血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效

doi:10.3969/j.issn.1006-9771.2023.07.004

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (7): 761-769.doi: 10.3969/j.issn.1006-9771.2023.07.004

• 专题运动系统功能康复 • 上一篇下一篇

血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效

唐流泉¹, 彭兴云²()

1.重庆城市职业学院通识教育学院，重庆市 402160
2.重庆城市管理职业学院智慧康养学院，重庆市 401331

收稿日期:2022-08-08 修回日期:2023-03-10 出版日期:2023-07-25 发布日期:2023-08-30
通讯作者: 彭兴云(1982-)，男，汉族，硕士，副教授，主要研究方向：运动与特殊人群骨骼健康促进。E-mail： pengxingyun890@sina.com
作者简介:唐流泉(1983-)，男，汉族，四川宜宾市人，硕士，副教授，主要研究方向：体育锻炼与慢性疾病防治。
基金资助:
重庆市高等教育教学改革研究项目(203712)

Effect of exercise under blood flow restriction on risk of fragility fractures in postmenopausal patients with chronic obstructive pulmonary disease

TANG Liuquan¹, PENG Xingyun²()

1. Chongqing City Vocational College, Chongqing 402160, China
2. Chongqing City Management College, Chongqing 401331, China

Received:2022-08-08 Revised:2023-03-10 Published:2023-07-25 Online:2023-08-30
Contact: PENG Xingyun, E-mail： pengxingyun890@sina.com
Supported by:
Chongqing Higher Education Teaching Reform Research Project(203712)

摘要/Abstract

摘要：

目的探讨在有氧运动联合低强度抗阻运动中加入血流限制(BFR)，对绝经后慢性阻塞性肺疾病(COPD)患者骨强度、激素分泌、肺功能和运动能力的影响，以降低COPD患者脆性骨折和死亡风险。

方法 2020年6月至2021年1月，选取重庆渝西医院等7所社区医院绝经后COPD患者67例，随机分为对照组(n = 33)和观察组(n = 34)。两组均接受常规治疗和有氧联合低强度抗阻运动的肺康复方案；观察组于低强度抗阻运动时加入BFR，共24周。干预前后采用双能X射线骨扫描检测股骨颈骨密度(BMD)，ELISA检测白细胞介素6 (IL-6)、肿瘤坏死因子α (TNF-α)、25羟维生素D₃ [25(OH)D₃]、雌二醇(E₂)、骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRACP)、骨钙素(BGP)、β-I型胶原交联C-末端肽(β-CTX)、生长激素(GH)和胰岛素样生长因子1 (IGF-1)水平，肺功能测试检测第1秒用力呼气容积(FEV₁)和用力肺活量(FVC)，心肺运动试验检测最大摄氧量(VO_2max)和无氧阈(AT)，观察6分钟步行测试(6MWT)距离，生物电阻抗法检测体质量指数(BMI)和肌肉量，等速肌力测试检测膝关节屈伸峰力矩和疲劳指数，并采用修订版跌倒效能量表(MFES)、计时起立行走测试(TUGT)和Tinetti平衡与步态评定量表(Tinetti)进行评定。

结果对照组4例脱落，观察组5例脱落。干预后，观察组各项指标均改善(|t| > 2.208, P < 0.05)，对照组多数指标也有改善(|t| > 2.052, P < 0.05)，观察组E₂、GH、IGF-1、IL-6、TNF-α、TRACP、β-CTX、BALP、FEV₁、AT、6MWT距离、肌肉量、膝屈伸峰力矩、疲劳指数，以及TUGT时间、Tinetti评分和MFES评分均优于对照组(|t| > 2.141, P < 0.05)。

结论在运动疗法中加入BFR，可改善绝经后COPD患者骨骼强度、肺功能、雌激素分泌和运动功能，可能有助于减少脆性骨折的风险。

关键词: 绝经, 慢性阻塞性肺疾病, 血流限制, 运动, 脆性骨折

Abstract:

Objective To explore the effect of blood flow restriction (BFR)-based aerobic exercise and low-intensity resistance program on bone strength, hormone secretion, lung function and exercise capacity in postmenopausal patients with chronic obstructive pulmonary disease (COPD), to relieve the risk of fragility fractures and mortality.

