老年慢性心力衰竭患者的胰岛素抵抗状态及运动训练对其的影响——附60例报告  

The insulin resistance state and the effect of physical training on it in the elderly patients with chronic heart failure

作　　者：鹿庆华[1] 董兆强[1] 徐红丽[1] 蒋乐[1] 曾秋堂[2] 

机构地区：[1]山东大学第二医院心内科,250033 [2]华中科技大学同济医学院附属协和医院心内科,430022

出　　处：《新医学》2008年第6期361-363,共3页Journal of New Medicine

摘　　要：目的:观察老年慢性心力衰竭(chronic heart failure,CHF)患者胰岛素抵抗(insulin re-sistance,IR)状态及运动训练对其的影响。方法:110例NYHA心功能Ⅱ～Ⅲ级的老年CHF患者为CHF组,随机分为训练组(60例)和常规治疗组(50例),2组患者均接受常规的抗心力衰竭药物治疗,训练组还接受每日2次,每次6min,长达20周的运动训练。选同期32名老年健康体检者为正常对照组。比较训练组和常规治疗组患者治疗前后用稳态模式评估法计算的胰岛素抵抗指数(insulin resistance index,IR),即HOMA-IR,胰岛素敏感指数(insulin sensitivity index,ISI),LVEF,左心室的短轴缩短率(fraction shortening,FS),6min步行试验(6-minute walking test,6-MWT),心率及平均动脉压的变化。结果:与正常对照组比较,CHF患者ISI降低,HOMA-IR增加(P<0.01)。治疗后训练组与常规治疗组比较,训练组的LVEF与FS值、6-MWT行走距离及ISI增加,而心率、平均动脉压及HOMA-IR降低,2组比较差异有统计学意义(P<0.05～0.01)。结论:老年CHF患者存在胰岛素抵抗,运动训练在改善其心功能及运动功能的同时,亦能增强胰岛素敏感性、改善胰岛素抵抗状态。Objective： To investigate insulin resistance state and the effect of physical training on it in the elderly patients with chronic heart failure （CHF）. Methods： One hundred and ten NYHA Ⅱ - Ⅲ old CHF patients （CHF group） were randomly divided into training group （ n = 60） and routine therapy group （ n = 50）. Both groups were treated with routely anti-CHF drugs, and the training group patients received 6 min physical training twice a day for 20 weeks. The changes of insulin resistance index （ HOMA- IR）, insulin sensitivity index （ISI）, LVEF, fraction shortening （FS）, 6-minute walking test （6-MWT）, heart rate and mean blood pressure were compared before and after physical training in training group and routine therapy group. Results： Comparing with normal control group, ISI was reduced, HOMA-IR was increased in CHF group （P 〈 0. 01 ）. After physical training, Comparing with the routine therapy group, LVEF, FS, 6-MWT walking distance and ISI were all improved, and heart rate, mean blood pressure and HOMA-IR were reduced in training group. There were significant differences between the two group （ P 〈 0. 05 - 0. 01 ）. Conclusion ： IR state exists in the old patients with CHF. Physical training could improve heart function, exercising function, insulin sensitivity and IR state in the old patients with CHF.

关 键 词：心力衰竭 慢性 胰岛素抵抗 运动训练 6分钟步行试验 心功能 运动功能 

分 类 号：R541.6[医药卫生—心血管疾病]