有氧运动辅助常规药物对原发性高血压患者血压和血管内皮功能影响
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摘要
为了探讨有氧运动辅助常规药物对治疗原发性高血压患者血压和血管内皮功能影响,本研究选取2010年4月至2013年12月本院收治的140例原发性高血压患者,采用抛掷硬币的方法随机分为对照组和治疗组各70例,两组患者均采用硝苯地平联合厄贝沙坦治疗、饮食控制等措施,治疗组患者在医生指导下进行有氧运动,比较两组患者的血压控制情况以及反映高血压患者血管内皮功能的指标血清中一氧化氮(nitric oxide,NO)、内皮素-1 (endothelin-1, ET-1)、基质金属蛋白酶28 (matrixmetalloproteinase-28, MMP-28)、超敏C反应蛋白(high-sensitive C-reactive protein, hs-CRP)水平,通过血流介导的血管扩张(flow mediateddilation, FMD)和硝酸甘油介导的血管扩张反应(nitroglycerin-mediateddilation, NMD)检测血管内皮功能。治疗前,比较两组患者的收缩压(systolic blood pressure, SBP)和舒张压(diastolic blood pressure, DBP)测定值无显著性差异(p>0.05);治疗后,治疗组患者的SBP和DBP测定值均明显低于对照组(p<0.05);治疗前,比较两组患者的ET-1、NO、hs-CRP、MMP-28的水平均无明显差异(p>0.05);治疗后,治疗组患者的ET-1、hs-CRP、MMP-28的水平均明显低于对照组(p<0.05),治疗组患者NO水平明显高于对照组(p<0.05);治疗前,两组患者的FMD、NMD无明显差异(p>0.05);治疗后,治疗组患者的FMD、NMD明显高于对照组(p<0.05);治疗后,治疗组患者显效88.57%、有效11.43%,对照组显效74.29%、有效25.71%,两组患者比较具有明显差异(p<0.05)。有氧运动辅助常规药物治疗原发性高血压患者有助于进一步降低血压、减轻高血压状态对患者血管内皮功能的损伤。
To investigate the effects of aerobic exercises on blood pressure and endothelial function in patients with essential hypertension, this study selected forty patients with essential hypertension who were admitted to our hospital from April 2010 to December 2013, and randomly divided into the control group and the treatment group with 70 cases each by tossing coin. Both groups were treated with nifedipine combined with Eritrea Beisutan treatment, diet control and other measures. The patients in the treatment group underwent aerobic exercise under the guidance of doctors. This study compared the level of nitric oxide(NO), Endothelin-1(ET-1), matrixmetalloproteinase-28(MMP-28) and high-sensitive C-reactive protein(hs-CRP), which reflected the indexes of vascular endothelial function in patients with hypertension. And we detected vascular endothelial function by flow-mediated dilation(FMD) and nitroglycerin-mediated diathesis(NMD). There was no significant difference in systolic blood pressure(SBP) and diastolic blood pressure(DBP) between the two groups before treatment(p >0.05). Aftertreatment, the estimated value of SBP and DBP in the treatment group were significantly higher than the control group(p<0.05). Before treatment, the levels of ET-1, NO, hs-CRP and MMP-28 in the two groups had no significant difference(p>0.05). After treatment, the levels of ET-1, hs-CRP and MMP-28 were significantly lower in the treatment group than those in the control group( p>0.05), and the levels of NO in the treatment group were significantly higher than those in the control group(p>0.05)(p>0.05). After treatment, the FMD and NMD in the treatment group were significantly higher than those in the control group(p>0.05). After treatment, the effective rate of the treatment group was 88.57% and the effective rate was 11.43%. Markedly effective 74.29%, effective 25.71%,the two groups had significant differences(p>0.05). Aerobic exercise aids routine drug therapy in patients with essential hypertension could help further reduce blood pressure and reduce the state of hypertension in patients with vascular endothelial dysfunction.
