运动诱导的心脏保护作用及相关分子机制  

Exercise induced cardioprotective effects and related molecular mechanisms

作　　者：刘瑞 鲁燕[2] 贾永平[2] 马逸超 LIU Rui;LU Yan;JIA Yongping;MA Yichao(The First Clinical Medical College of Shanxi Medical University,Taiyuan,Shanxi 030001,China;不详)

机构地区：[1]山西医科大学第一临床医学院,山西太原030001 [2]山西医科大学第一医院心血管内科,山西太原030001

出　　处：《中华全科医学》2023年第6期1021-1025,共5页Chinese Journal of General Practice

基　　金：山西省重点研发计划项目(201903D321180)。

摘　　要：心血管疾病仍是目前全球疾病负担的主要原因。缺乏身体活动是心血管疾病的可控危险因素之一,在临床实践中,运动被推荐作为心血管疾病预防和康复的重要手段。运动有助于降低心血管疾病患病风险,并且能够改善缺血性心脏病、心力衰竭等心血管疾病患者的预后以及健康相关生活质量,运动还可以改善蒽环类药物导致的心脏毒性。尽管运动诱导的心血管保护机制尚未完全阐明,人们已通过动物运动模型对相关机制进行广泛研究。在研究中,可将运动作为一种预处理使运动后心脏对病理刺激表现出抵抗作用;也可在疾病发生后进行运动干预,一定程度上缓解心脏损伤并维持心脏功能。从机制上讲,运动诱导的心脏保护作用是多方面的,这种保护作用与运动促进心脏生理性肥大,抑制病理性肥大,促进心肌细胞增殖,减少心肌细胞凋亡,改善心脏纤维化以及促进心脏血管生成有关。运动诱导的心脏保护作用相关分子机制涉及胰岛素样生长因子1(IGF-1)/磷酸肌醇3-激酶(PI3K)/蛋白激酶B(AKT)、神经调节素1(NRG1)/酪氨酸激酶受体(ErbB)、Hippo等信号通路以及肌因子、运动诱导肽、Sirtuin蛋白、外泌体和miRNA等分子。本文将从上述方面对运动诱导的心脏保护作用及相关分子机制进行阐述,以期为心脏疾病的防治和运动康复研究提供思路。Cardiovascular disease(CVD)is still the main cause of the global burden of disease at present.Physical inactivity is one of the controllable risk factors for CVD,and in clinical practice,exercise is recommended as an important means of CVD prevention and rehabilitation.Exercise is beneficial in reducing the risk of CVD and improves outcomes as well as health-related quality of life in patients with CVD such as ischemic heart disease and heart failure,and it also ameliorates anthracycline-induced cardiotoxicity.Although the mechanism of exercise-induced cardiovascular protection has not been fully elucidated,the related mechanisms have been extensively studied by animal exercise models.In research,exercise may be used as a preconditioning to render the post exercise heart resistant to pathological stimuli;Exercise intervention can also be performed after the occurrence of the disease,to a certain extent,alleviating cardiac injury and maintaining cardiac function.Mechanistically,exercise-induced cardioprotection is multifaceted and this protective effect is associated with exercise promoting physiological cardiac hypertrophy,inhibiting pathological hypertrophy,promoting cardiomyocyte proliferation,reducing cardiomyocyte apoptosis,improving cardiac fibrosis,and promoting angiogenesis in the heart.The molecular mechanisms involved in exercise-induced cardioprotection involve signaling pathways such as IGF-1/PI3K/Akt,NRG1/ErbB,and Hippo,as well as molecules such as myokines,exercise-induced peptides,sirtuin,exosomes,and miRNAs.In this review,the cardioprotective effects induced by exercise and related molecular mechanisms will be elaborated from the above aspects,in the hope of providing ideas for the prevention and treatment of cardiac diseases and exercise rehabilitation research.

关 键 词：运动 心脏保护 心脏肥大 心肌细胞 心脏纤维化 血管生成 

分 类 号：R455[医药卫生—运动医学] R541[医药卫生—治疗学]