心肺运动训练对心房颤动伴糖尿病患者纤维蛋白溶解系统和内皮功能调节的影响

Effect of cardiopulmonary exercise training on regulation of fibrinolysis system and endothelial function in patients with atrial fibrillation and diabetes mellitus

目的探讨心肺运动训练对心房颤动伴糖尿病患者纤维蛋白溶解系统和内皮功能调节的影响。方法将心房颤动伴糖尿病患者分成两组:药物治疗+运动训练组(运动训练组)及单纯药物治疗组(对照组)。治疗开始前1天,开始治疗后1、3、6个月第1天检测患者血清中D-二聚体、组织纤溶酶原激活物抑制物(PAI)、内皮素-1(ET-1)、血清血管内皮生长因子(VEGF),并采用心肺运动试验评估两组峰值摄氧量(VO2 peak)、峰值能量代谢当量(MET peak)及最大功率相关指标。结果治疗后第1、3、6个月,运动训练组较对照组D-二聚体、PAI、ET-1明显下降,VEGF明显升高(t分别=3.37、15.55、17.68;2.63、8.15、12.70;20.37、41.34、68.18;-5.70、-12.37、-17.86,P均<0.05);VO2 peak、MET peak及最大功率、最快心率均升高,基础心率明显降低,差异有统计学意义(t分别=19.42、31.08、43.89;5.03、15.41、13.61;3.06、14.01、18.88;8.38、12.73、15.76;-5.29、-9.69、-18.00,P均<0.05)。结论心肺运动训练在心房颤动伴糖尿病患者中可显著改善纤维蛋白溶解系统及内皮功能,改善患者的运动耐量,对于预防心房颤动伴糖尿病患者复发及改善预后有一定的作用。

Objective To explore the effect of cardiopulmonary exercise training on the regulation of fibrinolytic system and endothelial function in patients with atrial fibrillation(AF)with diabetes mellitus.Methods Patients with AF with diabetes mellitus were divided into the experimental group and control group.The experimental group received drug therapy and exercise training,and the control group received drug therapy only.The D-dimer,PAI,ET-1,and VEGF were detected,and the peak oxygen intake(VO2 peak),metabolic equivalent peak(MET peak)and maximum power were evaluated at 1 day before treatment and 1,3 and 6 months after treatment.Results At 1,3 and 6 months after treatment,the D-dimer,PAI and ET-1 of the experimental group were significantly decreased when compared with the control group,while the VEGF was significantly increased(t=3.37,15.55,17.68,2.63,8.15,12.70,20.37,41.34,68.18,-5.70,-12.37,-17.86,P<0.05).The VO2 peak,MET peak,maximum power,and maximum heart rate were significantly increased when compared with the control group,while the basic heart rate was significantly decreased(t=19.42,31.08,43.89,5.03,15.41,13.61,3.06,14.01,18.88,8.38,12.73,15.76,-5.29,-9.69,-18.00,P<0.05).Conclusion Cardiopulmonary exercise training can significantly improve fibrinolysis and endothelial function and exercise tolerance in patients with AF and diabetes mellitus.It has a certain effect on preventing the recurrence of atrial fibrillation and improving the prognosis of patients with diabetes mellitus.