肥胖症青少年心脏对运动减肥适应及机制研究
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摘要
研究目的：
儿童青少年肥胖是不容忽视的健康问题，我国儿童青少年的肥胖率已接近发达国家水平，肥胖青少年心血管疾病危险因素聚集发生率日益增加，对肥胖的及早防控已成为全球主要卫生问题之一。本研究拟根据不同肥胖程度青少年心率、血压、超声心动图心脏结构和功能各参数及心脏标志物等的变化，比较不同肥胖程度青少年心脏形态结构和功能的差异；探讨肥胖青少年心脏结构和功能对小强度长时间有氧运动产生的适应性变化及其可能机制，为运动减肥促进肥胖青少年健康、早期预防和治疗肥胖青少年心血管疾病提供参考。
研究方法：
以上海体育学院巅峰减重有限公司参加运动减肥的小班成员和VIP会员33名作为研究对象，其中男性16名，平均年龄为19.63±3.03岁；女性17名，平均年龄19.71±3.96岁。根据体脂百分比分为中-重度肥胖组（15人，20.09±3.71岁，体脂率为39.07±4.76%）和极重度肥胖（18人，19.36±3.36岁，体脂率为52.64±7.65%）两组。运动减肥前根据受试者的健康状况和运动负荷试验结果确定运动强度，制定个性化运动处方，全封闭式营养和运动干预为期3个月。由专业营养师根据基础代谢率配餐，保证脂肪酸、必需氨基酸、维生素等营养素的供给，安排膳食。受试者分别于运动减肥前一天、一个月末、三个月末前一天测量身体形态指标（身高、体重、BMI、体脂率、腰围、臀围等）、血液生化指标（空腹血糖、血脂四项、胰岛素和hs-CRP）、心脏分子标志物（心肌酶谱、 cTnI和NT-proBNP）、彩色多普勒超声心动图测量心脏结构和功能指标、测量安静血压和心率（基础心率、安静心率、运动负荷试验前、运动后即刻心率及负荷试验结束后1min恢复心率）。
研究结果：
1运动减肥对肥胖青少年身体形态、血脂、胰岛素和hs-CRP的影响
与运动减肥前比较，实验第1个月、3个月后不同性别肥胖症青少年体重、BMI、体脂率、腰围、臀围均显著下降(P<0.01)；
与运动减肥前比较，实验第1个月、3个月后不同肥胖程度青少年的FBG、TC、LDL-C、TG、FINS、HOMA-IR均显著性下降(P<0.01)，差异无统计学意义（P＞0.05)。与运动减肥前相比，1个月、3个月后肥胖青少年hs-CRP水平显著下降（P<0.01），3个月末与第1个月末比较，下降显著（P<0.01）。
相关性分析表明，运动减肥前血清hs-CRP与体脂率、臀围、腰围、脂肪量、空腹血糖、胰岛素抵抗等呈显著正相关（P<0.05），与高密度脂蛋白胆固醇呈负相关（P<0.05）。
2运动减肥对肥胖青少年心率和血压的影响
与运动减肥前比较，运动减肥1个月、3个月后，不同性别、不同肥胖程度受试者基础心率、安静心率、运动负荷即刻心率、和运动结束后1min恢复心率均显著性下降（P<0.01），心率与负荷强度之间的直线斜率显著降低，且截距减小。与运动减肥前比较，1个月、3个月运动减肥后，肥胖青少年收缩压、舒张压下降显著（P<0.01）。
3运动减肥对肥胖青少年血清NT-proBNP和cTnT水平的影响
与运动减肥前比较、1个月末和3个月末安静、定量负荷试验后即刻及24h后血清心肌肌钙蛋白（cTnT）无显著性差异（P＞0.05）。
与运动减肥前比较，减肥1个月、3个月后，肥胖青少年安静血清NT-proBNP水平显著性下降（P<0.05)，运动减肥1个月与3个月相比，无显著性差异（P＞0.05)。
定量负荷试验即刻后NT-proBNP明显高于安静水平；与运动减肥前比较，1个月、3个月后相同定量负荷试验运动即刻后NT-proBNP和安静水平均无明显差异（P＞0.05）。
与运动减肥前比较，运动减肥1个月末，定量负荷跑台试验后即刻NT-proBNP水平没有显著性差异（P＞0.05)，运动减肥3个月后，定量负荷即刻NT-proBNP水平显著下降（P<0.05）。
4运动减肥对肥胖青少年心脏形态结构和功能的影响
运动减肥前，极重度肥胖青少年心脏形态结构指标室间隔厚度、左室后壁厚度和左室质量均显著高于中重度肥胖青少年（P<0.05），左室舒张末内径差异不显著；收缩功能指标EDV/BSA、CI、SI显著低于中度肥胖青少年(P<0.05)，心输出量高于中重度肥胖组，但无统计学意义。舒张功能指标二尖瓣舒张晚期峰值流速A、二尖瓣环舒张晚期峰值流速Va显著高于中重肥胖组，E/A、和Ve/Va显著低于中度肥胖青少年(P<0.05)。
与运动减肥前相比，减肥1个月后，中重度、极重度肥胖患者IVSd、LVPWd、 LVM、标化LVMI和极重度组RWT显著降低（P<0.05）。运动减肥3个月后，中重度、极重度肥胖患者AOD、IVSd、IVSs、LVPWd、RWT、 LVM、标化LVMI均非常显著性下降（P<0.01），极重度肥胖组LVPWs显著降低（P<0.05）， LVDd减肥前后差异不显著（P＞0.05)。经过3个月运动减肥后，极重肥胖组AOD、IVSd、LVPWd、LVM、标化LVM与中重度组相比，仍存在显著差异（P<0.05）。
