运动训练可减轻心脏移植受者肱动脉反应性的渐进性下降。

Exercise training attenuates progressive decline in brachial artery reactivity in heart transplant recipients.

作者信息

Braith Randy W, Schofield Richard S, Hill James A, Casey Darren P, Pierce Gary L

机构信息

Center for Exercise Science, Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida 32611, USA.

出版信息

J Heart Lung Transplant. 2008 Jan;27(1):52-9. doi: 10.1016/j.healun.2007.09.032.

DOI:10.1016/j.healun.2007.09.032

PMID:18187087

Abstract

BACKGROUND

Heart transplantation normalizes central hemodynamics, but endothelial dysfunction persists after transplantation.

METHODS

To investigate the effects of aerobic exercise on arterial function, oxidative stress, lipid profile, and sympathetic nervous system activity, 20 heart transplant recipients (age, 54.3 +/- 9.1 years; 17 men, 3 women) were randomly assigned to 12 weeks of supervised treadmill exercise (Trained; n = 10) or standard medical care (Control; n = 10). Supervised exercise was initiated at 8 weeks after transplant. Brachial artery reactivity was assessed using flow-mediated dilation.

RESULTS

The VO2 peak increased 26% in the Trained patients (15.4 +/- 4.3 vs 19.4 +/- 5.5 ml/kg/min; p < or = 0.05) but did not change in the Controls (16.2 +/- 5.2 vs 16.8 +/- 2.8 ml/kg/min; p > or = 0.05). Brachial artery flow-mediated dilation (10.1% +/- 6.1% vs 9.6% +/- 6.2%) and absolute brachial diameter (0.48 +/- 0.22 vs 0.42 +/- 0.24 mm) did not change in Trained patients, but brachial flow-mediated dilation (10.5% +/- 2.8% vs 7.9% +/- 5.1%) and the absolute change in brachial diameter (0.48 +/- 0.16 vs 0.36 +/- 0.24 mm) decreased significantly (p < or = 0.05) in the Control patients. Resting norepinephrine decreased significantly (p < or = 0.05) after training (0.32 +/- 0.19 vs 0.22 +/- 0.22 ng/ml), but there was a nonsignificant trend toward increased norepinephrine in the Controls (0.26 +/- 0.17 vs 0.53 +/- 0.41 ng/ml; p = 0.07). The lipid profile and marker of oxidative stress did not differ between the groups before or after the intervention.

CONCLUSIONS

To our knowledge, this is the first prospective, randomized study to investigate the effects of heart transplantation and aerobic exercise on peripheral artery function in the same cohort of heart transplant recipients. Brachial artery flow-mediated dilation increased early in the post-operative period. Aerobic exercise preserved but did not improve brachial artery flow-mediated dilation. Heart transplant recipients who did not participate in supervised exercise showed a progressive decline in brachial artery flow-mediated dilation.

摘要

背景

心脏移植可使中心血流动力学恢复正常，但移植后内皮功能障碍仍然存在。

方法

为研究有氧运动对动脉功能、氧化应激、血脂谱和交感神经系统活性的影响，将20名心脏移植受者（年龄54.3±9.1岁；男性17名，女性3名）随机分为两组，一组接受为期12周的有监督的跑步机运动训练（训练组；n = 10），另一组接受标准医疗护理（对照组；n = 10）。有监督的运动在移植后8周开始。使用血流介导的血管舒张评估肱动脉反应性。

结果

训练组患者的峰值摄氧量增加了26%（15.4±4.3 vs 19.4±5.5 ml/kg/min；p≤0.05），而对照组无变化（16.2±5.2 vs 16.8±2.8 ml/kg/min；p≥0.05）。训练组患者的肱动脉血流介导的血管舒张（10.1%±6.1% vs 9.6%±6.2%）和肱动脉绝对直径（0.48±0.22 vs 0.42±0.24 mm）无变化，但对照组患者的肱动脉血流介导的血管舒张（10.5%±2.8% vs 7.9%±5.1%）和肱动脉直径的绝对变化（0.48±0.16 vs 0.36±0.24 mm）显著降低（p≤0.05）。训练后静息去甲肾上腺素显著降低（p≤0.05）（0.32±0.19 vs 0.22±0.22 ng/ml），但对照组去甲肾上腺素呈非显著升高趋势（0.26±0.17 vs 0.53±0.41 ng/ml；p = 0.07）。干预前后两组的血脂谱和氧化应激标志物无差异。