Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial
Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial
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DOI：
10.1016/j.rmed.2017.12.005
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发表时间：
2018-01-01
影响因子：
4.3
通讯作者：
Liborio, Alexandre Braga
中科院分区：
文献类型：
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作者：
Campos, Nataly Gurgel;Marizeiro, Debora Fortes;Liborio, Alexandre Braga
简介：血液透析（HD）患者的肺功能改变，这与内皮功能受损和心血管事件相关。呼吸肌训练（RMT）有可能改善维持性HD患者的心血管结局。在这里，我们评估了RMT对内皮细胞/糖萼，氧化应激生物标志物和肺功能测试在HD patients.Methods的影响：这是一项随机对照临床试验，包括41例患者进行每周三次的维持HD。患者以2：1的比例随机分配，在HD治疗期间接受或不接受RMT，持续8周。主要结局是与内皮活化（血管细胞粘附分子1，VCAM-1和细胞间粘附分子1，ICAM-1），糖萼紊乱（syndecan-1），异常血管生成（血管生成素-2）和氧化应激（丙二醛）相关的生物标志物水平与基线相比的变化。测定最大吸/呼气压（MIP）、最大呼气末压（MEP）、用力肺活量（FVC）和第一秒用力呼气量（FEV 1）。其他结局包括功能容量和肺功能检查的变化。我们还进行了事后分析血浆内皮素-1 levels.Results：随机分配的56例患者中，41例被纳入主要的最终分析。与安慰剂相比，RMT增加了评估的所有肺功能参数，并在8周时显著降低了血浆syndecan-1水平（组间差异：-84.5; 95%CI，-148.1至-20.9）。此外，血管生成素-2的血浆水平降低（组间差异：-0.48; 95% CI，-1.03至-0.097）。此外，静息时平均血压显著降低（组间差异：-12.2; 95%CI，-17.8至-6.6），与内皮素-1水平降低（组间差异：-0.164; 95%CI，-0.293至-0.034）相关。内皮细胞活化或氧化stress.Conclusion的生物标志物没有差异：短期RMT程序改善FVC，FEV 1，并降低syndecan-1和血管生成素-2生物标志物水平。最后，在训练过程中获得了更好的血压控制，这与内皮素-1水平的降低有关。
Introduction: Hemodialysis (HD) patients have altered pulmonary function and this is associated with impaired endothelial function and cardiovascular events. Respiratory muscle training (RMT) has the potential to improve cardiovascular outcomes in patients undergoing maintenance HD. Here, we evaluated the effects of RMT on endothelium/glycocalyx, oxidative stress biomarkers and pulmonary function test in HD patients.Methods: This is a randomized controlled clinical trial including 41 patients undergoing thrice-weekly maintenance HD. Patients were randomly assigned at a 2: 1 ratio to receive or not RMT during HD sessions for 8 weeks. Main outcomes were changes in levels of the biomarkers related to endothelium activation (vascular cell adhesion molecule 1, VCAM-1, and intercellular adhesion molecule 1, ICAM-1), glycocalyx derangement (syndecan-1), aberrant angiogenesis (angiopoietin-2) and oxidative stress (malondialdehyde) compared to baseline. Also, maximal inspiratory/expiratory pressure (MIP, MEP), Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were evaluated. Other outcomes included changes in functional capacity and pulmonary function test. We also performed a post-hoc analysis of plasma endothelin-1 levels.Results: Of 56 randomly assigned patients, 41 were included in the primary final analyses. RMT increased all pulmonary function parameters evaluated and significantly reduced plasma syndecan-1 levels at 8 weeks compared to placebo (between-group difference:-84.5; 95% CI, -148.1 to -20.9). Also, there was a reduction in plasma levels of angiopoietin-2 (between-group difference: -0.48; 95% CI, -1.03 to -0.097). Moreover, there was a significant reduction in mean blood pressure at rest (between-group difference: -12.2; 95% CI, -17.8 to -6.6) associated with a reduction in endothelin-1 levels (between-group difference: -0.164; 95% CI, -0.293 to -0.034). There was no difference regarding biomarkers of endothelial activation or oxidative stress.Conclusion: A short-term RMT program ameliorate FVC, FEV1 and reduces syndecan-1 and angiopoietin-2 biomarker levels. Finally, better blood pressure control was attained during training and it was associated with a reduction in endothelin-1 levels.