与运动减肥前相比，运动减肥1个月后，中重度、极重度肥胖患者SI、 EDV/BSA和极重度组SV显著增加（P<0.05）；运动减肥3个月后，两肥胖度青少年SI和EDV/BSA显著增大（P<0.01）、SV与中重度肥胖组ET明显增加而两肥胖度青少年CO显著降低（P<0.05）、极重度肥胖组SI和EDV/BSA均低于中重度肥胖组（P<0.05）。
与运动减肥前相比，减肥1个月后，中重度组、极重度肥胖患者E/A和Ve/Va均显著增大。运动减肥3个月后，不同肥胖组E、Ve、E/A和Ve/Va显著增大， A、 Va明显下降（P<0.05）；极重度肥胖组Va、 Ve/Va与中重度肥胖患者比较，仍存在显著差异（P<0.05）。
运动减肥前，肥胖青少年中有46%LVH，其中12%为向心性肥大，28%为向心性重构，离心性肥大为6%，3个月运动减肥后仅有6%肥胖青少年仍存在LVH，向心性肥厚和离心性肥厚的受试者均恢复到正常构型，正常心脏构型比率由原来的54%提到94%；运动减肥后未出现正常左室构型发展为左室肥大。
与运动减肥前比较，运动减肥1个月后，LVH受试者LVM、LVMI、LVPWd、 RWT和IVSd显著性降低（P<0.01）， SI， E、 E/A和Ve/Va显著增大（P<0.05）。3个月运动减肥后，RWT、LVM、IVSd、LVMI、LVPWd非常显著性降低，SI、mVcf和EDV/BSA显著增大（P<0.05）。E、Ve显著增大，A、Va显著降低，（P<0.05），E/A非常显著性增大（P<0.01）。
相关性分析显示，心脏形态指标标化LVM与身体形态（BMI、PBF和WC）、HOMA-IR、E/Va和NT-proBNP呈显著正相关（P<0.05）。EF与CRP呈显著负相关(P<0.05)。E/A与PBF、WC和DBP呈显著正相关（P<0.05）；Ve/Va与BMI和PBF呈非常显著性负相关(P<0.01)。E/Va与PBF和LVMI呈显著性相关（P<0.05）。
研究结论：
1三个月小强度长时间有氧运动能有效降低肥胖青少年体重和体脂百分比，明显改善身体形态、脂代谢紊乱和胰岛素抵抗，显著降低血清hs-CRP水平，对预防和降低肥胖青少年心血管疾病的发生和发展，促进肥胖青少年健康具有重要意义。
2运动减肥能显著降低肥胖青少年基础心率、安静心率和各级负荷运动后即刻心率及运动后1min恢复心率，减少心肌耗氧量，提高心率储备。
3.肥胖青少年明显存在心脏肥大，向心性重构是肥胖青少年左室构型变化的主要形式，3个月小强度长时间有氧运动能明显降低肥胖青少年左室质量、减少左室后壁和室间隔厚度等心脏结构，能良性逆转肥胖青少年左室重构，肥胖青少年心脏改变具有可复性。
4.肥胖症青少年心脏舒张功能与肥胖程度呈负相关。极重度肥胖患者心脏肥大明显异常，心脏功能降低明显。3个月小强度长时间有氧运动能明显改善肥胖青少年的收缩和舒张功能，极重度肥胖青少年逆转心功能可能需要更长的锻炼时间和体重的进一步降低。
5.肥胖青少年cTnT和NT-proBNP在安静和定量负荷运动后即刻都处于正常范围，可能与本研究所选取的研究对象没有其它明显疾病的健康青少年有关，也反映了本研究受试对象心脏结构的完整性和血液动力学功能正常。运动减肥能降低肥胖症青少年NT-proBNP水平，改善左室舒张功能。
Objective: Health problems of obese adolescents is not ignored now. Aggregate incidence ofobese adolescents' cardiovascular risk factors is increasing the the developed countries. Therate of adolescents obesity in our country has close to that of developed countries, earlyprevention and control has become one of major health problems. Based on the changes ofheart rate, blood pressure, echocardiographic parameters, the myocardial enzymes, etcmolecular markers level of different degree of obesity, this paper compared the difference ineffects of different degree of obesity on adolescents' cardiac structure and function of theeffect, explored adaptability and mechanism of cadiac structure and function of obeseadolescents under long-term and low-intensity exercise intervention, and provide thetheorical basis of effects of exercise induced weight loss on obese adolescents' health, earlyprevetion and cure.
