摘要
目的 探讨 6min步行运动训练治疗充血性心力衰竭患者的价值 ;观察不同程度充血性心衰患者白细胞及分类和血浆肿瘤坏死因子 (TNF)α水平的变化以及运动训练对其影响。方法 6 0例Ⅱ、Ⅲ级心功能充血性心衰患者在入院 2 4h之内作 6min步行运动实验 ,记录其行走距离 ,静息状态和运动后心率 ,血浆TNFα ,血液白细胞总数及分类。然后随机分为两组 (训练组 32例 ,对照组 2 8例 ) ,两组均行常规抗心衰药物治疗 ,但训练组每天 2次行 6min步行运动训练 ,8周后重复检测上述指标。对 2 3例Ⅳ级心功能CHF患者观察了入院时上述血浆细胞因子和白细胞及分类的变化。结果Ⅲ、Ⅳ级CHF患者白细胞总数、中性粒细胞和单核细胞百分比较Ⅱ级CHF患者明显增高 (P <0 0 1) ;血浆TNFα在Ⅱ、Ⅲ、Ⅳ级CHF中的差异有显著性。运动训练可显著改善CHF症状 ,减慢增快的心率 ,增加行走距离。训练组与对照组的差异有显著性 (P <0 0 5 )。运动训练组治疗 8周后 ,CHF患者白细胞、中性粒、单核细胞百分比和血浆TNFα的下降程度较对照组相比更显著 (P <0 0 5 )。结论 6min步行运动训练不仅可明显改善心衰患者的TNFα等细胞因子的过度激活 ,还可改善心衰患者可能存在着的免疫机能缺陷。
Objective To evaluate six minute walking test (6 MWT) in treatment of CHF and to investigate the effect of exercise training on blood leucocyte and its components and plasma TNF α in CHF patients. Methods 60 cases with NYHAⅡ ⅢCHF patients underwent 6 MWT within 24 hours after hospitallization. The walking distance, heartbeat, plasma TNF α, and blood leucocyte and its components were investigated before and after walking test. These patients were then randomized into two groups, a training group (32 cases) and a control group (28 cases). Besides routine medication, 6 MWT was performed in the training group twice a day for 8 weeks. The same parameters were redetermined after 8 weeks of follow up. 23 cases with NYHA Ⅳ CHF patients were investigated with the same parameters in the first day after hospitalization. Results Blood leucocyte count and percentage of granulocytes and mononuclears in cases with NYHAⅢ Ⅳ were significantly higher than those with NYHAⅡ. There were significant reduction of heartbeat and prolongation of walking distance in CHF patients after exercise training. Blood leucocyte count and the percentage of granulocytes and mononuclear and plasma TNFα level were reduced more in the training group than the control group after 8 weeks the treatment. Conclusions There is significantly higher leucocyte count and percentage of granulocytes and mononuclears in CHF with NYHAⅢ Ⅳ than those with NYHA Ⅱ. 6 MWT, as an exercise training, is simple, safe, and not harmful. It can not only evaluate the severity of CHF but also serve as a therapeutic measure for CHF. Moreover the excessive activation of cytokines as TNFα could be reduced by 6 MWT training in CHF patients.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2002年第4期237-240,共4页
Chinese Journal of Internal Medicine
