Department of Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany.
Eur Heart J. 2010 Jan;31(1):112-9. doi: 10.1093/eurheartj/ehp398. Epub 2009 Sep 30.
Patients with type 2 diabetes mellitus (T2DM) suffer from accelerated coronary artery disease. We assessed the effects of a multifactorial intervention with focus on exercise training on coronary endothelial function, vascular structure, and inflammation in serum and skeletal muscle biopsies, including mRNA expression of diabetes candidate genes.
Twenty-three patients were randomized to either 4 weeks in-hospital exercise training (6 x 15 min bicycle/day, 5 days/week) and a hypocaloric diet, followed by a 5 months ambulatory program (30 min ergometer/day, 5 days/week, plus 1 h group exercise/week), or a control group. At the beginning of the study, at 4 weeks, and after 6 months changes in diameter of coronary arteries in response to acetylcholine and mean peak flow velocity were invasively measured; intramural plaques were assessed by intravascular ultrasound. Six months of intervention led to significant improvement of coronary endothelial function, whereas intramural plaque burden remained unchanged. After 4 weeks, endothelial function remained unchanged, however, lowest values for fasting glucose, HbA1c, high-sensitive C-reactive protein, total and LDL-cholesterol, and highest values for mRNA expression in skeletal muscle of p22, gp91, haem oxygenase 1, peroxisome proliferator activator receptor (PPAR) alpha and gamma were observed. There was a continuous increase for AdipoR1, AdipoR2, Glut4, interleukin-6, endothelial nitric oxide synthase, and PPARgamma-coactivator-1alpha mRNA expression in skeletal muscle.
This is the first study to demonstrate improvement in coronary endothelial function by a multifactorial intervention which focused on exercise training in patients with T2DM. This coincided with improved markers of hyperglycaemia, insulin sensitivity, and inflammation both in serum and skeletal muscle biopsies.
2 型糖尿病（T2DM）患者易发生冠状动脉疾病加速进展。我们评估了多因素干预（重点为运动训练）对冠状动脉内皮功能、血管结构和血清及骨骼肌活检中炎症的影响，包括糖尿病候选基因的 mRNA 表达。
23 例患者被随机分为住院 4 周运动训练组（每天 6 次、每次 15 分钟骑自行车，每周 5 天）和低热量饮食组，随后进行 5 个月的门诊运动训练组（每天 30 分钟测力计运动，每周 5 天，外加每周 1 小时团体运动）或对照组。在研究开始时、第 4 周和 6 个月时，通过血管内超声评估乙酰胆碱和平均峰值流速反应的冠状动脉直径变化；通过血管内超声评估壁内斑块。6 个月的干预导致冠状动脉内皮功能显著改善，而壁内斑块负担保持不变。4 周后，内皮功能保持不变，但空腹血糖、HbA1c、高敏 C 反应蛋白、总胆固醇和 LDL 胆固醇最低，骨骼肌 p22、gp91、血红素加氧酶 1、过氧化物酶体增殖物激活受体（PPAR）α和γ 的 mRNA 表达最高。骨骼肌中 AdipoR1、AdipoR2、Glut4、白细胞介素 6、内皮型一氧化氮合酶和 PPARγ 共激活因子 1α mRNA 表达持续增加。
这是第一项研究，证明了多因素干预（重点为运动训练）可改善 T2DM 患者的冠状动脉内皮功能，同时改善血清和骨骼肌活检中高血糖、胰岛素敏感性和炎症的标志物。