Methods:A total of33obese adolescents-smaller-class and the VIP members, including16men with an average age of19.63±3.03years and17Women with an average age of19.71±3.96years old, Aeeording to body fat percentage(BFP),underwent exercise-inducedweight loss interventions in Dianfeng Co. LTD, Shanghai Universtiy of sports. The subjectswere divided into moderately-to-severely obese group(15,mean age20.09士3.71,meanBFP=39.07士4.76)and severely obese group(18,mean age19.36士3.36,mean BFP=52.64士7.65). Before experiment, on the basis of health status and exercise stress testing, exerciseintensity was determined, individual exercise prescription and3-month fully-closed nutritionand exercise-induced weight loss interventions were formulated. Somatotype indicators (bodyheight, body weight, BMI, body fat ratio (BF%), waist and hip circumference, etc), bloodbiochemical indicators (fasting blood glucose, four blood lipid items, insulin and hs-CRP),cardiac molecular markers (myocardial enzyme, cTnI and NT-proBNP) were measured,cardiac structure and function parameters were also measured by Color DopplerEchocardiography, and as well as resting blood pressure and pre-exercise, post-exerciseinstantly and resting for a while heart rate in the first day, the day before the four weeks andthe day before leaving.
Results：
1Effects of exercise-induced weight loss on somatotype, lipid, insulin and hs-CRP of obeseadolescents
Compared with pre-trainning, body weight, BMI, body fat ratio, waist circumference,hip circumference of different gender obese adolescents are significantly decreased after1month and3months exercise training(P<0.01).
FBG,TC, LDL-C, TG, FINS and HOMA-IR level of obese teenageers and adolescentsare notably declined(P<0.01); HDL-C has no statistically significant compared withpre-training (P>0.05).
There is a significant positive correlation between serum hs-CRP and body fat rate, hipcircumference, waist circumference, body fat mass, fasting blood glucose, insulinresistance(P<0.05), and negatively related to high-density lipoprotein cholesterol (P<0.05).
2Effects of exercise-induced weight loss on heart rate and BP of obese adolescents
Basal heart rate and resting heart rate, heart rate instantly after exercise load and heartrate recovery after resting1min decrease significantly after1month and3months compared with pre-training(P<0.01), slope between obese adolescents' heart rate and load intensitysignificantly lowered, intercept also decreased. Compared with pre-training, both obeseadolescents' systolic and diastolic pressure significantly decreased after1month and3months (P<0.01).
3Effects of exercise-induced weight loss on NT-proBNP and biomarker of myocardialdamage of obese adolescents
24h after quantitative exercise load test in pre-training,1-and3-month end,serumcardiac troponin calcium protein T(cTnT) has no significant difference (P>0.05),24hafter quantitative exercise load test, serum resting cTnT had no significant differences inpre-training, the last day of1month and3months, and value also in normal range.
After1-and3-months, obese adolescents' serum resting NT-proBNP levels droppedsignificantly than pre-training (P<0.05). NT-proBNP level of1month and3-month traininghad no significant difference (P>0.05).
Compared with pre-training, NT-proBNP level after immediately quantitative load testwas significantly higher than resting value(P<0.05). NT-proBNP had no significantlydifference in the same quantitative load test after1month and3months (P>0.05).
Compared with pre-training, NT-proBNP level after the same-grade quantitative loadtest immediately had no significant difference (P>0.05), after3months, NT-proBNP levelinstantly after quantitative load significantly decreased (P<0.05).