To investigate the effects of aerobic exercises on blood pressure and endothelial function in patients with essential hypertension, this study selected forty patients with essential hypertension who were admitted to our hospital from April 2010 to December 2013, and randomly divided into the control group and the treatment group with 70 cases each by tossing coin. Both groups were treated with nifedipine combined with Eritrea Beisutan treatment, diet control and other measures. The patients in the treatment group underwent aerobic exercise under the guidance of doctors. This study compared the level of nitric oxide(NO), Endothelin-1(ET-1), matrixmetalloproteinase-28(MMP-28) and high-sensitive C-reactive protein(hs-CRP), which reflected the indexes of vascular endothelial function in patients with hypertension. And we detected vascular endothelial function by flow-mediated dilation(FMD) and nitroglycerin-mediated diathesis(NMD). There was no significant difference in systolic blood pressure(SBP) and diastolic blood pressure(DBP) between the two groups before treatment(p >0.05). Aftertreatment, the estimated value of SBP and DBP in the treatment group were significantly higher than the control group(p<0.05). Before treatment, the levels of ET-1, NO, hs-CRP and MMP-28 in the two groups had no significant difference(p>0.05). After treatment, the levels of ET-1, hs-CRP and MMP-28 were significantly lower in the treatment group than those in the control group( p>0.05), and the levels of NO in the treatment group were significantly higher than those in the control group(p>0.05)(p>0.05). After treatment, the FMD and NMD in the treatment group were significantly higher than those in the control group(p>0.05). After treatment, the effective rate of the treatment group was 88.57% and the effective rate was 11.43%. Markedly effective 74.29%, effective 25.71%,the two groups had significant differences(p>0.05). Aerobic exercise aids routine drug therapy in patients with essential hypertension could help further reduce blood pressure and reduce the state of hypertension in patients with vascular endothelial dysfunction.
引文
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Chen H.L.,Liu C.Q.,and Shen X.F.,2017,Effect of different physical activities on blood pressure in elderly patients with hypertension,Zhonghua Laonian Yixue Zazhi(Chinese Journal of Geriatrics),36(2):135-137(陈慧兰,刘超群,沈小芬,2017,不同体力活动对老年高血压患者运动血压的影响,中华老年医学杂志,36(2):135-137)
Chen Y.,Zhang H.M.,Zhang Y.Y.,Lu N.,Zhang L.,and Shi L.,2015,Exercise intensity-dependent reverse and adverse remodeling of voltage-gated Ca2+channels in mesenteric arteries from spontaneously hypertensive rats,Hypertension Research:Official Journal of the Japanese Society of Hypertension,38(10):656-665
Chu J.,Wang L.H.,Xu A.Q.,Li Y.C.,Wang H.C.,Guo X.L.,Lu Z.L.,Zhang X.F.,and Zhang J.Y.,2014,Analysis on prevalence states and associated factors of hypertension and prehypertension among adults in Shandong province,Zhonghua Yufang Yixue Zazhi(Chinese Journal of Preventive Medicine),48(1):12-17(楚洁,王临虹,徐爱强,李镒冲,王卉程,郭晓雷,鹿子龙,张啸飞,张吉玉,2014,山东省成年人高血压与高血压前期流行情况及影响因素分析,中华预防医学杂志,48(1):12-17)
