低温下有氧运动干预对糖尿病肾病肾脏代谢和短期预后的影响  

Effect of aerobic exercise intervention at low temperature on renal metabolism and short-term prognosis in diabetic nephropathy

作　　者：王琳琳[1] 李志鹏[2] 刘翠兰[1] 韩小丽 郭宝珠 刘华[1] 刘圣君[1] Wang Linlin;Li Zhipeng;Liu Cuilan;Han Xiaoli;Guo Baozhu;Liu Hua;Liu Shengjun(Dept of Nephrology,The First Hospital Affiliated of Hebei North University,Zhangjiakou 075000;Basic Medical College,Hebei North College,Zhangjiakou 075000)

机构地区：[1]河北北方学院附属第一医院肾内科,张家口075000 [2]河北北方学院基础医学院,张家口075000

出　　处：《安徽医科大学学报》2023年第11期1859-1864,1871,共7页Acta Universitatis Medicinalis Anhui

基　　金：河北省科学技术厅技术创新引导计划项目(编号:20477705D)。

摘　　要：目的探究低温下有氧运动干预对糖尿病肾病肾脏代谢和短期预后的影响。方法①32只糖尿病肾病小鼠随机分为模型组、低温组、运动组和低温运动组,另择8只为正常组。运动组和低温运动组分别在室温和低温环境下给予为期8周的跑台运动干预,低温组仅给予低温环境干预。用生化分析仪检测空腹血糖(FBG)、血肌酐(Scr)、血尿素氮(BUN)和24 h尿蛋白水平;苏木精-伊红(HE)法观察肾脏病变情况;蛋白质免疫印迹法检测肾组织中核因子E2相关因子2(NRF2)和血红素氧合酶1(HO-1)水平。②前瞻性入组194例糖尿病肾病患者。根据低温下有氧运动干预频次将患者分为运动组(1次/周,n=35)、运动组(≥2次/周,n=47)和对照组(0次/周,n=112)。比较3组的Scr、BUN、尿酸(UA)、尿白蛋白/肌酐比值(UACR)和估算的肾小球滤过率(eGFR)水平。用Kaplan-Meier和COX回归分析低温下有氧运动干预与短期预后的关系。结果①与正常组比较,模型组的FBG、Scr、BUN、24 h尿蛋白和肾脏损伤评分均升高,NRF2和HO-1水平均降低(P<0.05)。与模型组比较,运动组和低温运动组的FBG、Scr、BUN、24 h尿蛋白和肾脏损伤评分均降低,NRF2和HO-1水平均升高(P<0.05)。与低温组和运动组比较,低温运动组的FBG、Scr、BUN、24 h尿蛋白和肾脏损伤评分均降低,NRF2和HO-1水平均升高(P<0.05)。②低温有氧运动干预后,运动组(1次/周)和运动组(≥2次/周)的Scr、BUN和UACR水平均低于对照组,eGFR水平均高于对照组(P<0.05)。运动组(≥2次/周)的累积预后不良发生率为2.13%(1/47),低于运动组[1次/周,11.43%(4/35)]和对照组[16.07%(18/112),P<0.05]。COX回归分析结果显示运动干预≥2次/周(HR=0.123,95%CI:0.016~0.925)较不干预可降低糖尿病肾病患者短期预后不良发生风险。结论低温下有氧运动干预可纠正糖尿病肾病肾脏代谢异常,保护肾脏组织,降低短期预后不良发生风险,其机制可能与上调Objective To investigate the effects of aerobic exercise intervention at low temperature on renal metabolism and short-term prognosis in diabetic nephropathy.Methods①32 mice with diabetic nephropathy were randomly divided into a model group,a low-temperature group,an exercise group,and a low-temperature exercise group,and another 8 mice were selected as members of the normal group.The exercise group and the low-temperature exercise group were given an 8-week running table exercise intervention at room temperature and low temperature,respectively,while the low-temperature group was only given the low temperature intervention.Fasting blood glucose(FBG),serum creatinine(Scr),blood urea nitrogen(BUN),and 24 h urine protein levels were measured by a biochemical analyzer;renal lesions were observed by the hematoxylin-eosin(HE)method;and nuclear factor E2-related factor 2(NRF2)and heme oxygenase 1(HO-1)levels in renal tissues were measured by Western blot.②194 patients with diabetic nephropathy were prospectively enrolled and divided into the exercise group(1 time/week,n=35),the exercise group(≥2 times/week,n=47),and the control group(0 time/week,n=112)according to the frequency of aerobic exercise intervention at low temperature.Scr,BUN,uric acid(UA),urinary albumin/creatinine ratio(UACR),and estimated glomerular filtration rate(eGFR)levels were compared in the 3 groups.Kaplan-Meier and COX regression were performed to analyze the relationship between aerobic exercise interventions at low temperature and short-term prognosis.Results①Compared with the normal group,the levels of FBG,Scr,BUN,24 h urine protein,and the kidney injury score in the model group increased,while the levels of NRF2 and HO-1 in the model group decreased(P<0.05).Compared with the model group,the levels of FBG,Scr,BUN,24 h urine protein,and the kidney injury score in the exercise group and the low-temperature exercise group decreased,while the levels of NRF2 and HO-1 in the exercise group and the low-temperature exercise group increased(P<0.

关 键 词：糖尿病肾病 低温 有氧运动 肾脏代谢 短期预后 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]