4Effects of exercise-induced weight loss on cardiac structure and function of obeseadolescents
Before pre-training, extremely severe obese adolescents cardiac structure index such asventricular septal thickness, left ventricular wall thickness and left ventricular mass weresignificantly higher than moderate obese adolescents (P<0.05), left ventricular end-diastolicdiameter has no significant difference; Systolic function index such as EDV/BSA, CI, SIsignificantly lower than moderate obese adolescents (P <0.05), cardiac output higher thanmoderate-to severe-obesity groups, but has no significance. Diastolic function index such aspeak flow velocity late diastole mitral valve A, mitral valve ring late diastole peak flowvelocity in the Va significantly higher than moderately-to severely-obese group, E/A, andVe/Va significantly lower than moderate obese adolescents (P <0.05).
Compared with pre-training, after a month, IVSd, LVPWd, LVM and standardizedLVMI in moderate-to severe-and severely obese patients and RWT in severely obese groupsignificantly reduced (P <0.05). After3months, IVSd, IVSs AOD, LVPWd, RWT, LVMand standardized LVMI in moderate-to severe-and severely obese patients are verysignificant decline (P<0.01), LVPWs in extremely severe obesity group significantly reduced(P<0.05), LVDd before and after reducing weight had no significant difference (P>0.05).After3months, AOD, compared with that of moderate to severe group, IVSd, LVPWd,LVM and standardized LVM is significant in of severely obese group(P <0.05).
Compared with pre-training, after a month, SI and EDV/BSA in moderate-to severe-and severely obese patients and SV in the latter increased significantly (P <0.05); after3months, SI and EDV/BSA increase significantly (P <0.01), SV and ET in moderately-toseverely-obese group significantly increased, CO reduced significantly (P <0.05), SI andEDV/BSA in severely obese group were lower than those of moderately-to severe-obeselygroup (P <0.05).
Compared with pre-training, after a month, E/A and Ve/Va in moderately-to severely-obese group and severely obese patients were significantly increased. After3months, E, Ve,E/A and Ve/Va in different obese group increased significantly, and A and Va declinedobviously (P <0.05); Compared with moderately-to severely-obese patients, there issignificant difference in Va, Ve/Va in severely obese group (P <0.05).
Before reducing weight,46%of obese adolescents were LVH, of which12%was28%for remodeling and6%for eccentric hypertrophy. After three months, only6%obeseadolescents still existed LVH,and eccentric hypertrophy recovered to the normalconfiguration, normal cardiac geometric alteration ratio were from54%to94%; Afterreducing weight, it appeared that normal left ventricular configuration did not develop to leftventricular hypertrophy.
Compared with pre-training, after a month, LVM, LVMI, LVPWd, RWT and IVSd inLVH subjects significantly reduced, and SI, E, E/A and Ve/Va increase obviously (P <0.05).After Three months, RWT, LVM, IVSd, LVMI, LVPWd very significantly decreased. SI,mVcf and EDV/BSA increase significantly (P <0.05). E and Ve increase significantly, A andVa significantly reduced,(P <0.05), E/A notably increased (P <0.01).
The correlation analysis shows that the cardiac structural index such as standardizedLVM and body somatotype(BMI, PBF and WC), HOMA-IR, E/Va and NT-proBNP had asignificant positive correlation(P <0.05). EF was significant negative correlated with CRP (P<0.05). E/A and PBF, WC and DBP had a significant positive correlation(P <0.05); Ve/Vais very significant negative correlated with BMI and PBF(P <0.01). E/Va were significantlycorrelated to PBF and LVMI (P <0.05).
Conclusion:
1Three months and low-intensity aerobic exercise can reduce obese adolescents' weight andbody fat percentage, improve somatotype, lipid metabolism status and IR, reduce serumhs-CRP levels significantly, hve the importance to prevent, reduce the occurrence anddevelopment of cardiovascular disease, and promote the obese adolescents health.
2Exercise-induced weight loss can significantly lowered basal heart rate, resting heart rateand the immediate heart rate at each level exercise load and1-min recovery heart rate ofobese adolescents, enhance heart rate reserve, reduce myocardial oxygen consumption, andimprove cardiac function.
3Obese adolescents had cardiac hypertrophy obviously, the concentric remodeling is themain form of the conformational changes of the left heart.3month low-intensity aerobicexercise can reverse obese adolescents left ventricular remodeling.
4Low-intensity aerobic exercise can reverse the cardiac structure including left ventricularmass, left ventricular posterior wall and interventricular septal thickness, significantlyimproved systolic and diastolic function of obese adolescents. Very severely obese patientsmay be more severe than moderately-to severely-obese group needed reducing more weightand longer exercise time to fully recover their diastolic function.
5After exercise training, the resting and exercise immediately serum NT-proBNP levelsreduced in obese adolescents, long-term and low-intensity aerobic exercise can improveseverely obese subjects with cardiac capacity overload and improve cardiac function.