Don E.H.,Xu M.,Guo L.J.,Bu J.,and Pao Y.,2017,Effect of"brisk walking"on male elderly with hypertension in community-based health centers,Shanghai Jiaotong Daxue Xuebao(Yixueban)(Journal of Shanghai Jiaotong University(Medical Science)),37(2):230-233(董恩宏,徐明,郭丽君,卜佳,鲍勇,2017,“健步行”运动对社区老年男性高血压人群健康促进效果的研究,上海交通大学学报(医学版),37(2):230-233)
Harun H.,Anuar A.N.,Ujang Z.,Rosman N.H.,and Othman I.,2014,Performance of aerobic granular sludge at variable circulation rate in anaerobic-aerobic conditions,Water Science and Technology,69(11):2252-2257
Ke X.J.,Wang R.W.,and Jiu B.H.X.,2003,Effects of aerobic training on blood pressure,lipid and glucose metabolize in essential hypertension,Zhongguo Kangfu Yixue Zazhi(Chinese Journal of Rehabilitation Medicine),18(4):214-216(柯小剑,王人卫,久保晃信,2003,有氧运动对原发性高血压病患者血压、脂代谢及糖代谢的影响,中国康复医学杂志,18(4):214-216)
Klawitter M.,Quero L.,Bertolo A.,Mehr M.,Stoyanov J.,Nerlich A.G.,Klasen J.,Aebli N.,Boos N.,and Wuertz K.,2011,Human mmp28 expression is unresponsive to inflammatory stimuli and does not correlate to the grade of intervertebral disc degeneration,Journal of Negative Results in Biomedicine,10(1):9
Li H.M.,Duan M.,Chen N.,Zhang Y.B.,Jin J.R.,Wang X.F.,Shang X.D.,and Yu B.,2016,Impact for family history of hypertension on masked hypertension morbidity with relevant cardiac damage,Zhongguo Xunhuan Zazhi(Chinese Circulation Journal),31(7):654-658(李海明,段淼,陈念,张源波,金婧茹,汪晓芬,尚晓东,渝斌,2016,高血压家族史对隐形高血压发病及心脏损害的影响,中国循环杂志,31(7):654-658)
Li J.,Ma Y.H.,and Cheng W.J.,2016,Relation of adiponectin,homocysteine and hypersensitive C-reactive protein with hypertension,Zhongguo Dangdai Yiyao(China Modern Medicine),23(28):44-46(李晶,马宇虹,程文俊,2016,脂联素、同型半胱氨酸和超敏C-反应蛋白与高血压的关系,中国当代医药,23(28):44-46)
Liu X.L.,Zhang L.,and Yang H.,2009,Effects of aerobic exercises on circular endothelium cell,endothelia-1 and nitrogen monoxide in middle and elderly mild hypertensive patients,Shandong Tiyu Xueyuan Xuebao(Journal of shandong institute of physical education and sports),25(1):48-50(刘香兰,章岚,杨华,2009,有氧运动对中老年轻度高血压病患者循环内皮细胞数量、内皮素-1和一氧化氮含量的影响,山东体育学院学报,25(1):48-50)
Ma L.Q.,Pan W.W.,and Ding H.M.,2015,Influence of exercise intervention on oxidative stress and glucose metabolism in patients with hypertension accompanied by pre-diabetes,Zhongguo Xunzheng Xinxueguan Yixue Zazhi(Chinese Journal of Evidence-Based Cardiovascular Medicine),4(4):539-541(玛黎清,潘巍巍,丁华民,2015,运动干预对高血压伴糖尿病前期患者氧化应激和糖代谢的影响,中国循证心血管医学杂志,4(4):539-541)
Nie J.,Yang Z.H.,and Ma G.X.,2013,Relationships among insulin resistance,endothelin-1 and essential hypertension grading,Linnan Xinxueguan bing Zazhi(South China Journal of Cardiovascular Diseases),19(4):481-482(聂劼,杨振汉,马国祥,2013,原发性高血压分级与胰岛素抵抗、血浆内皮素-1的关系,岭南心血管病杂志,19(4):481-482)
Ping L.Y.,Du L.S.,and Xiong W.,2016,Analysis on significance of serum Hcy and hs-CRP changes in diagnosis of pregnancy induced hypertension,GuoJi Jianyan Yixue Zazhi(International Journal of Laboratory Medicine),37(1):13-15(平龙玉,杜立树,熊伟,2016,血清同型半胱氨酸及超敏c-反应蛋白变化诊断妊娠期高血压意义分析,国际检验医学杂志,37(1):13-15)
