《生命科学》 2024, 36(11): 1407-1419

运动改善病理性心肌肥厚的分子机制研究进展

孙忠广 , 张　慧 , 张铭宸 , 陈明华 , 段玉双^*

山东第二医科大学康复医学院，潍坊 261

摘　要：

已有大量基础研究和临床研究证实运动可以改善病理性心肌肥厚，但其机制以及运动参数和病情程度等因素对运动效果的影响尚不清楚，因此本文对上述机制及可能影响运动效果的因素进行了综述。主动脉缩窄(transverse aortic constriction, TAC) 是目前众多建立压力超负荷心肌肥厚动物模型的方案中应用最广泛的手段。本文系统检索了近几年中英文文献数据库(PubMed、EMBASE、Web of Science、Medline 和中国知网) 中的相关文献，发现多数中低强度有氧运动、抗阻运动和自主运动可以缓解病理性心肌肥厚，相关分子机制包括运动调节非编码RNA (non-coding RNA, ncRNA) 表达、凋亡、氧化应激、炎症、线粒体功能、钙离子稳定和交感神经兴奋等。适宜的运动类型和强度治疗效果更佳，过量运动可能会加重病理性心肌肥厚。另外，常规的运动干预可能无法改善甚至加重重度TAC 诱导的病理性心肌肥厚。运动方案的个性化、安全性和临床应用将是病理性心肌肥厚领域发展的必然趋势，需要考虑到机体病理性心肌肥厚的症状、运动强度适应、年龄和副作用等，为科学制定心力衰竭的预防和康复方案提供新的思路。

通讯作者：段玉双 , Email:duanysh@sdsmu.edu.cn

Research progress on molecular mechanism of exercise improving pathological myocardial hypertrophy

SUN Zhong-Guang , ZHANG Hui , ZHANG Ming-Chen , CHEN Ming-Hua , DUAN Yu-Shuang^*

School of Rehabilitation Medicine, Shandong Second Medical University, Weifang 261053, China

Abstract:

Most basic and clinical studies have confirmed that exercise can improve pathological myocardial hypertrophy. However, the mechanism and the impact of exercise parameters and disease severity on the effectiveness of exercise are still unclear. This paper aims to clarify the mechanism mentioned above and the factors that may affect the effectiveness of exercise. Transverse aortic constriction (TAC) is the most widely used method for establishing pressure-overload myocardial hypertrophy models. A systematic search was conducted in recent years in Chinese and English literature databases, including PubMed, EMBASE, Web of Science, Medline, and CNKI. It was found that most low- and medium-intensity aerobic exercise, resistance exercise, and autonomic exercise can alleviate pathological myocardial hypertrophy. The related molecular mechanisms include the influence of exercise on non-coding RNA (ncRNA) expression, apoptosis, oxidative stress, inflammation, mitochondrial function, calcium ion stability, and sympathetic nerve excitation. Appropriate types of exercise and intensity have better therapeutic effects, and excessive exercise may aggravate pathological cardiac hypertrophy. Besides, conventional exercise interventions may not improve and, in some cases, may even exacerbate severe pathological cardiac hypertrophy induced by TAC. The personality, safety, and clinical application of exercise programs will be an inevitable trend in the field of pathological myocardial hypertrophy. It is necessary to consider the symptoms of pathological myocardial hypertrophy, the adaptation of exercise intensity, age, side effects, etc., in order to offer new
perspectives for scientific prevention and rehabilitation of heart failure.

Communication Author：DUAN Yu-Shuang , Email:duanysh@sdsmu.edu.cn