儿童青少年肥胖是不容忽视的健康问题，我国儿童青少年的肥胖率已接近发达国家水平，肥胖青少年心血管疾病危险因素聚集发生率日益增加，对肥胖的及早防控已成为全球主要卫生问题之一。本研究拟根据不同肥胖程度青少年心率、血压、超声心动图心脏结构和功能各参数及心脏标志物等的变化，比较不同肥胖程度青少年心脏形态结构和功能的差异；探讨肥胖青少年心脏结构和功能对小强度长时间有氧运动产生的适应性变化及其可能机制，为运动减肥促进肥胖青少年健康、早期预防和治疗肥胖青少年心血管疾病提供参考。
研究方法：
以上海体育学院巅峰减重有限公司参加运动减肥的小班成员和VIP会员33名作为研究对象，其中男性16名，平均年龄为19.63±3.03岁；女性17名，平均年龄19.71±3.96岁。根据体脂百分比分为中-重度肥胖组（15人，20.09±3.71岁，体脂率为39.07±4.76%）和极重度肥胖（18人，19.36±3.36岁，体脂率为52.64±7.65%）两组。运动减肥前根据受试者的健康状况和运动负荷试验结果确定运动强度，制定个性化运动处方，全封闭式营养和运动干预为期3个月。由专业营养师根据基础代谢率配餐，保证脂肪酸、必需氨基酸、维生素等营养素的供给，安排膳食。受试者分别于运动减肥前一天、一个月末、三个月末前一天测量身体形态指标（身高、体重、BMI、体脂率、腰围、臀围等）、血液生化指标（空腹血糖、血脂四项、胰岛素和hs-CRP）、心脏分子标志物（心肌酶谱、 cTnI和NT-proBNP）、彩色多普勒超声心动图测量心脏结构和功能指标、测量安静血压和心率（基础心率、安静心率、运动负荷试验前、运动后即刻心率及负荷试验结束后1min恢复心率）。
研究结果：
1运动减肥对肥胖青少年身体形态、血脂、胰岛素和hs-CRP的影响
与运动减肥前比较，实验第1个月、3个月后不同性别肥胖症青少年体重、BMI、体脂率、腰围、臀围均显著下降(P<0.01)；
与运动减肥前比较，实验第1个月、3个月后不同肥胖程度青少年的FBG、TC、LDL-C、TG、FINS、HOMA-IR均显著性下降(P<0.01)，差异无统计学意义（P＞0.05)。与运动减肥前相比，1个月、3个月后肥胖青少年hs-CRP水平显著下降（P<0.01），3个月末与第1个月末比较，下降显著（P<0.01）。
相关性分析表明，运动减肥前血清hs-CRP与体脂率、臀围、腰围、脂肪量、空腹血糖、胰岛素抵抗等呈显著正相关（P<0.05），与高密度脂蛋白胆固醇呈负相关（P<0.05）。
2运动减肥对肥胖青少年心率和血压的影响
与运动减肥前比较，运动减肥1个月、3个月后，不同性别、不同肥胖程度受试者基础心率、安静心率、运动负荷即刻心率、和运动结束后1min恢复心率均显著性下降（P<0.01），心率与负荷强度之间的直线斜率显著降低，且截距减小。与运动减肥前比较，1个月、3个月运动减肥后，肥胖青少年收缩压、舒张压下降显著（P<0.01）。
3运动减肥对肥胖青少年血清NT-proBNP和cTnT水平的影响
与运动减肥前比较、1个月末和3个月末安静、定量负荷试验后即刻及24h后血清心肌肌钙蛋白（cTnT）无显著性差异（P＞0.05）。
与运动减肥前比较，减肥1个月、3个月后，肥胖青少年安静血清NT-proBNP水平显著性下降（P<0.05)，运动减肥1个月与3个月相比，无显著性差异（P＞0.05)。
定量负荷试验即刻后NT-proBNP明显高于安静水平；与运动减肥前比较，1个月、3个月后相同定量负荷试验运动即刻后NT-proBNP和安静水平均无明显差异（P＞0.05）。
与运动减肥前比较，运动减肥1个月末，定量负荷跑台试验后即刻NT-proBNP水平没有显著性差异（P＞0.05)，运动减肥3个月后，定量负荷即刻NT-proBNP水平显著下降（P<0.05）。
4运动减肥对肥胖青少年心脏形态结构和功能的影响
运动减肥前，极重度肥胖青少年心脏形态结构指标室间隔厚度、左室后壁厚度和左室质量均显著高于中重度肥胖青少年（P<0.05），左室舒张末内径差异不显著；收缩功能指标EDV/BSA、CI、SI显著低于中度肥胖青少年(P<0.05)，心输出量高于中重度肥胖组，但无统计学意义。舒张功能指标二尖瓣舒张晚期峰值流速A、二尖瓣环舒张晚期峰值流速Va显著高于中重肥胖组，E/A、和Ve/Va显著低于中度肥胖青少年(P<0.05)。
与运动减肥前相比，减肥1个月后，中重度、极重度肥胖患者IVSd、LVPWd、 LVM、标化LVMI和极重度组RWT显著降低（P<0.05）。运动减肥3个月后，中重度、极重度肥胖患者AOD、IVSd、IVSs、LVPWd、RWT、 LVM、标化LVMI均非常显著性下降（P<0.01），极重度肥胖组LVPWs显著降低（P<0.05）， LVDd减肥前后差异不显著（P＞0.05)。经过3个月运动减肥后，极重肥胖组AOD、IVSd、LVPWd、LVM、标化LVM与中重度组相比，仍存在显著差异（P<0.05）。
与运动减肥前相比，运动减肥1个月后，中重度、极重度肥胖患者SI、 EDV/BSA和极重度组SV显著增加（P<0.05）；运动减肥3个月后，两肥胖度青少年SI和EDV/BSA显著增大（P<0.01）、SV与中重度肥胖组ET明显增加而两肥胖度青少年CO显著降低（P<0.05）、极重度肥胖组SI和EDV/BSA均低于中重度肥胖组（P<0.05）。
