24周太极拳结合弹力带抗阻运动对2型糖尿病患者足背微循环功能的影响

Effect of 24-week Taijiquan Combined with Elastic Band Resistance Exercise on Dorsalis Pedis Microcirculation in Patients with Type 2 Diabetes Mellitu

目的:比较24周太极拳运动、太极拳结合弹力带抗阻运动对2型糖尿病(T2DM)患者足背微循环功能的影响,并从血管内皮功能探讨运动改善T2DM患者足背微循环功能的机制。方法:将60名T2DM患者分为对照组、太极拳运动组、太极拳结合弹力带抗阻运动组。太极拳运动组受试者每周进行6次、每次1 h的24式简化太极拳锻炼。太极拳结合弹力带抗阻运动组受试者每周进行4次太极拳锻炼(太极拳锻炼方法同太极拳运动组),同时,每周进行2次、每次1 h的弹力带抗阻运动,2次弹力带抗阻运动训练间隔2~3天。对照组受试者保持正常的生活习惯不变。分别在运动干预前后对3组受试者的微血管反应性(MR)、经皮氧分压(TcPO_(2))、肌氧饱和度(SmO_(2))、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、一氧化氮(NO)、内源性一氧化氮合酶(eNOS)、内皮素-1(ET-1)、血管内皮细胞生长因子(VEGF)等指标进行测试。运用协方差分析探讨运动干预后不同组间各指标的差异,运用t检验探讨组内受试者运动干预前后各指标的差异。结果:(1)在运动干预后,太极拳组和太极拳结合抗阻运动组的体脂率、腰臀比、FBG、HbA1c、FINS、HOMA-IR与对照组相比有显著差异(p<0.05),太极拳结合抗阻运动组的体重、BMI与对照组相比有显著差异(p<0.05),太极拳结合抗阻运动组的HOMA-IR与太极拳组相比有显著差异(p<0.05);(2)在运动干预后,太极拳组和太极拳结合抗阻运动组的MBP加热值、AVBC加热值、TcPO_(2)和SmO_(2)与对照组及运动干预前相比有显著差异(p<0.05),太极拳结合抗阻运动组的MBP加热值与太极拳组相比有显著差异(p<0.05);(3)在运动干预后,太极拳组和太极拳结合抗阻运动组NO、eNOS、ET-1、VEGF与对照组及运动干预前相比有显著差异(p<0.05)。结论:24周太极拳运动和太极拳结合抗阻运动可显著改善T2DM患者的足背微循环功能,其机制可能与血管内皮功能的增强有关。但是2种运动方式对T2DM患者的足背微循环功能及血管内皮功能的干预效应无显著差异。

Objective:To compare the effects of 24-week Taijiquan exercise and Taijiquan combined with e lastic band resistance exercise on microcirculation function in patients with type 2 diabetes mellitus(T2DM),and to explore the mechanism of exercise improving microcirculation function in patients with T2DM from the change of vascular endothelial function.Methods:Sixty patients with T2DM were divided into control group,Taijiquan exercise group and Taijiquan combined with elastic band resistance exercise group.The Taijiquan exercise group has 24 simplified Taijiquan exercises for 1 hour six times a week;Taijiquan combined with elastic band resistance exercise group takes Taijiquan exercise four times a week(Taijiquan exercise method is the same as Taijiquan exercise group),and at the same time takes an elastic band resistance exercise twice a week for one hour each time,with an interval of 2-3 days between the two elastic band resistance trainings.The subjects in the control group maintained their normal living habits.Microvascular reactivity,percutaneous oxygen partial pressure(TCPO_(2)),muscle oxygen saturation(SmO_(2)),fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),nitric oxide(NO),endogenous nitric oxide synthase(eNOS),endothelin-1(ET-1)and endothelial growth factor(VEGF)were measured before and after the intervention.The differences in each indicator among the different groups after the intervention were analyzed using covariance analysis,and data before and after exercise interventions within the group were analyzed using paired t-test.Results:(1)After intervention,the waist-to-hip ratio(WHR),FBG,HbA1c,FINS,and HOMA-IR of Taijiquan exercise group and Taijiquan combined resistance exercise group were significantly different from those of the control group(p<0.05).The body weight and BMI of Taijiquan combined resistance exercise group were significantly different from those of the control group(p<0.05).The HOMA-IR of Taijiquan combined resistance exercise group was significantly different from that of Taijiquan exercise group(p<0.05).(2)After intervention,the MBP heating value,AVBC heating value,TcPO_(2),and SmO_(2) of Taijiquan exercise group and Taijiquan combined resistance exercise group were significantly different from those of the control group and before intervention(p<0.05),and the MBP heating value of Taijiquan combined resistance exercise group was significantly different from that of Taijiquan exercise group.(3)After intervention,the NO,eNOS,ET-1,and VEGF of Taijiquan exercise group and Taijiquan combined resistance exercise group were significantly different from those of the control group and before intervention(p<0.05).Conclusion:24-week Taijiquan exercise and Taijiquan combined with resistance exercise may improve the microcirculation function of dorsal foot of T2DM patients by regulating vascular endothelial function.The mechanism may be related to the enhancement of vascular endothelial function.However,there was no significant difference in the intervention effect of the two exercise modes on the dorsum microcirculation and vascular endothelial function of T2DM patients.