Methods From June, 2020 to January, 2021, 67 postmenopausal patients with COPD were selected from seven community hospitals such as Chongqing Yuxi Hospital, etc. The patients were randomly divided into control group (n = 33) and experimental group (n = 34). Both groups received conventional treatment and implemented a pulmonary rehabilitation program consisting of aerobic exercise and low-intensity resistance, while the experimental group finished the low-intensity resistance under BFR, for 24 weeks. Before and after intervention, the femoral neck bone mineral density (BMD) was measured with dual-energy X-ray; the interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), 25-hydroxyvitamin D₃ [25(OH)D₃], estradiol (E₂), bone-specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase (TRACP), osteocalcin (BGP), β-I collagen cross-linked C-terminal peptide (β-CTX), growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were measured with ELISA; the forced expiratory volume in the first second (FEV₁) and forced vital capacity (FVC) were measured with lung function test; the maximum oxygen uptake (VO_2max) and anaerobic threshold (AT) were measured with cardiopulmonary exercise test; the body mass index (BMI) and muscle mass were measured with bioelectrical impedance; the peak torque of knee flexion and extension, and fatigue index were measured with isokinetic muscle strength test; and they were also assessed with distance of 6-minute walk test (6MWT), modified Falls Efficacy Scale (MFES), Timed Up and Go Test (TUGT), and Tinetti Performance Oriented Mobility Assessment (Tinetti).

Results Four cases dropped down in the control group, and five in the experimental group. All the indexes improved in the experimental group after intervention (|t| > 2.208, P <0.05), and most of the indexes improved in the control group (|t| > 2.052, P <0.05); while the E₂, GH, IGF-1, IL-6, TNF-α, TRACP, β-CTX, BALP, FEV₁, AT, distance of 6MWT, muscle mass, peak torque of knee flexion and extension, fatigue index, time of TUGT, and scores of Tinetti and MFES were better in the experimental group than in the control group (|t| > 2.141, P <0.05).

Conclusion Exercise under BFR may improve the bone strength, lung function, estrogen secretion and exercise ability of postmenopausal patients with COPD, which may help to relieve the risk of fragility fractures.

Key words: menopause, chronic obstructive pulmonary disease, blood flow restriction, exercise, fragility fracture

中图分类号:

R681

唐流泉, 彭兴云. 血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效[J]. 《中国康复理论与实践》, 2023, 29(7): 761-769.

TANG Liuquan, PENG Xingyun. Effect of exercise under blood flow restriction on risk of fragility fractures in postmenopausal patients with chronic obstructive pulmonary disease[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 761-769.

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指标	对照组 (n = 33)	观察组 (n = 34)	χ²/t值	P值
年龄/岁	55.4±4.3	56.2±3.7	0.816	0.170
BMI/(kg·m^-2)	21.42±4.01	20.86±3.69	0.553	0.250
BMI < 18.5 kg/m²患者数/n	1	2	0.024	0.872
绝经时间/年	3.8±0.8	4.5±1.6	0.523	0.250
COPD病程/年	8.9±2.3	9.4±3.1	0.224	0.095
BMD T值≤ -2.5患者数/n	30	31	0.022	0.794
并发症/n			0.032	0.803
1项	22	23
2项	10	9
3项	1	2
脱落人数/n	4	5	0.421	0.476

主要危险因素	次级危险因素(评定指标)
COPD	心肺功能(VO_2max、AT、FEV₁、FEV₁/FVC、6MWT)；体质量(BMI、肌肉量) 肌力(膝屈曲和伸展PT、疲劳指数)；炎症(IL-6、TNF-α)；维生素D〔25(OH)D₃〕
绝经	雌激素(E₂)
低骨强度	骨量(股骨颈BMD)；骨重建(IGF-1、BALP、TRACP、BGP、β-CTX、GH)
跌倒	平衡功能(TUGT、Tinetti)；跌到风险/恐惧(MFES)

