【作者】 刘红军；

【导师】 马云；

【作者基本信息】 上海体育学院 ， 运动医学， 2011， 硕士

【摘要】 研究目的对参加高原训练的游泳运动员进行超声心动图检测,探讨其三周训练前后心脏形态、结构及功能的变化情况,同时筛选出能够反映高原训练心功能变化的敏感超声心动图指标。通过对三周高原训练前后运动员免疫学指标进行检测,探讨高原训练对与心功能密切相关的细胞因子肿瘤坏死因子(TNF-α)和转移性生长因子(TGF-β)的影响,及其与心功能的关系。通过三周训练前后两次检测的心肌损伤生物学标志物-心型脂肪酸结合蛋白(H-FABP),观察游泳运动员高原训练后H-FABP的变化情况,探讨其能否作为心肌损伤的新指标,及其随心功能改变的变化规律。研究方法以参加高原训练的35名国家游泳队运动员为研究对象。第一周初(2009.12.28-29)晚上7:00-10:00,对游泳运动员进行超声心动图检测,以此作为高原训练前基础参照值,分别以M型超声心动图测量心脏形态、结构指标:左心室收缩末期前后径(LVSD)和左心室舒张末期前后径(LVDD)、左心室间隔厚度、左心室后壁厚度;二维超声心动图测量左心收缩功能及右心形态指标:左心房前后径、右心室内径、右心房横径,并计算左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、心搏出量(CO)、心输出量(SV)、左心室射血分数(EF)、左心室短轴缩短率(FS);多普勒模式测量左心舒张功能指标:二尖瓣环舒张早期峰值速度(VE)、左心房收缩期峰值速度(VA),并计算VE/VA;多普勒超声心动图检测左室Tei指数、右室Tei指数。经过三周习服、大强度、大负荷运动量训练后,第三周末(2010.1.18-19)晚上7:00-10:00再次进行超声心动图检测。将两次检测的各项超声心动图指标进行t检验统计分析,观察游泳运动员经过高原训练后心功能的变化情况,并筛选出能够反映高原训练心功能变化的敏感超声心动图指标。第一周初(2009.12.28)清晨7:30抽血,备用测试TNF-α、TGF-β和H-FABP。在三周训练后第三周末(2010.1.18)清晨7:30再次抽血,备用测试相关指标。以酶联免疫法(ELISA)法测试其浓度水平。两次检测的TNF-α、TGF-β和H-FABP分别进行前后对照t检验,观察TNF-α和TGF-β的变化规律趋势,探讨高原训练对与心功能密切相关的细胞因子TNF-α和TGF-β的影响,及其与心功能的关系。观察H-FABP的变化规律趋势,探讨其能否作为心肌损伤的新指标,并探讨其随心功能改变的变化规律。结果反映心脏形态和结构,左心室收缩功能,左心室舒张功能的各项指标均没有发生明显改变(P>0.05)。反映左心整体功能的Tei指数(P < 0.01 )和反映右心整体功能的Tei指数(P < 0.05)三周训练前后均具有明显差异,且均呈现降低的变化趋势。三周训练前后TNF-α、TGF-β没有发生明显改变,无统计学意义(P>0.05)。H-FABP具有非常明显差异(P < 0.01 ),且呈现降低的的变化趋势。结论1.高原训练前后游泳运动员左心室、右心室Tei指数呈现降低的变化趋势,提示其心脏整体收缩和舒张功能增强。且与常规超声指标相比,Tei指数能够作为评估心功能的早期敏感指标。2.高原训练前后游泳运动员心功能有明显变化。提示高原训练确实可以提高游泳运动员心功能水平。3.三周训练前后检测的TNF-α、TGF-β没有发生明显改变。TNF-α可能未介导负性心力作用,未对心功能产生下调作用。考虑到H-FABP的下降,TGF-β可能发挥了积极的生物学效应,保护了缺血心肌细胞,拮抗心肌损伤,维持正常心脏的功能。4.三周训练前后检测的心肌损伤标志物H-FABP随运动训练呈现降低的变化趋势,可以尝试作为心肌损伤的新指标,同时提示心肌损伤的程度减少,与游泳运动员经高原训练后心功能增强同步正向变化。更多还原

