步行试验,测量体质量、身高及血压。检测血网膜素-1、C反应蛋白(CRP)、血常规、血生化,彩色超声心动测定心血管参数,对6分钟步行距离(6MWDs)与年龄、CRP、左室射血分数(LVEF)、血网膜素-1间进行相关分析。结果 MHD组网膜素-1、CRP均较对照组升高,LVEF较对照组下降(均P<0.01);有氧运动组经有氧运动6个月后,6MWDs、LVEF、血红蛋白及血网膜素-1较治疗前增加,并且6MWDs、LVEF、血红蛋白较常规组治疗后增加;CRP、空腹血糖、收缩压较治疗前下降,CRP、空腹血糖、收缩压亦较常规组治疗后下降;治疗前MHD患者6MWDs与年龄、CRP呈负相关,与LVEF、血网膜素-1呈正相关(r分别为-0.418、-0.229、0.252、0.234,均P<0.05)。结论有氧运动可明显增加MHD患者6MWDs、LVEF、血红蛋白及血网膜素-1,降低CRP、空腹血糖和收缩压,改善身体活动能力、心功能及微炎症状态,从而降低心血管事件的发生和死亡风险。

Objective To explore the effects of aerobic exercise on 6-minute walk distance and serum level of omentin-1 in maintenance hemodialysis (MHD) patients. Methods A total of 89 MHD patients (MHD group) in the 5th Central Hospital of Tianjin were included in the study from December 2013 to November 2014. Patients were randomly divided into two groups:routine treatment group (n=43) and aerobic exercise treatment group (aerobic exercise group, n=46). Fifty healthy subjects were selected as normal control group. Both groups received the same hemodialysis and regular treatments, and the aerobic exercise group received 6-month interdialytic aerobic exercise, and the routine group did not take any exercise intervention. The 6-minute walk distances (6MWDs),body mass,height and blood pressure were recorded, and serum levels of omentin-1, C-reactive protein (CRP), blood routine test and biochemistry test were determined in two groups. The relationship between 6 MWDs, age, CRP, left ventricular ejection fraction (LVEF) and omentin-1 were analyzed. Results The serum levels of omentin-1 and CRP weresignificantly higher, LVEF was significantly lower, in MHD group than those of healthy control group (P<0.01). After 6 months of aerobic exercise, 6MWDs, LVEF, hemoglobin and serum level of omentin-1 were significantly increased than those before treatment in aerobic exercise group. The 6MWDs, LVEF and hemoglobin were significantly increased after treatment than routine group. The levels of CRP, fasting glucose and blood pressure were significant decreased after treatment. The levels of CRP, fasting glucose and systolic blood pressure were decreased in treatment group than those of routine group. Before treatment, 6MWDs was negatively related with age and CRP, and positively related with LVEF and serum level of omentin-1 in MHD patients (r=-0.418,-0.229, 0.252 and 0.234, P<0.05). Conclusion Aerobic exercise can significantly increase values of 6MWDs, LVEF, hemoglobin and serum level of omentin-1, and reduce values of CRP, fasting blood glucose and systolic blood pressure in MHD patients. Aerobic exercise can improve physical performance,heart function and micro inflammatory state, thereby reduce cardiovascular events and mortality risk in MHD patients.