运动干预对代谢异常患者代谢指标影响的实践评估

doi:10.3969/j.issn.1673-5765.2022.05.009

摘要/Abstract

摘要：

目的对代谢异常患者进行运动干预指导，评价其对患者代谢指标的影响，探索非药物干预措施预防心脑血管疾病的临床价值。

方法本研究为前瞻性研究，一次性募集代谢异常患者，通过医学检查、体适能测试，开具个体化运动处方。通过微信群管理与现场运动指导相结合的方式进行运动干预，运动形式为有氧运动与力量训练结合，共12周。比较干预前后患者的BMI 、体质量、腰围、血压、空腹血糖、血脂等代谢相关指标；计算并比较代谢综合征严重度积分（metabolic syndrome severity score，MSSS）、内脏脂肪指数（visceral adiposity index，VAI）干预前后变化。

结果共招募109例代谢异常患者参与研究，完成12周干预者107例，其中男性43例（40.2%），女性 64例（59.8%），平均年龄42.6±9.3岁。运动干预后空腹血糖[5.1（4.7～5.5）mmol/L vs. 5.4（5.0～6.0） mmol/L，P ＜0.01]、LDL-C[2.8（2.4～3.6）mmol/L vs . 3.2（2.7～3.7）mmol/L，P =0.04] 、TC[ 4.8 （4.3～5.4）mmol/L vs. 5.6（4.6～5.8）mmol/L，P =0.01]、TG[1.3（0.9～1.7）mmol/L vs. 1.5（1.1～2.3） mmol/L，P＜0.01]等代谢性指标水平显著下降。MSSS[-1.8（-3.6～0.1）vs. -0.4（-2.7～1.5），P＜0.01]、 VAI[1.4（1.0～2.1）vs. 1.8（1.2～3.0），P＜0.01]较运动干预前均显著下降。

结论制订个体化运动处方，通过现场与互联网线上指导、督促患者执行处方的运动干预方法可以作为改善代谢异常的治疗手段之一。

文章导读： 本研究对存在代谢异常，心脑血管疾病风险较高的人群制订个体化运动处方，通过现场与互联网线上指导、督促患者执行处方，并辅以基础饮食指导，坚持干预12周后发现，该综合治疗措施可以显著改善患者的代谢指标。

关键词: 运动干预; 代谢综合征严重度积分; 内脏脂肪指数; 代谢异常

Abstract:

Objective To evaluate the effect of exercise intervention on metabolic indexes of patients with metabolic abnormality, and explore the clinical value of non-drug intervention to prevent cardiocerebrovascular diseases. Methods This prospective study recruited the patients with metabolic abnormality at one time. According to medical examination results and physical fitness test, every patient was offered personalized exercise prescription. A total of 12-week exercise intervention was conducted through combining Wechat group management with on-site exercise guidance, with the exercise form of combining with aerobic exercise and strength training. The subjects’ metabolic indexes such as BMI, body mass, waist circumference, blood pressure, fasting blood glucose, and blood lipid were compared before and after the intervention. Metabolic syndrome severity score (MSSS) and visceral adiposity index (VAI) were calculated and compared before and after the intervention. Results A total of 109 patients were included, of whom 107 patients completed the whole-course intervention, including 43 males (40.2%) and 64 females (59.8%), with an average age of 42.6±9.3 years. After exercise intervention, metabolic indexes such as fasting blood glucose [5.1 (4.7-5.5) mmol/L vs . 5.4 (5.0-6.0) mmol/L, P <0.01], LDL-C [2.8 (2.4-3.6) mmol/L vs . 3.2 (2.7-3.7) mmol/L, P =0.04], TC [4.8 (4.3-5.4) mmol/L vs . 5.6 (4.6-5.8) mmol/L, P =0.01], TG [1.3 (0.9-1.7) mmol/L vs . 1.5 (1.1-2.3) mmol/L, P <0.01] decreased significantly. MSSS [-1.8 (-3.6-0.1) vs . -0.4 (-2.7-1.5), P <0.01] and VAI [1.4 (1.0-2.1) vs . 1.8 (1.2-3.0), P <0.01] after exercise intervention were also decreased significantly compared to that before exercise intervention. Conclusions Making personalized exercise prescription and urging patients to implement the exercise intervention through on-site and network guidance, can be a kind of effective treatment means of improving metabolic abnormality.

Key words: Exercise intervention; Metabolic syndrome severity score; Visceral adiposity index; Metabolic abnormality

邹煦, 谷荣娜, 张晗. 运动干预对代谢异常患者代谢指标影响的实践评估[J]. 中国卒中杂志, 2022, 17(05): 491-496.

