康复运动治疗心绞痛的疗效及其对心脏自主神经功能、IL-6、BNP水平的影响

Therapeutic effect of rehabilitative exercise on angina pectoris and its impact on cardiac autonomic nervous function,IL-6 and BNP level

目的:研究康复运动治疗心绞痛的疗效及对心脏自主神经功能、白介素(IL)-6、脑钠肽(BNP)水平的影响。方法:选择2013年1月～2016年12月我院收治的心绞痛患者128例纳入康复运动组(接受常规治疗及康复运动治疗),治疗6个月。另选择128例健康人作为健康对照组。观察比较健康对照组与治疗前后康复运动组的血脂、心率变异性(HRV)指标、IL-6和BNP水平。结果:1.血脂和BNP的比较(表2,4):(1)康复运动组治疗前后比较:治疗6个月后康复运动组TG、TC、LDL-C、IL-6和BNP水平均显著降低,HDL-C水平显著升高,P均=0.001;(2)两组间治疗后比较,与健康对照组比较,康复运动组治疗后TG [(1.56±0.17)mmol/L比(2.15±0.22)mmol/L]、TC [(1.53±0.20)mmol/L比(4.01±0.43)mmol/L]、LDL-C [(2.79±0.29)mmol/L比(3.21±0.25)mmol/L]、IL-6 [(12.21±1.34)pg/ml比(20.18±2.19)pg边/ml]和BNP [(89.96±9.21)ng/L比(410.69±42.76)ng/L]水平均显著升高,HDL-C水平[(1.16±0.19)mmol/L比(0.98±0.11)mmol/L]显著降低,P均=0.001;2.HRV指标的比较(表3):(1)健康对照组安静与运动后比较:运动后lnVLF、lnLF、lnHF和lnTP均显著降低,ln (LF/HF)显著升高,P均=0.001;(2)康复运动组治疗前安静与运动后比较,运动后仅lnVLF显著降低P=0.005;(3)治疗前,健康对照组与康复运动组比较,无论安静或运动后,康复运动组lnVLF、lnLF、lnHF和lnTP均显著降低,ln (LF/HF)显著升高,P均=0.001;(4)康复运动组治疗后安静或运动后比较,运动后lnVLF、lnLF、lnHF、lnTP和ln (LF/HF)均显著降低,P=0.001;(5)康复运动组治疗前后安静时比较,治疗后lnVLF、lnLF、lnHF和lnTP均显著升高,P均=0.001;(6)康复运动组治疗前后运动后比较,治疗后lnLF、lnHF显著升高,ln (LF/HF)显著降低,P均<0.01。结论:康复运动可显著改善心绞痛患者血脂水平,缓解机体炎性反应,提高心脏自主神经功能,疗效显著,安全可靠。

Objective:To study therapeutic effect of rehabilitative exercise on angina pectoris and its impact on cardiac autonomic nervous function,levels of interleukin(IL)-6and brain natriuretic peptide(BNP).Methods:A total of128patients with angina pectoris,who were treated in our hospital from Jan2013to Dec2016,were enrolled as rehabilitative exercise group(received routine treatment and rehabilitative exercise)and treated for six months.Another128healthy subjects were regarded as healthy control group.Blood lipid levels,indexes of heart rate variability(HRV),levels of IL-6and BNP were observed and compared between two groups before and after treatment.Results:1.Comparison of blood lipids and BNP(table2,4):(1)Before vs.after treatment in rehabilitative exercise group:after six-month treatment,there were significant reductions in levels of TG,TC,LDL-C,IL-6and BNP,and significant rise in HDL-C level,P=0.001all;(2)Comparison between two groups after treatment:Compared with healthy control group after treatment,there were significant rise in levels of TG[(1.56±0.17)mmol/L vs.(2.15±0.22)mmol/L],TC[(1.53±0.20)mmol/L vs.(4.01±0.43)mmol/L],LDL-C[(2.79±0.29)mmol/L vs.(3.21±0.25)mmol/L],IL-6[(12.21±1.34)pg/ml vs.(20.18±2.19)pg/ml]and BNP[(89.96±9.21)ng/L vs.(410.69±42.76)ng/L],and significant reduction in HDL-C level[(1.16±0.19)mmol/L vs.(0.98±0.11)mmol/L]in rehabilitative exercise group,P=0.001all.2.HRV index comparison(table3):(1)Healthy control group(resting vs.after exercise):after exercise there were significant reductions in lnVLF,lnLF,lnHF and lnTP,and significant rise in ln(LF/HF),P=0.001all;(2)Rehabilitative exercise group before treatment(resting vs.after exercise):after exercise only lnVLF significantly reduced,P=0.005;(3)Healthy control group vs.rehabilitative exercise group before treatment,no matter resting or after exercise,there were significant reductions in lnVLF,lnLF,lnHF and lnTP,and significant rise in ln(LF/HF)in rehabilitative exercise group,P=0.001all;(4)Rehabilitative exercise group after treatment(resting vs.after exercise):after exercise there were significant reductions in lnVLF,lnLF,lnHF,lnTP and ln(LF/HF),P=0.001all;(5)Rehabilitative exercise group resting(before vs.after treatment):after treatment there were significant rise in lnVLF,lnLF,lnHF and lnTP,P=0.001all;(6)Rehabilitative exercise group after exercise(before vs.after treatment):after treatment there were significant rise in lnLF and lnHF,and significant reduction in ln(LF/HF),P<0.01all.Conclusion:Rehabilitation exercise can significantly improve blood lipid levels,relieve inflammation,improve cardiac autonomic nervous function with significant therapeutic effect in patients with angina pectoris,and it's safe and reliable.