Bestavashvili Afina, Glazachev Oleg, Bestavashvili Alexander, Suvorov Alexander, Zhang Yong, Zhang Xinliang, Rozhkov Andrey, Kuznetsova Natalia, Pavlov Chavdar, Glushenkov Dmitriy, Kopylov Philippe
Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia.
Department of Normal Physiology, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia.
Biomedicines. 2022 Feb 28;10(3):566. doi: 10.3390/biomedicines10030566.
The aim of this study was to evaluate efficacy and applicability of the “intermittent hypoxic-hyperoxic exposures at rest” (IHHE) protocol as an adjuvant method for metabolic syndrome (MS) cardiometabolic components. A prospective, single-center, randomized controlled clinical study was conducted on 65 patients with MS subject to optimal pharmacotherapy, who were randomly allocated to IHHE or control (CON) groups. The IHHE group completed a 3-week, 5 days/week program of IHHE, each treatment session lasting for 45 min. The CON group followed the same protocol, but was breathing room air through a facial mask instead. The data were collected 2 days before, and at day 2 after the 3-week intervention. As the primary endpoints, systolic (SBP) and diastolic (DBP) blood pressure at rest, as well as arterial stiffness and hepatic tissue elasticity parameters, were selected. After the trial, the IHHE group had a significant decrease in SBP and DBP (Cohen’s d = 1.15 and 0.7, p < 0.001), which became significantly lower (p < 0.001) than in CON. We have failed to detect any pre-post IHHE changes in the arterial stiffness parameters (judging by the Cohen’s d), but after the intervention, cardio-ankle vascular indexes (RCAVI and LCAVI) were significantly lowered in the IHHE group as compared with the CON. The IHHE group demonstrated a medium effect (0.68; 0.69 and 0.71 Cohen’s d) in pre-post decrease of Total Cholesterol (p = 0.04), LDL (p = 0.03), and Liver Steatosis (p = 0.025). In addition, the IHHE group patients demonstrated a statistically significant decrease in pre-post differences (deltas) of RCAVI, LCAVI, all antropometric indices, NTproBNP, Liver Fibrosis, and Steatosis indices, TC, LDL, ALT, and AST in comparison with CON (p = 0.001). The pre-post shifts in SBP, DBP, and HR were significantly correlated with the reduction degree in arterial stiffness (ΔRCAVI, ΔLCAVI), liver fibrosis and steatosis severity (ΔLFibr, ΔLS), anthropometric parameters, liver enzymes, and lipid metabolism in the IHHE group only. Our results suggested that IHHE is a safe, well-tolerated intervention which could be an effective adjuvant therapy in treatment and secondary prevention of atherosclerosis, obesity, and other components of MS that improve the arterial stiffness lipid profile and liver functional state in MS patients.
本研究旨在评估“静息时间歇性低氧-高氧暴露”（IHHE）方案作为代谢综合征（MS）心脏代谢组分辅助治疗方法的疗效和适用性。对65例接受最佳药物治疗的MS患者进行了一项前瞻性、单中心、随机对照临床研究，这些患者被随机分配至IHHE组或对照组（CON）。IHHE组完成了为期3周、每周5天的IHHE方案，每次治疗持续45分钟。CON组遵循相同方案，但通过面罩呼吸室内空气。在3周干预前2天和干预后第2天收集数据。选择静息时收缩压（SBP）和舒张压（DBP）以及动脉僵硬度和肝组织弹性参数作为主要终点。试验后，IHHE组的SBP和DBP显著降低（科恩d值分别为1.15和0.7，p<0.001），且显著低于CON组（p<0.001）。我们未能检测到IHHE前后动脉僵硬度参数的任何变化（根据科恩d值判断），但干预后，与CON组相比，IHHE组的心脏-脚踝血管指数（RCAVI和LCAVI）显著降低。IHHE组在总胆固醇（p = 0.04）、低密度脂蛋白（p = 0.03）和肝脂肪变性（p = 0.025）的前后降低方面显示出中等效应（科恩d值为0.68；0.69和0.71）。此外，与CON组相比，IHHE组患者在RCAVI、LCAVI、所有人体测量指标、NTproBNP、肝纤维化和脂肪变性指数、总胆固醇、低密度脂蛋白、谷丙转氨酶和谷草转氨酶的前后差异（差值）方面有统计学意义的降低（p = 0.001）。仅在IHHE组中，SBP、DBP和心率的前后变化与动脉僵硬度（ΔRCAVI，ΔLCAVI）、肝纤维化和脂肪变性严重程度（ΔLFibr，ΔLS）、人体测量参数、肝酶和脂质代谢的降低程度显著相关。我们的结果表明，IHHE是一种安全、耐受性良好的干预措施，可能是治疗和二级预防动脉粥样硬化、肥胖以及MS其他组分的有效辅助疗法，可改善MS患者的动脉僵硬度、血脂谱和肝功能状态。
