摘要目的 观察12周渐进抗阻力运动对2型糖尿病(T2DM)患者空腹时以及口服葡萄糖耐量试验(OGTT)后自主神经功能的影响并探讨其可能作用机制.方法 采用随机数字表法按3:2比例将50例T2DM患者分为运动组(30例)及对照组(20例).2组患者均保持日常生活习惯不变,运动组患者在此基础上给予12周渐进抗阻力运动.于干预前、干预12周后测定2组患者血糖控制参数[包括血糖、血胰岛素、糖化血红蛋白以及胰岛素抵抗指数(IRI)等]以及空腹和OGTT后自主神经功能参数(如心率变异性、血压变异性和压力反射敏感性等).结果 干预后运动组患者空腹血糖控制参数(血胰岛素除外)均明显低于干预前水平(P<0.05),而自主神经功能参数较干预前无明显改变(P>0.05);干预后运动组患者OGTT时自主神经功能参数总功率(LnTP)、低频功率(LFn)、LnLF/高频功率(HF)和LFSBP均较干预前明显增加(P<0.05);对照组干预后上述各项指标均无明显改变(P>0.05).组间比较发现,干预后运动组患者血糖控制参数(血胰岛素除外)均显著低于对照组水平(P<0.05),2组患者空腹时自主神经功能各参数组间差异均无统计学意义(P>0.05),OGTT后运动组LnTP、LFn、LnLF/HF和LFSBP均显著高于对照组水平(P<0.05).通过相关分析发现,运动组患者△LnLF/HF与△IRI(r=-0.469,P<0.05)具有负相关性.结论 12周渐进抗阻力运动虽然对T2DM患者空腹时自主神经功能无明显影响,但能增强OGTT后心交感和交感缩血管神经调制,其作用机制可能与抗阻力运动诱导的胰岛素抵抗减轻有关.

abstractsObjective To explore the effect and possible mechanism of 12 weeks of progressively resistive exercises on the autonomic nervous function of patients with type 2 diabetes mellitus ( T2DM) fasting and after an oral glucose tolerance test ( OGTT) . Methods Fifty T2DM patients were randomly divided into an exercise group ( E, n=30) and a control group ( C, n=20) . Group E performed progressively resistive exercises for 12 weeks, while group C maintained their normal lifestyle. Blood glucose, insulin, glycosylated hemoglobin, an insulin resist-ance index ( IRI) , heart rate variability, blood pressure variability and baroreflex sensitivity were measured after fasting and after an OGTT before and after the intervention. Results After the intervention, in the fasting state and after an OGTT, all of group E's glycemic control variables except insulin levels were significantly lower than be-fore the intervention ( P≤0.05) . No significant changes were observed in the autonomic nervous function parame-ters. However, after the intervention total power (LnTP), a comprehensive indicator of autonomic nervous system activity, normalized low frequency power (LFn), LnLF/high frequency power (LnLR/HF) and the low-frequency component of systolic blood pressure (LFSBP) increased significantly after OGTT in group E (P≤0.05), while there were no significant changes in the control group. Moreover, after the intervention there were no significant differences between the two groups in the indicators of autonomic nervous system functioning after fasting, but the LnTP, LFn, LnLF/HF and LFSBP2 of group E were significantly higher than those of group C after an OGTT (P≤0.05). In addition, the △LnLF/HF of group E was negatively correlated with △IRI (r=-0.469, P≤0.05). Conclusions Twelve weeks of progressively resistive exercises has no effect on autonomic nervous functioning after fasting for patients with T2DM, but it improves sympathetic neural responses after an OGTT. This may be related to its ameliorating insulin resistance.