Ren J.S.,and Yao J.P.,2013,Clinical significance of measurement the changes of plasma ET-1 and serum NO,CGRPlevels both before and after treatment in patients with essential hypertension,Fangshe Mianyixue Zazhi(Journal of radioimmunology),26(4):403-404(任军生,姚加平,2013,原发性高血压患者治疗前后血浆ET-1和血清no、cgrp检测的临床意义,放射免疫学杂志,26(4):403-404)
Shreenivas S.,and Oparil S.,2007,The role of endothelin-1 in human hypertension,Clinical Hemorheology&Microcirculation,37(1-2):157-178
Wang J.,2012,NO,Ca2+and essential hypertension,Linchuang Yu Bingli Zazhi(International Journal of Pathology and Clinical Medicine),32(5):410-415(王静,2012,NO,Ca2+与高血压,临床与病理杂志,32(5):410-415)
Wang L.,Liu Z.Q.,Huo Y.Q.,Yao L.J.,Wei X.G.,and Wang Y.F.,2013,Change of hs-crp,svcam-1,nt-probnp levels in patients with pregnancy-induced hypertension after therapy with magnesium sulfate and nifudipine,Asian Pacific Journal of Tropical Medicine,6(11):897
Wang Y.,Li L.,Cong W.H.,and Huang L.,2016,Relationship analysis between vascular endothelial function and primary hy-pertension,Shijie Zhongxiyi Jiehe Zazhi(Word Journal of Integrated Traditional and Western),11(3):395-399(王燕,李琳,丛伟红,黄力,2016,原发性高血压与血管内皮功能的相关性分析,世界中西医结合杂志,11(3):395-399)
Wang Z.B.,Qiu C.G.,Huang Z.W.,Han Z.Y.,Sun G.J.,and Sun H.,2014,The effects of walking exercise on glycometabolis-m,dynamic blood pressure and the quality of life of patients with hypertension and type 2 diabetes,Zhonghua Wuli Yixue Yu Kangfu Zazhi(Chinese Journal of Physical Medicine and Rehabilitation),36(8):609-613(王正斌,邱春光,黄振文,韩战营,孙国举,孙寒,2014,步行运动对高血压合并糖尿病患者糖代谢、动态血压及生活质量的影响,中华物理医学与康复杂志,36(8):609-613)
Yang Z.W.,Xu J.,Don B.,Zeng L.Z.,and Shen D.P.,2015,Effect of aerobic treadmill exercise on vascular endothelial function in elderly patients with isolated systolic hypertension,Zhonghua Laonian Xinnaoxueguanbing Zazhi(Chinese Journal of Geriatric Heart Brain and Vessel Diseases),17(7):711-714(杨志伟,徐佳,董波,曾令忠,沈丹萍,2015,有氧踏车运动对老年单纯收缩期高血压患者血管内皮功能的影响,中华老年心脑血管病杂志,17(7):711-714)
Yu W.,Yan J.,Zhang Y.F.,Fang S.Y.,Luo J.Y.,Yang L.,Xu X.L.,Ding F.,and Tang X.H.,2014,Prevalence and associated factors of hypertension and prehypertension among elderly residents in city community of Zhejiang province,Zhonghua Laonian Yixue Zazhi(Chinese Journal of Geriatrics),33(6):668-671(俞蔚,严静,章一丰,方顺源,罗建勇,杨丽,徐小玲,丁芳,唐新华,2014,浙江三市社区老年人高血压前期和高血压患病及心血管病危险因素调查,中华老年医学杂志,33(6):668-671)
Zhang Y.Y.,Liu Y.J.,Bai P.,Wu Y.,and Shi L.J.,2017,Inhibition of aerobic exercise on enhanced functional coupling of Ry R-BKCa channel in hypertension cerebral arterial smooth muscle cells,Tiyu Kexue(China Sport Science),37(1):55-61,80(张严焱,刘雨佳,柏平,吴迎,石丽君,2017,有氧运动抑制高血压脑动脉平滑肌Ry R-BKCa通道功能耦联上调,体育科学,37(1):55-61,80)
Zhou F.,Zhao Z.G.,Pan H.P.,and Wang L.,2015,Effects of a single exercise on blood pressure,autonomic function and redox regulation in hypertension patients,Zhongguo Kangfu Yixue Zazhi(Chinese Journal of Rehabilitation Medicine),30(9):894-897(周方,赵志刚,潘化平,王磊,2015,单次运动对轻度高血压患者血压、自主神经功能和氧化应激的影响,中国康复医学杂志,30(9):894-897)
