1st Department of Internal Medicine, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece.
Diabetes Metab. 2010 Apr;36(2):144-51. doi: 10.1016/j.diabet.2009.11.004. Epub 2010 Feb 9.
This study assessed the impact of regular exercise on inflammatory markers (high-sensitivity C-reactive protein [hsCRP], fibrinogen), and matrix metalloproteinases (MMPs) and their inhibitors (TIMPs), in patients with type 2 diabetes mellitus (T2DM).
Fifty overweight patients with T2DM were randomly assigned to two groups: (A) an exercise group (EXG, n=25), with self-controlled exercise for at least 150 min/week and one additional supervised exercise session/week; and (B) a control group (COG, n=25), with no exercise instructions. All participants were taking oral antidiabetic drugs, and none had diabetic complications. Clinical parameters, exercise capacity (VO(2 peak)), ventilatory threshold (VT), insulin resistance indices (fasting insulin, HOMA-IR, HOMA%S), hsCRP, fibrinogen, MMP-2, MMP-9, TIMP-1 and TIMP-2 were assessed at baseline and after 16 weeks.
No significant changes were found in body mass index, waist/hip ratio, insulin-resistance indices, MMP-2 and TIMP-1 throughout the study in either group (P>0.05). Compared with controls, the EXG showed a significant decrease in systolic and mean blood pressure, total and LDL cholesterol, and HbA(1c) (P<0.05). Also, exercise significantly suppressed levels of fibrinogen (P=0.047), hsCRP (P=0.041) and MMP-9 (P=0.028), and the MMP-9-to-TIMP-1 ratio (P=0.038), whereas VO(2 peak) (P=0.011), VT (P=0.008) and plasma TIMP-2 levels (P=0.022) were considerably upregulated in the EXG vs. COG. Standard multiple-regression analyses revealed that MMP-9 changes were independently associated with fibrinogen and HbA(1c) changes, while fibrinogen changes independently predicted TIMP-2 alterations with exercise.
Mostly self-controlled exercise of moderate intensity ameliorated serum levels of pro- and anti-atherogenic markers in patients with T2DM, with no effects on body weight. These data offer further insight into the cardioprotective mechanisms of exercise in patients with T2DM.
本研究评估了规律运动对 2 型糖尿病（T2DM）患者炎症标志物（高敏 C 反应蛋白[hsCRP]、纤维蛋白原）和基质金属蛋白酶（MMPs）及其抑制剂（TIMP）的影响。
50 名超重的 T2DM 患者被随机分为两组：（A）运动组（EXG，n=25），自我控制运动至少 150 分钟/周，并每周增加一次监督运动；和（B）对照组（COG，n=25），无运动指导。所有参与者均服用口服降糖药，且均无糖尿病并发症。在基线和 16 周后评估临床参数、运动能力（VO2 峰值）、通气阈（VT）、胰岛素抵抗指数（空腹胰岛素、HOMA-IR、HOMA%S）、hsCRP、纤维蛋白原、MMP-2、MMP-9、TIMP-1 和 TIMP-2。
在整个研究过程中，两组的体重指数、腰围/臀围比、胰岛素抵抗指数、MMP-2 和 TIMP-1 均无显著变化（P>0.05）。与对照组相比，EXG 组收缩压和平均血压、总胆固醇和 LDL 胆固醇以及 HbA1c 显著降低（P<0.05）。此外，运动显著抑制了纤维蛋白原（P=0.047）、hsCRP（P=0.041）和 MMP-9（P=0.028）水平，以及 MMP-9/TIMP-1 比值（P=0.038），而 VO2 峰值（P=0.011）、VT（P=0.008）和血浆 TIMP-2 水平（P=0.022）在 EXG 组显著上调。多元逐步回归分析显示，MMP-9 的变化与纤维蛋白原和 HbA1c 的变化独立相关，而纤维蛋白原的变化则与运动时 TIMP-2 的变化独立相关。
以自我控制为主的中等强度运动改善了 T2DM 患者的血清前、后动脉粥样硬化标志物水平，而对体重无影响。这些数据进一步深入了解了运动对 T2DM 患者的心脏保护机制。
