有氧训练对心肌梗死后合并慢性心力衰竭患者的心肌缺血及心功能影响

Effects of aerobic training on myocardial ischemia and cardiac function in patients with chronic heart failure after myocardial infarction

目的探讨有氧训练对心肌梗死后合并慢性心衰患者心功能的影响,并试述其机制。方法将2016年6月~2019年10月证实的42例心肌梗死后合并慢性心衰的患者随机分为有氧组21例和对照组21例,两组患者均接受正规药物的治疗,有氧组患者行有氧训练3个月,采用酶联免疫吸附法(ELISA)检测有氧组及对照组外周血管内皮生长因子(VEGF)的含量浓度,通过免疫定量分析仪判读患者外周血N-末端脑钠肽前体(NT-proBNP),单光子发射计算机断层显像(SPECT)的静息灌注总评分(SRS)检测心肌缺血区灌注,心脏彩超及6 min步行试验检测心室功能,比较两组间及3个月前后患者外周血的血管内皮生长因子VEGF的浓度、缺血心肌灌注及心功能等指标。结果有氧训练前后心率血压比较,差异无统计学意义(P>0.05),两组在3个月前VEGF、心肌灌注与心功能指标无明显差异,有氧组经过3个月训练,有氧组的VEGF浓度、NT-pro BNP、SRS、左室射血分数(LVEF)及6 min步行距离均有显著改善,差异有统计学意义(P<0.001),然而对照组3个月前后自身比较,差异无统计学意义(P>0.05)。结论有氧训练可安全有效地改善心肌梗死后合并慢性心衰患者的心脏灌注,进而改善其心功能。

Objective To explore the effect of aerobic training on cardiac function in patients with chronic heart failure after myocardial infarction,and to describe its mechanism.Methods Forty-two patients with myocardial infarction and chronic heart failure confirmed from June 2016 to October 2019 were randomLy divided into an aerobic group(n=21)and control group(n=21).Both groups received regular drugs treatment.The aerobic group was treated with aerobic training for 3 months.The content of vascular endothelial growth factor(VEGF)in the peripheral blood of both groups was measured by enzyme-linked immunosorbent assay(ELISA).The peripheral blood N-terminal brain natriuretic peptide precursor(NT-proBNP)was interpreted by immunoquantitative analyzer.The perfusion of myocardial ischemia was detected by summed rest score(SRS)of single photon emission computed tomography(SPECT).The ventricular function was detected by color Doppler ultrasound and six-minute walk.The VEGF concentration,ischemic myocardial perfusion and cardiac function before and after 3 months of treatment were compared between the two groups.Results There was no statistically significant difference in heart rate and blood pressure before and after aerobic training(P>0.05).There were no significant differences in VEGF,myocardial perfusion,and cardiac function indexes between the two groups at 3 months before training.After 3-month training,the VEGF concentration,NT-proBNP,SRS,left ventricular ejection fraction(LVEF),and six-minute walking distance were significantly improved in the two groups,and the differences were statistically significant(P<0.001).However,there was no statistical difference in the control group before and after 3 months of treatment(P>0.05).Conclusion Aerobic training can safely and effectively improve cardiac perfusion in patients with myocardial infarction and chronic heart failure,and then improve their cardiac function.