生理性缺血训练抑制心肌梗死患者心室重构及室性心律失常的作用

关键词：生理性缺血训练  急性心肌梗死  早期心室重构  室性心律失常  血管新生

Keywords:physiological ischemic training  acute myocardial infarction  early ventricular remodeling  ventricular arrhythmias  revascularization

摘要：

      摘要 目的：验证生理性缺血训练在急性心肌梗死早期是否能够抑制心室重构、减少室性心律失常的作用。 方法：急性心肌梗死成功行再灌注治疗的患者中，合并低血压和或慢心率组患者分成生理性缺血训练（physiological ischemia training， PIT）组和对照组，血压和心率正常的患者分成PIT联合药物ACEI和/或β受体阻滞剂（angiotensin-converting enzyme inhibitor and/or β-blocker， AB）组及单纯AB组。其中，PIT组和PIT+AB组患者接受生理性缺血训练。比较各组患者3个月干预治疗后肾素-血管紧张素-醛固酮系统（RASS）活性、心室重构、心功能、血管新生和室性心律失常等指标。 结果：经过3个月的干预治疗后，PIT组、PIT+AB组及AB组患者的RASS活性、心室重构、左室射血分数（left ventricular ejection fraction， LVEF）和QT间期（QTd）等指标明显改善（P＜0.05），其中PIT+AB组较AB组患者改善更加明显（P＜0.05）；PIT组、PIT+AB组患者经3个月的干预治疗后，循环血中血管内皮生长因子（vascular endothelial growth factor， VEGF）和一氧化氮（nitric oxide， NO）水平明显增高（P＜0.05）。4组患者经3个月的干预治疗后，Lown's分级均较前明显降低（P＜0.05），其中PIT+AB组降低最明显。在康复锻炼过程中，患者舒张压一定程度增加，收缩压及心率无明显影响。 结论：生理性缺血训练可以有效抑制心梗后患者早期心室重构、促进冠脉侧支循环新生、减少室性心律失常发生风险，一定程度改善患者心功能。如果生理性缺血训练联合ACEI/ARB及β受体阻滞剂，能进一步使患者临床获益。

Abstract:

      Abstract Objective： To verify whether physiological ischemia training （PIT） can inhibit ventricular remodeling and reduce the occurrence of ventricular arrhythmias in the early stage of acute myocardial infarction （AMI）. Method： AMI patients with hypotensive or slow heart rate （HR） group were divided into PIT （n=21） and control （n=20） groups randomly, while patients with normal blood pressure （BP） and heart rate were divided into a PIT combined with drug angiotensin-converting enzyme inhibitor and/or β-blocker (AB) group（n=30） and a sole AB group （n=30）. After 3 months of intervention， indicators including renin-angiotensin-aldosterone system (RASS) activity， ventricular remodeling， cardiac function， vascular neovascularization， and ventricular arrhythmias were compared among the groups. Result： After 3 months of intervention， RASS activity， ventricular remodeling， left ventricular ejection fraction (LVEF) and QT dispersion (QTd) were significantly improved in PIT， PIT+AB and AB groups（P<0.05）, with the PIT+AB group showing more significant improvements than the AB（P<0.05）. Following the 3-month intervention, the levels of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in the circulation significantly increased in the PIT and PIT+AB groups（P<0.05）. The Lown’s classification of all four groups was significantly reduced after 3-month intervention (P<0.05), with the most significant reduction in the PIT+AB group（P<0.05）. During PIT， diastolic blood pressure （DBP） increased to some extent， while there were no significant effects on systolic blood pressure （SBP） and heart rate. Conclusion： PIT can effectively inhibit early ventricular remodeling in post-myocardial infarction patients， promotes the neogenesis of coronary collateral circulation, and reduce the risk of ventricular arrhythmias after myocardial infarction， thereby improving cardiac function to some extent, which can be further benefit patients if PIT combines with ACEIs/ARBs and beta-blockers.