Research On The Effects Of Exercise On The Endothelium Function In Middle-aged Impaired Glucose Tolerance Patients And Its Mechanism

Objective Discuss the Relationship between the endothelium function in middle-agedImpaired Glucose Tolerance patients and body composition, insulin resistin, glucosemetabolism, adiponectin cytokines, and products of fat metabolism; Discuss the effects ofexercise interference on walking group and walking plus anti-resistance training group onendothelium function, body composition, insulin resistance, glucose metabolism,adiponectin cytokines and products of fat metabolism, as well as the different effects onthese two exercise groups; Discuss the functional mechanism of exercise on endotheliumfunction in Impaired Glucose Tolerance patients, and provide theoretical basis for the factthat exercise can improve early illness of blood vessel in Impaired Glucose Tolerancepatients. Methods Through questionnaire and physical examination, choose 22middle-aged subjects from the volunteers, aged 50.4±4.5 years, who have the normalglucose tolerance, and conduct medical examination and OGTT on 129 high-riskpopulation, and finally identify 61 Impaired Glucose Tolerance patients as subjects, aged49.8±4.8 years. Use CNP, ET-1, IMT and vasodilation as indexes for endotheliumfunction; Use HOMA—IR to represent insulin resistance index; Use fasting bloodglucose, fasting insulin and 2-hour postprandial blood glucose as indexes for glucosemetabolism; Use BMI, waist circumference, WHR and BF% as indexes for bodycomposition; Use leptin, resistin, adiponectin and Tumor necrosis factor-αas indexes foradiponectin cytokines; Choose FFA as index for products of fat metabolism. Check allthe indexes above of the normal glucose tolerance group and Impaired Glucose Tolerancegroup. Use t-test between the groups, and Pearson analysis in correlation analysis to studyendothelium function and other related factors in middle-aged Impaired GlucoseTolerance patients. 61 Impaired Glucose Tolerance patients are divided into ExerciseGroupⅠ, Exercise GroupⅡand control group. Practice 24-week-long walkinginterference on GroupⅠ, 24-week-long walking plus anti-resistance training interferenceon GroupⅡ. Check all the indexes above before and after 24-week-long exercise.Through pair t-test, analysis of variance and multi-analysis among groups, study theeffects and the mechanism of different exercise ways on endothelium function inmiddle-aged Impaired Glucose Tolerance patients. Results (1) The rate of Impaired Glucose Tolerance Group to catch coronary heart disease, the positive rate of diabetesfamily history and the positive rate of family history in cardiovascular disease, are allobviously higher than the normal glucose tolerance Group. Compared with normalglucose tolerance Group, there exist clear difference in CNP, ET-1, IMT and△Dia-P, butthere is no significant difference in the brachial arterial internal diameter and△Dia-N. (2)There is no significant difference in the change of IMT, BMI and fasting blood glucose inGroup 1 and GroupⅡafter 24 weeks, but there are significant differences in the changein CNP, ET-1,△Dia-P, BF%, waist circumference, WHR, HOMA-IR, fasting insulin,2-hour postprandial blood glucose, leptin, resistin, adiponectin and FFA. Fasting bloodglucose of Control group has great significance. The others of Control group expectFasting blood glucose are no significant difference. (3) Compare the indexes which havechanged after 24-week-long exercise interference in Group 1 and GroupⅡ. In the indexesof change, CNP, ET-1, and waist circumference is bigger in GroupⅡthan those in Group1, which has great significance.(4) The multi-analysis of the difference in endotheliumfunction and the all the indexes in Group 1 before and after 24-week-exercise interferenceshows that, the change in leptin and adiponectin is the predicted variant of the change ofCNP; Change in2-hour postprandial blood glucose is the predicted variant of ET-1 change;The change in adiponectin is the predicted variant of IMT change. The multi-analysis ofthe difference in endothelium function and all the indexes in GroupⅡbefore and after24-week-long exercise interference shows that, the change in FFA, fasting glucose andWHR is the predicted variant of IMT change, while the change in WHR is the predictedvariant of△Dia-P. Conclusion (1) Middle-aged Impaired Glucose Tolerance patientshave not only the increasing risk of catching cardiovascular diseases and the congregationof cardiovascular dangerous factors, but have abnormality on insulin resistance, glucosemetabolism and the quantity of fat(BMI, BF%, waist circumference and WHR) and thequality of fat (leptin, resistin, adiponectin and FFA). (2) Middle-aged Impaired GlucoseTolerance patients have early illness of blood vessel, which is represented by the fallinglevel of CNP secreting from the endothelium cells, the increasing ET-1 level, thewidening of IMT and the reduction of endothelium-dependent vasodilation. What's more,the abnormal function of endothelium cell is related with the change in insulin resistanceindex, body composition, leptin and adiponectin. The change in quantity and quality of fat plays an important role in the endothelium malfunction in Impaired Glucose Tolerancepatients. (3) The 24-week-long walking and walking plus anti-resistance training ofmiddle-aged Impaired Glucose Tolerance patients can improve endothelium function,which is shown as the increase of CNP level, the decrease of ET-1 level and the increaseof△Dia-P; It can improve the insulin sensitivity and glucose metabolism, which isrepresented by the decrease of HOMA-IR, OGTT2h glucose and fasting insulin; It couldalso improve body composition, reducing the waist circumference, WHR and BF%,increasing adiponectin level, reducing leptin, resistin and FFA level. However, there is nosignificant improvement in BMI, fasting blood glucose and IMT. After 24-week-longexercise interference on two groups, there shows different effectiveness in the indexeswhich have significant change. CNP, ET-1, waist circumference, adiponectin and FFAchange in waking plus anti-resistance exercise are bigger than those of walking. (4) Themechanism of 24-week long exercise interference improving endothelium function ofmiddle-aged people:①Walking can reduce leptin, OGTT2h glucose level, improveadiponectin level and endothelium function;②walking plus anti-resistance training canimprove endothelium function through reducing FFA, fasting serum insulin and WHR.