Chen H.L.,Liu C.Q.,and Shen X.F.,2017,Effect of different physical activities on blood pressure in elderly patients with hypertension,Zhonghua Laonian Yixue Zazhi(Chinese Journal of Geriatrics),36(2):135-137(陈慧兰,刘超群,沈小芬,2017,不同体力活动对老年高血压患者运动血压的影响,中华老年医学杂志,36(2):135-137)
Chen Y.,Zhang H.M.,Zhang Y.Y.,Lu N.,Zhang L.,and Shi L.,2015,Exercise intensity-dependent reverse and adverse remodeling of voltage-gated Ca2+channels in mesenteric arteries from spontaneously hypertensive rats,Hypertension Research:Official Journal of the Japanese Society of Hypertension,38(10):656-665
Chu J.,Wang L.H.,Xu A.Q.,Li Y.C.,Wang H.C.,Guo X.L.,Lu Z.L.,Zhang X.F.,and Zhang J.Y.,2014,Analysis on prevalence states and associated factors of hypertension and prehypertension among adults in Shandong province,Zhonghua Yufang Yixue Zazhi(Chinese Journal of Preventive Medicine),48(1):12-17(楚洁,王临虹,徐爱强,李镒冲,王卉程,郭晓雷,鹿子龙,张啸飞,张吉玉,2014,山东省成年人高血压与高血压前期流行情况及影响因素分析,中华预防医学杂志,48(1):12-17)
Don E.H.,Xu M.,Guo L.J.,Bu J.,and Pao Y.,2017,Effect of"brisk walking"on male elderly with hypertension in community-based health centers,Shanghai Jiaotong Daxue Xuebao(Yixueban)(Journal of Shanghai Jiaotong University(Medical Science)),37(2):230-233(董恩宏,徐明,郭丽君,卜佳,鲍勇,2017,“健步行”运动对社区老年男性高血压人群健康促进效果的研究,上海交通大学学报(医学版),37(2):230-233)
Harun H.,Anuar A.N.,Ujang Z.,Rosman N.H.,and Othman I.,2014,Performance of aerobic granular sludge at variable circulation rate in anaerobic-aerobic conditions,Water Science and Technology,69(11):2252-2257
Ke X.J.,Wang R.W.,and Jiu B.H.X.,2003,Effects of aerobic training on blood pressure,lipid and glucose metabolize in essential hypertension,Zhongguo Kangfu Yixue Zazhi(Chinese Journal of Rehabilitation Medicine),18(4):214-216(柯小剑,王人卫,久保晃信,2003,有氧运动对原发性高血压病患者血压、脂代谢及糖代谢的影响,中国康复医学杂志,18(4):214-216)
Klawitter M.,Quero L.,Bertolo A.,Mehr M.,Stoyanov J.,Nerlich A.G.,Klasen J.,Aebli N.,Boos N.,and Wuertz K.,2011,Human mmp28 expression is unresponsive to inflammatory stimuli and does not correlate to the grade of intervertebral disc degeneration,Journal of Negative Results in Biomedicine,10(1):9
Li H.M.,Duan M.,Chen N.,Zhang Y.B.,Jin J.R.,Wang X.F.,Shang X.D.,and Yu B.,2016,Impact for family history of hypertension on masked hypertension morbidity with relevant cardiac damage,Zhongguo Xunhuan Zazhi(Chinese Circulation Journal),31(7):654-658(李海明,段淼,陈念,张源波,金婧茹,汪晓芬,尚晓东,渝斌,2016,高血压家族史对隐形高血压发病及心脏损害的影响,中国循环杂志,31(7):654-658)
Li J.,Ma Y.H.,and Cheng W.J.,2016,Relation of adiponectin,homocysteine and hypersensitive C-reactive protein with hypertension,Zhongguo Dangdai Yiyao(China Modern Medicine),23(28):44-46(李晶,马宇虹,程文俊,2016,脂联素、同型半胱氨酸和超敏C-反应蛋白与高血压的关系,中国当代医药,23(28):44-46)
Liu X.L.,Zhang L.,and Yang H.,2009,Effects of aerobic exercises on circular endothelium cell,endothelia-1 and nitrogen monoxide in middle and elderly mild hypertensive patients,Shandong Tiyu Xueyuan Xuebao(Journal of shandong institute of physical education and sports),25(1):48-50(刘香兰,章岚,杨华,2009,有氧运动对中老年轻度高血压病患者循环内皮细胞数量、内皮素-1和一氧化氮含量的影响,山东体育学院学报,25(1):48-50)
