【作者】 李鹏飞；

【导师】 陈景开；

【作者基本信息】 江苏大学 ， 内科学， 2009， 硕士

【摘要】 研究背景:近几年,心肌标记物检测发展很快,发现了许多新的心肌标记物,如:缺血修饰蛋白(IMA)、心肌脂肪酸结合蛋白(H-FABP)、糖原磷酸化酶BB(GPBB)等。目前心肌标记物多用于坏死性心肌损伤病人的诊断,对于健康个体的心脏需血量急剧增加造成的心肌相对性缺血所引起的损伤则应用较少。已有的实验多选用反映心肌不可逆性损伤坏死的标记物,阳性率低,对于可逆性损伤的诊断率低,不能早期发现心肌损伤。目的:研究运动与心肌损伤的关系,测定、比较、评估心肌缺血、缺氧损伤早期的标志物,探讨能量代谢因素在心肌损伤中的作用,寻找降低心肌损伤的方法,衡量左卡尼汀在运动中对心肌的保护作用。方法:无长期耐力训练的健康年轻男性60人随机分为对照组和服药组。对照组空腹进行5000米越野跑,于运动前、运动后即刻、运动后4h抽血并游离血清备用。服药组在测试前口服左卡尼汀1.0g,3次/日×10天,再重复上述实验过程。应用酶联免疫吸附(ELISA)试验法检测血清中的缺血修饰蛋白(IMA)、心肌脂肪酸结合蛋白(H-FABP)、糖原磷酸化酶BB(GPBB)、游离脂肪酸(FFA),同时测量肌红蛋白(MB)、心肌型肌酸激酶(CK-MB)、肌钙蛋白T(CTnT)的浓度、血糖(GLU)、总胆固醇(TC)、甘油三酯(TG),比较运动前后上述指标的变化,并分析口服左卡尼汀对其影响。结果:血清GLU在服药组和对照组运动后即刻均显著升高(P<0.05),运动后4h均降至运动前水平(P>0.05);服药组均明显高于对照组(P<0.01)。对照组血清中FFA在运动后即刻和运动后4h较运动前均显著降低(P<0.01),而服药组血清中的FFA值在运动前、运动后即刻、运动后4h三个时点的值均无显著变化(P>0.05)。两组内CK-MB在运动前后均无显著差异(P>0.05)。服药组显著低于对照组(P<0.01)。CTnT在服药组和对照组运动前后均无显著差异(P>0.05)。对照组血清中的IMA在运动前、运动后即刻、运动后4h三个时点的值均未发生明显变化(P>0.05);服药组运动后4h血清中的IMA值较运动前升高(P<0.05);与对照组相比,服药组的对应三个时点的值均明显下降,差异具有显著的统计学意义(P<0.01)。在对照组,较运动前相比GPBB在运动后即刻和运动后4h显著升高(P<0.05)。服药组运动后4h较运动前出明显增加(P<0.01)。与对照组相比,服药组对应的各时点的值均出现了下降(P<0.05)。对照组运动后4h血清中H-FABP较运动前升高(P<0.01)。在服药组运动后4h出现了进一步的升高(P<0.01)。两组Mb在运动后即刻、运动后4h增幅不大,差异无统计学意义(P<0.05)。结论:5000m越野跑对心肌供能物质——葡萄糖和游离脂肪酸具有不同的影响:运动可引起血糖增高,却使血清游离脂肪酸降低。对传统的心肌坏死标记物无显著影响;对新的心肌标记物——糖原磷酸化酶BB、心肌脂肪酸结合蛋白,在运动前和运动后即刻、四小时后具有统计学意义的影响,其中以糖原磷酸化酶BB的变化幅度最大。左卡尼汀具有预防运动所造成的心肌标记物升高的作用。更多还原

【Abstract】 BACKGROUND:The studies of cardiac makers had been made developed by leaps and bounds in the pasted several years,and new ones have been found in groups such as ischemic-modified albumin(IMA), heart fatty acid-binding protein(H-FABP),glycogen posphorylase isoenzyme BB(GPBB) et al.Now the cardiac makers are used for the diagnosises of the necrotic injure of myocardium,but are seldom applied for the injure caused by the relative ischemia of caused myocardium due to the rapid increase of the demand of blood volume in the heart of healthy body.The markers which reflect irreversible myocardial damage are chosen too much for the existing experiments,so the diagnosis rate of reversible injure are lower and the injury of myocardium can not be discovered in the early stage.OBJECTIVE:The aims of studies are classified as below:To analyze the relation between exercise and myocardial damage,to determine,compare and assess the early stage makers of ischemic and hypoxia myocardial damage,To investigate the role of the factor of energy metabolism in the myocardial damage,to seek ways to reduce the injury of myocardium and to weigh the protective action of L-carnitine during the exercise.METHODS:Sixty young health men lacking of long-term endurance training are divided into two groups:control group and medicine group.The men in control group make cross-country running of long distance on empty stomachs,with their blood drawn and serum dissociated at three different times for test:before exercise,instantly after exercise and 4 hours after exercise.The medicine group taking L-carnitine in 1.0 gram,3times per day before the exercise,and then do the same procedure.The serum are tested for the concentration of ischemic myocardium makers including ischemic modified albumin(IMA),heart-fatty acid binding protein(H-FABP),glycogen phosphorylase isoenzyme BB(GPBB),myoglobin(MB),creatine kinase-MB and tropinin-T(CTnT).At the same time the following biochemical indexes are detected:blood glucose(GLU),total cholesterol (TC),triglyceride(TG)and free fatty acid(FFA).Compare the value of the indexes between pre-exercise and post-exercise and analyze the effect of L-carnitine on the myocardium in the exercise.RESULTS:The value of GLU in serum arose significantly in both medicine and control group(P<0.05),and returned to normal level in 4 hours after exercise(P>0.05);the value the medicine group was significant higher than the one of the control group.The concentration of FFA decreased significantly on instantly after the exercise and 4 hours post-exercise in control group(P<0.01),but didn’t in the medicine group (P>0.05).The values of CK-MB before and after the exercise in two groups neither had remarkable change,but the value of medicine was lower than the control group.Before and after exercise,there were not significant changes about CTnT in both groups.The IMA values in control group did not have obviously changes among before the exercise, the instantly after exercise and 4 hours after exercise(P>0.05).Compare to control group,the IMA value of the medicine group in the three times is lower obviously,the differences are significant(P<0.01).The value of GPBB in control group arose remarkably on instantly after exercise and 4 hours after exercise related to pre-exercise.So did the value in medicine group(P<0.01).Compare between two groups,the value in the medicine group in the three times is lower(P<0.05).In control group,the GPBB value arose obviously on instantly and 4 hours after sporting from before sporting.While only arose on 4 hours after exercise in medicine groups. When compared between two groups,relative the value of GPBB reduced in the medicine group(P<0.05).In control group,on the 4 hours after exercise the value of H-FABP arose(P<0.01).In medicine group the rise extent is higher(P<0.01).In both groups,the values of Mb on instantly after exercise and 4hours arise a little,the changes were not significant (p>0.05).CONCLUSION:The cross-country run of 5000 meters has different effects on the substance which providing energy for myocardium:it induced the blood glucose to arise,make the FFA in the serum become lower.There are not obviously action on the myocardial makers often used,but the influence on the new ones including, heart-fatty acid binding protein(H-FABP) is significant when compare the results pre-exercise,instantly after exercise and 4 hours after exercise,in which the change range of glycogen phosphorylase isoenzyme BB(GPBB) is more wider.Taking L-carnitine can prevent the myocardial makers from arising due to exercise.更多还原