有氧运动对代谢综合征患者的疗效观察及其机制研究

目的观察长期规律有氧运动对代谢综合征（MS）患者血清瘦素、白介素-18（IL-18）、C反应蛋白（CRP）、可溶性细胞间黏附因子-1（sICAM-1）及胰岛素抵抗指数（HOMA—IR）的影响，并初步探讨有氧运动的作用机制。方法入选40例平时缺乏运动的MS患者，分层随机抽样法分为运动干预组及非诺贝特组，运动干预组进行无氧阈心率水平运动，5次／周，30min/次；非诺贝特组口服非诺贝特胶囊200mg／d。各组干预12周，干预前后采用ELISA法测定血清瘦素、IL-18、CRP、sICAM-1水平。另选20例健康体检者作为正常对照组。结果MS患者血清瘦素（26．04±9．07）rig／mlVS（8．32±2．94）ng／ml，t=12．72，P〈0．01]、IL-18（308．27±50．39）pg／mlVS（230．60±29．15）pg／ml，t=6．41，P〈0．01]、CRP（2．65±0．57）ng／ml vs（1．26±0．23）ng／ml，t=9．69，P〈0．01]、sICAM-1（331．89±60．08）ng／mlVS（246．43±39．32）ng／ml，t=5．98，P〈0．01]及HOMA—IR（4．38±2．06vs2．12±0．50，t=4．81，P〈0.01）等指标职显高于健康人。经12周运动干预后，MS患者瘦素（26．38±10．85）ng／mlvs（19．63±6．27）ng／ml，t=2．22，P〈0．05]、IL-18（309．40±49．77）pg／mlvs（291．80±39．21）pg／ml，t=2．33，P〈0．05]、CRP（2．73±0．72）ng／mlvs（2．28±0．38）rig／ml，t=3．41，P〈0．01]及sICAM-1（333．85±55．97）ng／ml V8（306．24±50．55）ng／ml，t=3．16，P〈0．01]水平及HOMA—IR（4．53±2．39V82．89±0．69，t=2．87，P〈0．01）明显下降。结论有氧运动是MS患者一种有效的治疗方法。运动治疗的作用机制可能与降低机体脂肪炎症因子水平，改善血管内皮功能，进一步改善胰岛素抵抗有关。

Studies on the effect and mechanism of aerobic exercise on patients with metabolic syndrome

Objective To explore the effect of aerobic exercise on serum leptin, interleukin-18 （ IL-18 ） , soluble intercellular adhesion molecule-1 （ sICAM-1 ） , C reaction protein （CRP） concentration, and homeostasis model assessment insulin resistance （HOMA-IR） of patients with metabolic syndrome （MS）, and to explore its mechanism. Methods Forty sedentary patients with MS were randomly divided into exercise group and fenofibrate group. Patients in exercise group were trained at anaerobic threshold in- tensity （30 rain/times） for 12 weeks （5 times/wk）. Patients in fenofibrate group were treated with fenofi- brate 200 mg every night. Serum leptin, IL-18, CRP, and sICAM-1 concentration were measured by en- zyme linked immunosorbent assay （ELISA）. Twenty healthy subjects were selected as the control group. Results Serum concentration of leptin （26.0±9.07）ng/mlvs （8.32±2.94）ng/ml, t =12.72, P 〈 0. 01 ], IL-18 （308. 27 ±50. 39） pg/ml vs （230. 60 ± 29. 15） pg/ml, t = 6.41, P 〈 0. 01 ], CRP （2. 65 ±0. 57） ng/ml vs （ 1.26±0. 23） ng/ml, t =9. 69, P 〈0. 01 ], slCAM-1 （331.89 ＋60. 08） ng/ml vs （246.43±39.32）ng/ml, t =5.98,P 〈0.01], and HOMA-IR（4. 38 ±2. 06 vs 2.12±0. 50, t =4. 81, P 〈 0. 01 ） of patients with MS were significantly increased compared to the control. Serum concentration of leptin （26. 38 ±10. 85 ） ng/ml vs （19.63±6.27）ng/ml, t =2.22, P 〈0.05], IL-18（309.40 ± 49. 77） pg/ml vs （291.80± 39.21 ） pg/ml, t = 2. 33, P 〈 0.05 ], CRPE （2. 73 ± 0. 72） ng/ml vs （2. 28± 0. 38 ） ng/ml, t = 3.41, P 〈 0. 01 ], slCAM-1 （333.85 ±55.97 ） ng/ml vs （ 306. 24 ± 50. 55 ） ng/ml, t = 3.16, P 〈0. 01 ], and HOMA-IR（4. 53± 2. 39 vs 2. 89 ±0. 69, t = 2. 87, P 〈0.01 ） were significantly decreased after training for 12 weeks. Coneluslons Aerobic exercise is one of the effective treatments of patients with MS. Its underlying mechanism may be associated with reduction of serum inflammatory adipokine concentration, and improvement of vascular endothelial function and insulin resistance.