与运动减肥前相比，减肥1个月后，中重度组、极重度肥胖患者E/A和Ve/Va均显著增大。运动减肥3个月后，不同肥胖组E、Ve、E/A和Ve/Va显著增大， A、 Va明显下降（P<0.05）；极重度肥胖组Va、 Ve/Va与中重度肥胖患者比较，仍存在显著差异（P<0.05）。
运动减肥前，肥胖青少年中有46%LVH，其中12%为向心性肥大，28%为向心性重构，离心性肥大为6%，3个月运动减肥后仅有6%肥胖青少年仍存在LVH，向心性肥厚和离心性肥厚的受试者均恢复到正常构型，正常心脏构型比率由原来的54%提到94%；运动减肥后未出现正常左室构型发展为左室肥大。
与运动减肥前比较，运动减肥1个月后，LVH受试者LVM、LVMI、LVPWd、 RWT和IVSd显著性降低（P<0.01）， SI， E、 E/A和Ve/Va显著增大（P<0.05）。3个月运动减肥后，RWT、LVM、IVSd、LVMI、LVPWd非常显著性降低，SI、mVcf和EDV/BSA显著增大（P<0.05）。E、Ve显著增大，A、Va显著降低，（P<0.05），E/A非常显著性增大（P<0.01）。
相关性分析显示，心脏形态指标标化LVM与身体形态（BMI、PBF和WC）、HOMA-IR、E/Va和NT-proBNP呈显著正相关（P<0.05）。EF与CRP呈显著负相关(P<0.05)。E/A与PBF、WC和DBP呈显著正相关（P<0.05）；Ve/Va与BMI和PBF呈非常显著性负相关(P<0.01)。E/Va与PBF和LVMI呈显著性相关（P<0.05）。
研究结论：
1三个月小强度长时间有氧运动能有效降低肥胖青少年体重和体脂百分比，明显改善身体形态、脂代谢紊乱和胰岛素抵抗，显著降低血清hs-CRP水平，对预防和降低肥胖青少年心血管疾病的发生和发展，促进肥胖青少年健康具有重要意义。
2运动减肥能显著降低肥胖青少年基础心率、安静心率和各级负荷运动后即刻心率及运动后1min恢复心率，减少心肌耗氧量，提高心率储备。
3.肥胖青少年明显存在心脏肥大，向心性重构是肥胖青少年左室构型变化的主要形式，3个月小强度长时间有氧运动能明显降低肥胖青少年左室质量、减少左室后壁和室间隔厚度等心脏结构，能良性逆转肥胖青少年左室重构，肥胖青少年心脏改变具有可复性。
4.肥胖症青少年心脏舒张功能与肥胖程度呈负相关。极重度肥胖患者心脏肥大明显异常，心脏功能降低明显。3个月小强度长时间有氧运动能明显改善肥胖青少年的收缩和舒张功能，极重度肥胖青少年逆转心功能可能需要更长的锻炼时间和体重的进一步降低。
5.肥胖青少年cTnT和NT-proBNP在安静和定量负荷运动后即刻都处于正常范围，可能与本研究所选取的研究对象没有其它明显疾病的健康青少年有关，也反映了本研究受试对象心脏结构的完整性和血液动力学功能正常。运动减肥能降低肥胖症青少年NT-proBNP水平，改善左室舒张功能。
Objective: Health problems of obese adolescents is not ignored now. Aggregate incidence ofobese adolescents' cardiovascular risk factors is increasing the the developed countries. Therate of adolescents obesity in our country has close to that of developed countries, earlyprevention and control has become one of major health problems. Based on the changes ofheart rate, blood pressure, echocardiographic parameters, the myocardial enzymes, etcmolecular markers level of different degree of obesity, this paper compared the difference ineffects of different degree of obesity on adolescents' cardiac structure and function of theeffect, explored adaptability and mechanism of cadiac structure and function of obeseadolescents under long-term and low-intensity exercise intervention, and provide thetheorical basis of effects of exercise induced weight loss on obese adolescents' health, earlyprevetion and cure.
