胃旁路手术后进行随机体力训练对凝血激活标志物、纤维蛋白凝块特性和纤维蛋白溶解的影响。
Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis.
机构信息
Department of Medicine, Section of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
Department of Medicine, Section of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
出版信息
Surg Obes Relat Dis. 2018 Jul;14(7):918-926. doi: 10.1016/j.soard.2018.03.022. Epub 2018 Mar 26.
BACKGROUND
The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further.
OBJECTIVE
To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis.
SETTING
Bariatric center, Hospital of Southwest Jutland, Denmark.
METHODS
Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery.
RESULTS
Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%-38.9%) to 40.3% (28.5%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties.
CONCLUSION
We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.
背景
减重手术可降低心血管疾病的风险，但尚不清楚减重手术后进行运动是否会进一步降低这种风险。
目的
研究 Roux-en-Y 胃旁路术（RYGB）和 RYGB 后的监督性体能训练是否会改善凝血激活、纤维蛋白凝块特性和纤维蛋白溶解中的心血管疾病风险标志物。
地点
丹麦南日德兰医院减重中心。
方法
60 名肥胖患者接受 RYGB 治疗，术后 6 个月随机分为 26 周的体能训练组或对照组。分别于术前、术后 6、12 和 24 个月测量凝血激活、纤维蛋白凝块特性和纤维蛋白溶解的生物标志物。
结果
RYGB 后 6 个月，内源性凝血酶潜能从 1744（1603-2003）降至 1416（1276-1582）nM×min（P＜0.001）。纤维蛋白凝块特性的改变导致纤维蛋白溶解增加，从 23.8%（16.1%-38.9%）增加至 40.3%（28.5%-59.35%；P＜0.0001）。此外，纤维蛋白原从 12.6（11.1-14.7）降至 11.5（9.90-13.3）µM（P＜0.001），纤溶酶原激活物抑制剂抗原从 40.5（28.4-49.4）降至 24.4（15.4-32.7）ng/mL（P＜0.0001）。RYGB 后进行体能训练可使纤维蛋白溶解活性从 58.0（36.0-75.5）增加至 88.0（66.0-132.0）IU/mL，而对照组从 52.5（30.0-80.0）增加至 64.0（49.0-100.0）IU/mL（P＜0.01），纤溶酶原激活物抑制剂抗原从 23.5（16.7-35.4）降至 18.1（14.3-25.4）ng/mL，而对照组从 24.4（13.9-28.7）降至 24.2（14.1-29.6）ng/mL（P＜0.05）。体能训练对凝血激活和纤维蛋白凝块特性标志物无影响。
结论
我们观察到 RYGB 后血栓生成标志物、纤维蛋白凝块特性改善和纤维蛋白溶解增加的长期有利降低。RYGB 后进行监督性体能训练可进一步增加纤维蛋白溶解。
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