指标	对照组(n = 29)		观察组(n = 29)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
指标	干预前	干预后	干预前	干预后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
股骨颈BMD/(g·cm^-2)	0.697±0.223	0.706±0.175	0.689±0.206	0.725±0.201	1.382	0.187	2.236	0.038	0.428	0.703	0.265	0.790
E₂/(pg·mL^-1)	49.86±6.46	60.86±12.45	50.07±7.98	66.54±19.34	2.456	0.037	2.505	0.019	1.271	0.211	2.351	0.039
GH/(ng·mL^-1)	1.61±0.30	1.93±0.34	1.62±0.36	2.55±0.48	2.656	0.032	2.875	0.014	0.857	0.391	2.588	0.034
IGF-1/(μg·L^-1)	76.34±27.34	94.34±31.23	71.21±22.28	137.55±40.20	2.052	0.048	4.783	0.002	0.651	0.532	2.619	0.033
IL-6/(ng·mL^-1)	1.36±0.48	1.13±0.78	1.33±0.35	0.87±0.61	1.533	0.154	3.256	0.012	0.438	0.677	2.256	0.042
TNF-α/(pg·mL^-1)	236.35±44.31	206.67±54.33	240.90±68.64	169.98±67.39	1.885	0.109	3.241	0.010	0.860	0.389	2.789	0.030
TRACP/(U·L^-1)	5.01±1.34	4.86±0.97	5.16±1.92	4.36±1.12	0.858	0.382	4.006	0.006	0.483	0.709	2.698	0.031
β-CTX/(ng·mL^-1)	0.635±0.079	0.602±0.093	0.651±0.084	0.553±0.102	1.545	0.150	3.420	0.007	0.942	0.347	2.216	0.043
BGP/(pg·mL^-1)	14.04±4.12	13.46±5.23	14.46±5.29	12.21±4.40	0.946	0.288	2.970	0.020	1.280	0.129	1.847	0.079
BALP/(pg·mL^-1)	18.50±6.21	17.62±7.87	18.30±5.15	15.23±8.21	0.162	0.128	3.330	0.008	0.075	0.932	3.098	0.014
25(OH)D₃/(ng·mL^-1)	44.21±12.21	51.67±18.32	43.46±10.09	52.78±15.29	6.883	0.001	7.294	0.001	1.387	0.169	1.528	0.134

指标	对照组(n = 29)		观察组(n = 29)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
指标	干预前	干预后	干预前	干预后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
FEV₁/L	0.92±0.28	1.21±0.19	0.90±0.26	1.38±0.23	2.921	0.026	4.172	0.005	0.837	0.328	2.554	0.031
FEV₁/FVC/%	49.82±7.26	56.32±7.21	51.04±7.71	58.33±8.89	4.482	0.017	6.135	0.001	0.969	0.561	1.279	0.134
VO_2max/(mL·kg^-1·min^-1)	13.57±3.12	15.23±4.91	12.97±4.12	17.39±5.23	1.052	0.021	3.527	0.015	0.452	0.751	1.016	0.188
AT/(mL·kg^-1·min^-1)	10.84±3.31	12.55±3.90	10.21±2.09	13.89±3.32	2.535	0.034	3.846	0.024	0.529	0.386	2.678	0.038
6MWT/m	405.92±68.21	435.92±68.21	400.20±58.10	456.20±58.10	4.789	0.002	5.841	0.001	0.892	0.385	2.382	0.039

指标	对照组(n = 29)		观察组(n = 29)		t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
指标	干预前	干预后	干预前	干预后	t值^a	P值^a	t值^b	P值^b	t值^c	P值^c	t值^d	P值^d
BMI/(kg·m^-2)	21.12±3.24	22.34±5.65	20.88±4.01	23.55±5.32	2.154	0.041	2.208	0.039	0.209	0.801	1.133	0.177
肌肉量/kg	32.16±8.10	33.22±7.87	31.89±5.23	34.76±5.23	1.581	0.144	2.234	0.036	0.756	0.280	2.368	0.039
膝屈曲PT/N·m	33.80±10.48	43.23±18.23	32.94±11.08	53.91±14.09	2.855	0.015	4.317	0.003	0.310	0.760	3.217	0.002
膝伸展PT/N·m	73.12±17.21	84.98±20.78	71.09±15.59	93.54±17.19	2.256	0.029	6.192	0.001	1.475	0.131	4.923	0.001
疲劳指数	-1.08±0.47	-1.15±0.39	-0.98±0.68	-1.53±0.46	2.218	0.033	2.765	0.016	1.837	0.064	2.890	0.016

血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效

Effect of exercise under blood flow restriction on risk of fragility fractures in postmenopausal patients with chronic obstructive pulmonary disease

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