Methods:A total of33obese adolescents-smaller-class and the VIP members, including16men with an average age of19.63±3.03years and17Women with an average age of19.71±3.96years old, Aeeording to body fat percentage(BFP),underwent exercise-inducedweight loss interventions in Dianfeng Co. LTD, Shanghai Universtiy of sports. The subjectswere divided into moderately-to-severely obese group(15,mean age20.09士3.71,meanBFP=39.07士4.76)and severely obese group(18,mean age19.36士3.36,mean BFP=52.64士7.65). Before experiment, on the basis of health status and exercise stress testing, exerciseintensity was determined, individual exercise prescription and3-month fully-closed nutritionand exercise-induced weight loss interventions were formulated. Somatotype indicators (bodyheight, body weight, BMI, body fat ratio (BF%), waist and hip circumference, etc), bloodbiochemical indicators (fasting blood glucose, four blood lipid items, insulin and hs-CRP),cardiac molecular markers (myocardial enzyme, cTnI and NT-proBNP) were measured,cardiac structure and function parameters were also measured by Color DopplerEchocardiography, and as well as resting blood pressure and pre-exercise, post-exerciseinstantly and resting for a while heart rate in the first day, the day before the four weeks andthe day before leaving.
Results：
1Effects of exercise-induced weight loss on somatotype, lipid, insulin and hs-CRP of obeseadolescents
Compared with pre-trainning, body weight, BMI, body fat ratio, waist circumference,hip circumference of different gender obese adolescents are significantly decreased after1month and3months exercise training(P<0.01).
FBG,TC, LDL-C, TG, FINS and HOMA-IR level of obese teenageers and adolescentsare notably declined(P<0.01); HDL-C has no statistically significant compared withpre-training (P>0.05).
There is a significant positive correlation between serum hs-CRP and body fat rate, hipcircumference, waist circumference, body fat mass, fasting blood glucose, insulinresistance(P<0.05), and negatively related to high-density lipoprotein cholesterol (P<0.05).
2Effects of exercise-induced weight loss on heart rate and BP of obese adolescents
Basal heart rate and resting heart rate, heart rate instantly after exercise load and heartrate recovery after resting1min decrease significantly after1month and3months compared with pre-training(P<0.01), slope between obese adolescents' heart rate and load intensitysignificantly lowered, intercept also decreased. Compared with pre-training, both obeseadolescents' systolic and diastolic pressure significantly decreased after1month and3months (P<0.01).
3Effects of exercise-induced weight loss on NT-proBNP and biomarker of myocardialdamage of obese adolescents
24h after quantitative exercise load test in pre-training,1-and3-month end,serumcardiac troponin calcium protein T(cTnT) has no significant difference (P>0.05),24hafter quantitative exercise load test, serum resting cTnT had no significant differences inpre-training, the last day of1month and3months, and value also in normal range.
After1-and3-months, obese adolescents' serum resting NT-proBNP levels droppedsignificantly than pre-training (P<0.05). NT-proBNP level of1month and3-month traininghad no significant difference (P>0.05).
Compared with pre-training, NT-proBNP level after immediately quantitative load testwas significantly higher than resting value(P<0.05). NT-proBNP had no significantlydifference in the same quantitative load test after1month and3months (P>0.05).
Compared with pre-training, NT-proBNP level after the same-grade quantitative loadtest immediately had no significant difference (P>0.05), after3months, NT-proBNP levelinstantly after quantitative load significantly decreased (P<0.05).
