Byrkjeland Rune, Njerve Ida U, Arnesen Harald, Seljeflot Ingebjørg, Solheim Svein
1 Center for Clinical Heart Research (CCHR), Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.
2 Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway.
Diab Vasc Dis Res. 2017 Mar;14(2):94-103. doi: 10.1177/1479164116679077. Epub 2017 Jan 23.
We have previously reported insignificant changes in HbA after exercise in patients with both type 2 diabetes and coronary artery disease. In this study, we investigated the effect of exercise on endothelial function and possible associations between changes in endothelial function and HbA.
Patients with type 2 diabetes and coronary artery disease ( n = 137) were randomised to 12 months exercise or standard follow-up. Endothelial function was assessed by circulating biomarkers (E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, von Willebrand factor, tissue plasminogen activator antigen, asymmetric dimethylarginine and L-arginine/asymmetric dimethylarginine ratio). Differences between the randomised groups were analysed by analysis of covariance and correlations by Spearman's rho or Pearson's correlation.
No effect of exercise on endothelial function was demonstrated. The changes in HbA in the exercise group correlated with changes in E-selectin ( r = 0.56, p < 0.001), intercellular adhesion molecule-1 ( r = 0.27, p = 0.052), vascular cell adhesion molecule-1 ( r = 0.32, p = 0.022) and tissue plasminogen activator antigen ( r = 0.35, p = 0.011). HbA decreased significantly more in patients with versus without a concomitant reduction in E-selectin ( p = 0.002), intercellular adhesion molecule-1 ( p = 0.011), vascular cell adhesion molecule-1 ( p = 0.028) and tissue plasminogen activator antigen ( p = 0.009).
Exercise did not affect biomarkers of endothelial function in patients with both type 2 diabetes and coronary artery disease. However, changes in biomarkers of endothelial activation correlated with changes in HbA, and reduced endothelial activation was associated with improved HbA after exercise.
我们之前报道过，2型糖尿病和冠状动脉疾病患者运动后糖化血红蛋白（HbA）变化不显著。在本研究中，我们调查了运动对内皮功能的影响以及内皮功能变化与HbA之间可能存在的关联。
将137例2型糖尿病和冠状动脉疾病患者随机分为两组，一组进行为期12个月的运动干预，另一组进行标准随访。通过循环生物标志物（E选择素、细胞间黏附分子-1、血管细胞黏附分子-1、血管性血友病因子、组织型纤溶酶原激活剂抗原、不对称二甲基精氨酸和L-精氨酸/不对称二甲基精氨酸比值）评估内皮功能。采用协方差分析比较随机分组之间的差异，并使用Spearman秩相关系数或Pearson相关系数分析相关性。
未证实运动对内皮功能有影响。运动组中HbA的变化与E选择素（r = 0.56，p < 0.001）、细胞间黏附分子-1（r = 0.27，p = 0.052）、血管细胞黏附分子-1（r = 0.32，p = 0.022）和组织型纤溶酶原激活剂抗原（r = 0.35，p = 0.011）的变化相关。与E选择素（p = 0.002）、细胞间黏附分子-1（p = 0.011）、血管细胞黏附分子-1（p = 0.028）和组织型纤溶酶原激活剂抗原（p = 0.009）未同时降低的患者相比，这些指标同时降低的患者HbA显著下降更多。
运动对2型糖尿病和冠状动脉疾病患者的内皮功能生物标志物没有影响。然而，内皮激活生物标志物的变化与HbA的变化相关，运动后内皮激活降低与HbA改善相关。
