心脏运动康复对慢性心衰患者外周淋巴细胞MMP及JAK/STAT3通路的影响

Effects of rehabilitation exercise on MMP and JAK/STAT3 signal pathway of peripheral blood lymphocytes in patients with chronic heart failure

目的研究慢性心衰患者外周淋巴细胞线粒体膜电位(MMP)及JAK/STAT3信号通路分子的表达变化,并观察运动康复治疗对心衰的治疗作用。方法选取80例本院门诊及住院的慢性心衰患者作为研究对象,随机数字表法分为运动组和心衰组各40例,并选择40例健康体检者作为对照组。心衰组患者按照2012年慢性心衰指南药物常规抗心衰治疗。运动组患者在给予抗心衰药物治疗的基础上进行运动康复。收集并分离治疗前后患者的外周血淋巴细胞,采用JC-1荧光探针法检测MMP;采用real-time PCR法检测JAK、STAT3的mRNA水平;同时,采用电化学发光免疫法检测血清BNP浓度;行心脏彩超检测心内结构与功能指标变化;采用6MWT(6 min步行实验)评估患者运动耐力的变化。结果与对照组相比,心衰组及运动组患者外周血淋巴细胞JC1荧光比值、JAK、STAT3 mRNA表达水平均明显低于对照组(均P<0.05),血清BNP水平明显高于对照组(均为P<0.05)。而运动康复组患者外周血淋巴细胞线粒体JC1荧光比值、JAK及STAT3 mRNA水平均较心衰组明显升高(均为P<0.05),且血清BNP水平较心衰组明显降低(均为P<0.05)、心脏功能损伤及6MWT均明显改善。结论运动康复治疗可能通过减轻线粒体损伤,保护慢性心力衰竭患者的心脏功能。

Objective To observe the mitochondrial mitochondrial membrane potential and the expression of JAK/STAT3 of peripheral blood lymphocytes in patients with chronic heart failure(CHF)and to explore the effects of rehabilitation exercise on CHF.Methods Eighty chronic heart failure patients,more than sixty years old,were enrolled as the subjects.Patients were divided into rehabilitation exercise group(RE,n=40)and chronic heart failure group(CHF,n=40)by the random number table method.Forty healthy volunteers were enrolled as control group(n=40)during the same period.All patients in RE group and CHF group were treated with conventional drug therapy for heart failure.Patients in RE group were given rehabilitation exercise on the basis of drug therapy according to the guidelines.Blood samples were obtained after the treatment,and then,the peripheral lymphocytes were isolated and purified.MMP was detected by JC-1 fluorescence ratio,mRNA levels of JAK and STAT3 were detected by real time PCR,the serum BNP was detected using an electrochemiluminescence immunoassay and the cardiac function was detected by echocardiography.At the same time,six-minute walking test(6MWT)was carried out to evaluate the change of exercise tolerance.Results The serum BNP in both RE group and CHF group was significantly higher than that in control group(P<0.05),and the expression of JAK,STAT3 and JC-1 fluorescence ratio of lymphocytes were lower(P<0.05).All the above indicator were ameliorated in exercise group compared with CHF group,and the cardiac function and exercise tolerance were improved.Conclusion Rehabilitation exercise may protect the cardiac function of elderly patients with chronic heart failure by attenuating mitochondrial damage.