有氧运动对稳定期慢性阻塞性肺疾病患者血清炎性因子及心肺运动功能的影响

背景　慢性阻塞性肺疾病（COPD）是常见的慢性气道疾病，此病常年反复发作，严重危害患者的生活质量和健康。研究有氧运动对患者心肺功能储备和生活质量的影响具有重要意义。目的　观察稳定期COPD患者有氧运动前后血清白介素10（IL-10）、白介素17（IL-17）、基质金属蛋白酶9（MMP-9）及心肺运动功能情况，探讨有氧运动改善身体功能、促进康复的作用机制。方法　选择2019年1月至2020年7月解放军杭州疗养院收治的稳定期COPD患者60例为研究对象，根据随机数字表法将其分为对照组和试验组，各30例。对照组给予氧疗、舒张支气管等常规治疗12周，试验组（其中1名受试者因急性发作症状退出试验）在常规治疗的同时，脚踩功率自行车在无氧阈水平强度下规律进行有氧运动12周。比较治疗前后患者外周血清中IL-10、IL-17、MMP-9表达情况及心肺运动功能变化情况。结果　有氧运动12周后，试验组IL-17、MMP-9水平较治疗前及对照组下降，而IL-10水平高于治疗前及对照组，差异有统计学意义（P<0.05）；6 min步行距离（6MWD）、圣乔治呼吸问卷（SGRQ）得分、峰值摄氧量（Peak VO2）、最大分钟通气量（VEmax）较治疗前及对照组升高，而无氧阈时二氧化碳通气当量（VE/VCO2 at AT）低于治疗前及对照组，差异有统计学意义（P<0.05）。结论　早期启动、长期坚持有氧运动能够明显改善稳定期COPD患者健康状态，减轻炎性反应，增强心肺功能储备，提高生活质量，改善预后。

Impact of Aerobic Exercise on Serum Inflammatory Factors and Cardiopulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease

Background　Chronic obstructive pulmonary disease（COPD） is a common chronic airway disease that can occur repeatedly throughout the year，seriously endangering the quality of life and health of patients. It is quite necessary to explore the effect of aerobic exercise on enhancing cardiopulmonary reserve and quality of life. Objective　To comparatively analyze the levels of serum IL-10，IL-17，matrix metalloproteinase-9（MMP-9） and cardiopulmonary function in stable COPD patients before and after aerobic exercise，to explore the mechanism of aerobic exercise in improving body function and promoting rehabilitation. Methods　Sixty admitted inpatients with stable COPD were randomly and equally divided into control group and experimental group. Both groups received oxygen therapy，bronchodilator therapy and other usual care for 12 weeks，the experimental group（except one dropout due to acute exacerbation） also received a 12-week regular cycling with the intensity of the individual anaerobic threshold. Pre- and post-treatment expression levels of IL-10，IL-17 and MMP-9 in peripheral serum and cardiopulmonary functions were compared between the groups. Results　Compared to baseline，the mean levels of IL-17，MMP-9，and ratio of ventilation to carbon dioxide production at anaerobic threshold（VE/VCO2 at AT） deceased，while mean levels of IL-10，6-minute walk distance，peak oxygen uptake（Peak VO2） and maximal exercise ventilation（VEmax） as well as mean score of St. George's Respiratory Questionnaire（SGRQ） increased in the experimental group after treatment（P<0.05）. The experimental group showed lower mean post-treatment levels of IL-17 and MMP-9，and VE/VCO2 at AT，and higher mean post-treatment levels of IL-10，6-minute walk distance，peak VO2 and VEmax as well as higher mean post-treatment mean score of SGRQ than the control group（P<0.05）. Conclusion　Early initiating aerobic exercise and maintaining aerobic exercise adherence could significantly improve the health status，reduce inflammatory reaction，enhance cardiopulmonary reserve，quality of life and the prognosis of stable COPD patients.