运动训练对心力衰竭患者血液白细胞和肿瘤坏死因子的影响

目的 探讨6min步行运动训练治疗充血性心力衰竭患者的价值;观察同同程度充血性心衰患者白细胞及分类和血浆肿瘤坏死因子（TNF）α水平的变化以及运动训练对其影响。方法 60例Ⅱ、Ⅲ级心功能充血性心衰患者在入院24h之内作6min步行运动实验,记录其行走距离,静息状态和运动后心率,血浆TNFα,血液白细胞总数及分类,然后随机分为两组（训练组32例,对照组28例）,两组均行常规抗心衰药物治疗,但训练组2次行6min步行运动训练,8周后重复检测上述指标。对23例Ⅳ级心功能CHF患者观察了入院时上述血浆细胞因子和白细胞及分类的。结果 Ⅲ、Ⅳ级CHF患者白细胞总数、中性粒细胞和单核细胞百分比较Ⅱ级CHF患者明显增高（P＜0.010;血浆TNFα在Ⅱ、Ⅲ、Ⅳ级CHF中的差异有显著性。运动训练可显著改善CHF症状,减慢增快的心率,增加行走距离。训练组与对照组的差异有显著性（P＜0.05）。运动训练组治疗8周后,CHF患者白细胞、中性粒、单核细胞百分比和血浆TNFα的下降程度较对照组比更显著（P＜0.05）。结论 6min步行运动训练不仅可明显改善心衰患者的TNFα等细胞因子的过度激活,还可改善心衰患者可能存在着的免疫机能缺陷。

The effects of exercise training on plasma tumor necrosis factor-alpha,blood leucocyte and its components in congestive heart failure patients

OBJECTIVE: To evaluate six-minute walking test (6-MWT) in treatment of CHF and to investigate the effect of exercise training on blood leucocyte and its components and plasma TNF alpha in CHF patients. METHODS: 60 cases with NYHA II-III CHF patients underwent 6-MWT within 24 hours after hospitalization. The walking distance, heartbeat, plasma TNF alpha, and blood leucocyte and its components were investigated before and after walking test. These patients were then randomized into two groups, a training group (32 cases) and a control group (28 cases). Besides routine medication, 6-MWT was performed in the training group twice a day for 8 weeks. The same parameters were redetermined after 8 weeks of follow-up. 23 cases with NYHA IV CHF patients were investigated with the same parameters in the first day after hospitalization. RESULTS: Blood leucocyte count and percentage of granulocytes and mononuclears in cases with NYHA III-IV were significantly higher than those with NYHA II. There were significant reduction of heartbeat and prolongation of walking distance in CHF patients after exercise training. Blood leucocyte count and the percentage of granulocytes and mononuclear and plasma TNFalpha level were reduced more in the training group than the control group after 8 weeks the treatment. CONCLUSIONS: There is significantly higher leucocyte count and percentage of granulocytes and mononuclears in CHF with NYHA III-IV than those with NYHA II. 6-MWT, as an exercise training, is simple, safe, and not harmful. It can not only evaluate the severity of CHF but also serve as a therapeutic measure for CHF. Moreover the excessive activation of cytokines as TNFalpha could be reduced by 6-MWT training in CHF patients.