【Abstract】 ObjectiveTo test the echocardiography of swimming athletes who participated in the altitude training. Discuss their changes of heart form, structure and function after three weeks of training.Meanwhile,Select the sensitive indicators of echocardiography, which can reflect the change of cardiac function after altitude training.By testing the immunological indicators at the first and end of the altitude training, to discuss How altitude training effects TNF-αand TGF-βclosely related with the cardiac function,to discuss the relationship between TNF-α、TGF-βand cardiac function . By testing the biological markers of myocardial injury-the heart-type fatty acid binding protein (H-FABP) at the first and end of the altitude training, to observe the H-FABP changes, to discuss whether H-FABP can accomplish an new diagnosis of myocardial injury indicators, and to explore the variation of changes with cardiac function.MethodsSubjects were 35 national swimming athletes to participate in the altitude training.To test their echocardiography in the first weekly (2009.12.28-29) 7:00-10:00 pm , As a basis of reference values before the altitude training, Measure cardiac morphology and structure indicators by M-mode echocardiography. The indicators are concluded left ventricular end systolic diameter(LVSD),left ventricular end diastolic diameter(LVDD), left ventricular interval thickness, left entricular posterior thickness. Measure left ventricular systolic function and morphological indexes of right heart by two dimensional mode echocardiography.The indicators are concluded anteroposterior diameter of the left atrium, right ventricular diameter, right atrial diameter and calculate Left ventricular end systolic volume (ESV),Left ventricular end diastolic volume(EDV),Cardiac outpu (CO),Stroke volume(SV), left ventricular ejection fraction(LVEF), left ventricular fractional shortening(FS).To measure the Left ventricular diastolic function by means of Doppler mode echocardiography : Peak Velocity of Mitral Inflow during Early Diastole(VE), Peak Velocity of Mitral Inflow during Systole of Left Artriums(VA),and calculate VE/VA. To measure the Tei-index by Doppler echocardiography. After three weeks of acclimatization, high intensity, heavy load of exercise training, To measure all the indactors again at the third weekend (2010.1.18-19) 7:00-10:00 pm.The statistical analysis is T-test.Observe their changes of heart form, structure and function. Meanwhile, select the sensitive indicators of echocardiography, which can reflect the change of cardiac function after altitude training.The first weekly (2009.12.28) 7:30AM, get the blood and reserve to test TNF-α、TGF-βand H-FABP. At the third weekend (2010.1.18) 7:30AM after three weeks training, did it again. To test their Concentration levels by enzyme-linked immunosorbent assay (ELISA) method. The statistical analysis also is T-test. To explore their trend of changes and to discuss How altitude training effects TNF-αand TGF-βclosely related with the cardiac function. to discuss the relationship between TNF-α、TGF-βand cardiac function .To observe the H-FABP changes, to discuss whether H-FABP can accomplish an new diagnosis of myocardial injury indicatorsand to explore the variation of changes with cardiac function.ResultsThe indicators Reflecting the shape and structure of the heart, left ventricular systolic function, left ventricular diastolic function did not change significantly(P>0.05). The indicators Reflecting left overall ventricular function and right overall ventricular function have a statistically significant respectively (P < 0.01, P < 0.05), Showing the trend of decrease. TNF-αand TGF-βdid not change significantly before and after altitude training, There were not Statistically significant(P>0.05).H-FABP also show statistically significant (P < 0.01). Suggesting the trend is of decreasing.Conclusion1. Swimming athletes’left ventricle Tei index, right ventricular Tei index showed decreasing trend after altitude training. Suggesting cardiac systolic and diastolic function increase. Compared with conventional echocardiography indicators. Tei index to assess the cardiac function as the sensitive indicators.2. There were significant changes in the functions after altitude training, Altitude training can indeed improve the swimmer cardiac function level.3. There were no significant changes in cytokines TNF-α、TGF-β.Suggesting TNF-αmaybe did not play a negative role in cardiac function and did not weaken the cardiac function. Considering the results of H-FABP ,TGF-βperhaps exerts a positive biological effects, protects the ischemic myocardial cells, confront myocardial injury, maintains normal heart function.4. Cardiac injury markers H-FABP showed the trend of decrease with exercise training after three weeks of training, it maybe can accomplish an new diagnosis of myocardial injury indicators, suggesting the extent of myocardial injury reduce, and swimming athletes positively enhanced cardiac function simultaneously.更多还原