ZOU Xu, GU Rongna, ZHANG Han. The Effect of Exercise Intervention on Metabolic Indexes in Patients with Metabolic Abnormality[J]. Chinese Journal of Stroke, 2022, 17(05): 491-496.

参考文献

[1] SATISH M，SAXENA S K，AGRAWAL D K. Adipokine dysregulation and insulin resistance with atherosclerotic vascular disease：metabolic syndrome or independent sequelae[J]. J Cardiovasc Transl Res，2019，12（5）：415-424.
[2] MYERS J，KOKKINOS P，NYELIN E. Physical activity，cardiorespiratory fitness，and the metabolic syndrome[J]. Nutrients，2019，11（7）：1652.
[3] 国家体育总局群众体育司. 国民体质测定标准手册（成年人部分）[EB/OL]. （2003-12-08）[2021-11-12]. https://www.sport.gov.cn/qts/n4986/c670119/content.html.
[4] American College of Sports Medicine. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription，ninth edition[J]. Curr Sports Med Rep，2013，12（4）：215-217.
[5] OZEMEK C，TIWARI S，SABBAHI A，et al. Impact of therapeutic lifestyle changes in resistant hypertension[J]. Prog Cardiovasc Dis，2020，63（1）：4-9.
[6] COLBERG S R，SIGAL R J，FERNHALL B，et al. Exercise and type 2 diabetes：the American College of Sports Medicine and the American Diabetes Association：joint position statement executive summary[J]. Diabetes Care，2010，33（12）：2692-2696.
[7] ABDELBASSET W K. Resistance exercise versus aerobic exercise combined with metformin therapy in the treatment of type 2 diabetes：a 12- week comparative clinical study[J]. Endocr Metab Immune Disord Drug Targets. 2021，21（8）：1531-1536.
[8] 中国营养学会. 中国居民膳食指南（2016）[M]. 北京：人民卫生出版社，2016：1-140.
[9] JOHNSON J L，SLENTZ C A，HOUMARD J A，et al. Exercise training amount and intensity effects on metabolic syndrome（from studies of a targeted risk reduction intervention through defined exercise）[J]. Am J Cardiol，2007，100（12）：1759-1766.
[10] AMATO M C，GIORDANO C，GALIA M，et al. Visceral adiposity index：a reliable indicator of visceral fat function associated with cardiometabolic risk[J]. Diabetes Care，2010，33（4）：920-922.
[11] 陈伟伟，高润霖，刘力生，等. 《中国心血管病报告2015》概要[J]. 中国循环杂志，2016，31（6）：521-528.
[12] 沈安娜，郑德仲，胡兆霆. 原发性高血压患者昼夜节律与自主神经功能及心肌能量消耗的相关性[J]. 南方医科大学学报，2014，34（5）：713-717.
[13] DEL RJO R，QUIILTAILILLA R A，ORELLARIA J A，et al. Neuron- Glia cross talk in the autonomic nervous system and its possible role in the progression of metabolic syndrome：a new hypothesis[J/OL]. Front Physiol，2015，6：350[2021-11-12]. https://doi.org/10.3389/fphys.2015.00350.
[14] 张献博，郭立新. 2016年美国糖尿病学会体力活动/运动与糖尿病立场声明解读[J]. 中华糖尿病杂志，2017，9（8）：479-482.
[15] WIJNDAELE K，BEUNEN G，DUVIGNEAUD N，et al. A continuous metabolic syndrome risk score：utility for epidemiological analyses[J]. Diabetes Care，2006，29（10）：2329.
[16] BISWAS E，CHOUDHURY A K，AMIN M R，et al. Visceral adiposity index score is the better predictor of clinical and coronary angiographic severity assessment than other adiposity indices in patients with acute coronary syndrome[J]. Mymensingh Med J，2019，28（2）：382-388.
[17] WILEY J F，CARRINGTON M J. A metabolic syndrome severity score：a tool to quantify cardiometabolic risk factors[J/OL]. Prev Med，2016，88：189-195[2021-11-19]. https://doi.org/10.1016/j.ypmed.2016.04.006.
[18] PEKGOR S，DURAN C，BERBEROGLU U，et al. The role of visceral adiposity index levels in predicting the presence of metabolic syndrome and insulin resistance in overweight and obese patients[J]. Metab Syndr Relat Disord，2019，17（5）：296-302.