4Effects of exercise-induced weight loss on cardiac structure and function of obeseadolescents
Before pre-training, extremely severe obese adolescents cardiac structure index such asventricular septal thickness, left ventricular wall thickness and left ventricular mass weresignificantly higher than moderate obese adolescents (P<0.05), left ventricular end-diastolicdiameter has no significant difference; Systolic function index such as EDV/BSA, CI, SIsignificantly lower than moderate obese adolescents (P <0.05), cardiac output higher thanmoderate-to severe-obesity groups, but has no significance. Diastolic function index such aspeak flow velocity late diastole mitral valve A, mitral valve ring late diastole peak flowvelocity in the Va significantly higher than moderately-to severely-obese group, E/A, andVe/Va significantly lower than moderate obese adolescents (P <0.05).
Compared with pre-training, after a month, IVSd, LVPWd, LVM and standardizedLVMI in moderate-to severe-and severely obese patients and RWT in severely obese groupsignificantly reduced (P <0.05). After3months, IVSd, IVSs AOD, LVPWd, RWT, LVMand standardized LVMI in moderate-to severe-and severely obese patients are verysignificant decline (P<0.01), LVPWs in extremely severe obesity group significantly reduced(P<0.05), LVDd before and after reducing weight had no significant difference (P>0.05).After3months, AOD, compared with that of moderate to severe group, IVSd, LVPWd,LVM and standardized LVM is significant in of severely obese group(P <0.05).
Compared with pre-training, after a month, SI and EDV/BSA in moderate-to severe-and severely obese patients and SV in the latter increased significantly (P <0.05); after3months, SI and EDV/BSA increase significantly (P <0.01), SV and ET in moderately-toseverely-obese group significantly increased, CO reduced significantly (P <0.05), SI andEDV/BSA in severely obese group were lower than those of moderately-to severe-obeselygroup (P <0.05).
Compared with pre-training, after a month, E/A and Ve/Va in moderately-to severely-obese group and severely obese patients were significantly increased. After3months, E, Ve,E/A and Ve/Va in different obese group increased significantly, and A and Va declinedobviously (P <0.05); Compared with moderately-to severely-obese patients, there issignificant difference in Va, Ve/Va in severely obese group (P <0.05).
Before reducing weight,46%of obese adolescents were LVH, of which12%was28%for remodeling and6%for eccentric hypertrophy. After three months, only6%obeseadolescents still existed LVH,and eccentric hypertrophy recovered to the normalconfiguration, normal cardiac geometric alteration ratio were from54%to94%; Afterreducing weight, it appeared that normal left ventricular configuration did not develop to leftventricular hypertrophy.
Compared with pre-training, after a month, LVM, LVMI, LVPWd, RWT and IVSd inLVH subjects significantly reduced, and SI, E, E/A and Ve/Va increase obviously (P <0.05).After Three months, RWT, LVM, IVSd, LVMI, LVPWd very significantly decreased. SI,mVcf and EDV/BSA increase significantly (P <0.05). E and Ve increase significantly, A andVa significantly reduced,(P <0.05), E/A notably increased (P <0.01).
The correlation analysis shows that the cardiac structural index such as standardizedLVM and body somatotype(BMI, PBF and WC), HOMA-IR, E/Va and NT-proBNP had asignificant positive correlation(P <0.05). EF was significant negative correlated with CRP (P<0.05). E/A and PBF, WC and DBP had a significant positive correlation(P <0.05); Ve/Vais very significant negative correlated with BMI and PBF(P <0.01). E/Va were significantlycorrelated to PBF and LVMI (P <0.05).
Conclusion:
1Three months and low-intensity aerobic exercise can reduce obese adolescents' weight andbody fat percentage, improve somatotype, lipid metabolism status and IR, reduce serumhs-CRP levels significantly, hve the importance to prevent, reduce the occurrence anddevelopment of cardiovascular disease, and promote the obese adolescents health.
2Exercise-induced weight loss can significantly lowered basal heart rate, resting heart rateand the immediate heart rate at each level exercise load and1-min recovery heart rate ofobese adolescents, enhance heart rate reserve, reduce myocardial oxygen consumption, andimprove cardiac function.
3Obese adolescents had cardiac hypertrophy obviously, the concentric remodeling is themain form of the conformational changes of the left heart.3month low-intensity aerobicexercise can reverse obese adolescents left ventricular remodeling.
4Low-intensity aerobic exercise can reverse the cardiac structure including left ventricularmass, left ventricular posterior wall and interventricular septal thickness, significantlyimproved systolic and diastolic function of obese adolescents. Very severely obese patientsmay be more severe than moderately-to severely-obese group needed reducing more weightand longer exercise time to fully recover their diastolic function.
5After exercise training, the resting and exercise immediately serum NT-proBNP levelsreduced in obese adolescents, long-term and low-intensity aerobic exercise can improveseverely obese subjects with cardiac capacity overload and improve cardiac function.
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