运动改善血管重塑在心血管疾病中的研究进展

Research Progress on Exercise to Alleviate Vascular Remodeling in Cardiovascular Diseases

血管重塑(vascular remodeling,VR)是多因素共同介导的血管壁结构发生适应性改变的病理生理过程,其涉及炎症因子浸润、血管平滑肌增殖迁移、内皮功能障碍、细胞外基质的合成或降解。血管重塑是动脉粥样硬化、原发性高血压、肺动脉高压、血管阻塞或狭窄、血管成形术后、动脉瘤、动脉搭桥术后等疾病的病理性标志。近年来对这些慢性疾病的治疗集中于抗血管重塑的分子靶向治疗,而运动属于非药物治疗手段,从血流动力学上,增加血管壁的剪切应力(wall shear stress,WSS),维持正常的内皮弹性状态;从血管内皮功能上,有氧运动上调一氧化碳合酶的表达,促进内皮的一氧化氮(nitric oxide,NO)释放,减少活性氧(reactive oxygen species,ROS)的产生,使得管腔内NO/ROS处于平衡状态,是心血管疾病有效的预防和干预措施。本文将运动改善肺动脉高压、动脉粥样硬化、2型糖尿病和高血压病的血管重塑相关机制进行探讨。

Vascular remodeling(VR)is a pathophysiological process of adaptive changes in vascular wall structure mediated by multiple factors,which involves inflammatory factors infiltration,proliferation and migration of vascular smooth muscle,endothelial dysfunction,and synthesis or degradation of extracellular matrix.Vascular remodeling is a pathological marker of atherosclerosis,essential hypertension,pulmonary hypertension,vascular obstruction or stenosis,post-angioplasty,aneurysm,artery bypass grafting,and other diseases.In recent years,the treatment of these chronic diseases has focused on molecular targeted therapy against vascular remodeling,while exercise is a non-drug therapy.From the perspective of hemodynamics,it can increase wall shear stress(WSS)of blood vessels and maintain normal elastic state of endothelial.In terms of vascular endothelial function,aerobic exercise up-regulates expression of carbon monoxide synthase,promotes release of(nitric oxide,NO),which in the endothelium,reduces production of reactive oxygen species(ROS),and keeps NO/ROS in balance in blood vessels is an effective preventive and intervention measure for cardiovascular diseases.In this study,we investigated the mechanism of vascular remodeling in pulmonary hypertension,atherosclerosis,type 2 diabetes and hypertension by exercise.