Ma L.Q.,Pan W.W.,and Ding H.M.,2015,Influence of exercise intervention on oxidative stress and glucose metabolism in patients with hypertension accompanied by pre-diabetes,Zhongguo Xunzheng Xinxueguan Yixue Zazhi(Chinese Journal of Evidence-Based Cardiovascular Medicine),4(4):539-541(玛黎清,潘巍巍,丁华民,2015,运动干预对高血压伴糖尿病前期患者氧化应激和糖代谢的影响,中国循证心血管医学杂志,4(4):539-541)
Nie J.,Yang Z.H.,and Ma G.X.,2013,Relationships among insulin resistance,endothelin-1 and essential hypertension grading,Linnan Xinxueguan bing Zazhi(South China Journal of Cardiovascular Diseases),19(4):481-482(聂劼,杨振汉,马国祥,2013,原发性高血压分级与胰岛素抵抗、血浆内皮素-1的关系,岭南心血管病杂志,19(4):481-482)
Ping L.Y.,Du L.S.,and Xiong W.,2016,Analysis on significance of serum Hcy and hs-CRP changes in diagnosis of pregnancy induced hypertension,GuoJi Jianyan Yixue Zazhi(International Journal of Laboratory Medicine),37(1):13-15(平龙玉,杜立树,熊伟,2016,血清同型半胱氨酸及超敏c-反应蛋白变化诊断妊娠期高血压意义分析,国际检验医学杂志,37(1):13-15)
Ren J.S.,and Yao J.P.,2013,Clinical significance of measurement the changes of plasma ET-1 and serum NO,CGRPlevels both before and after treatment in patients with essential hypertension,Fangshe Mianyixue Zazhi(Journal of radioimmunology),26(4):403-404(任军生,姚加平,2013,原发性高血压患者治疗前后血浆ET-1和血清no、cgrp检测的临床意义,放射免疫学杂志,26(4):403-404)
Shreenivas S.,and Oparil S.,2007,The role of endothelin-1 in human hypertension,Clinical Hemorheology&Microcirculation,37(1-2):157-178
Wang J.,2012,NO,Ca2+and essential hypertension,Linchuang Yu Bingli Zazhi(International Journal of Pathology and Clinical Medicine),32(5):410-415(王静,2012,NO,Ca2+与高血压,临床与病理杂志,32(5):410-415)
Wang L.,Liu Z.Q.,Huo Y.Q.,Yao L.J.,Wei X.G.,and Wang Y.F.,2013,Change of hs-crp,svcam-1,nt-probnp levels in patients with pregnancy-induced hypertension after therapy with magnesium sulfate and nifudipine,Asian Pacific Journal of Tropical Medicine,6(11):897
Wang Y.,Li L.,Cong W.H.,and Huang L.,2016,Relationship analysis between vascular endothelial function and primary hy-pertension,Shijie Zhongxiyi Jiehe Zazhi(Word Journal of Integrated Traditional and Western),11(3):395-399(王燕,李琳,丛伟红,黄力,2016,原发性高血压与血管内皮功能的相关性分析,世界中西医结合杂志,11(3):395-399)
Wang Z.B.,Qiu C.G.,Huang Z.W.,Han Z.Y.,Sun G.J.,and Sun H.,2014,The effects of walking exercise on glycometabolis-m,dynamic blood pressure and the quality of life of patients with hypertension and type 2 diabetes,Zhonghua Wuli Yixue Yu Kangfu Zazhi(Chinese Journal of Physical Medicine and Rehabilitation),36(8):609-613(王正斌,邱春光,黄振文,韩战营,孙国举,孙寒,2014,步行运动对高血压合并糖尿病患者糖代谢、动态血压及生活质量的影响,中华物理医学与康复杂志,36(8):609-613)
Yang Z.W.,Xu J.,Don B.,Zeng L.Z.,and Shen D.P.,2015,Effect of aerobic treadmill exercise on vascular endothelial function in elderly patients with isolated systolic hypertension,Zhonghua Laonian Xinnaoxueguanbing Zazhi(Chinese Journal of Geriatric Heart Brain and Vessel Diseases),17(7):711-714(杨志伟,徐佳,董波,曾令忠,沈丹萍,2015,有氧踏车运动对老年单纯收缩期高血压患者血管内皮功能的影响,中华老年心脑血管病杂志,17(7):711-714)
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