中文摘要：

目的：观察冠心病患者外周肢体等长收缩诱导的生理性缺血训练是否可以促进远隔缺血心肌侧支循环形成，并探索其机制。方法：冠脉慢性完全闭塞患者21例随机分为对照组及等长握拳训练组。训练组患者进行3个月等长握拳诱导的生理性缺血训练，对照组不做任何训练活动。训练前后ELISA法测定血管内皮生长因子（vEGF）浓度、荧光激活流式细胞分离术测定内皮祖细胞（endothelial progenitor cells，EPCs）数量、心肌核素显像（single-photon emission computed tomography，SPECT）测定心肌缺血区血流灌注。结果：运动前，两组患者核素心肌显像静息节段总评分、外周血EPCs数量、VEGF浓度均无显著差异（P〉0．05）。经3个月等长握拳训练后，训练组EPCs数量、VEGF浓度均显著增加（P〈0．01）；训练组SPECT观察缺血区域节段总评分有明显减少（P〈0．05）。而对照组训练前后无显著差异（P〉0．05）。两组患者训练后EPCs增量与VEGF增量，VEGF增量与静息节段总评分改善均呈中度相关（r=0．56，r=-0．60）。结论：冠心病患者等长握拳诱导的生理性缺血训练可通过VEGF及EPCs释放促进远隔缺血心肌侧支循环形成。

英文摘要：

Objective： To investigate the effects and mechanism of isometric handgrip induced physical ischemia training on remote coronary growth. Method： 21 CAD patients were randomly divided into isometric handgrip training or non-training groups. Pa- tients in the training group performed three months of isometric handgrip training, while patients in the control group remained sedentary. Single-photon emission computed tomography（SPECT） was used to evaluate myocardi- al perfusion. Circulation endothelial progenitor cells（EPCs） were measured by flow cytometry at baseline and af- ter training. Plasma concentrations of vascular endothelial growth factor（VEGF） were determined by ELISA. Result： Myocardial perfusion and ejection fraction were significantly improved in training group （P〈0.05,P〈0.01） while it remained no significant change in control group（P〉0.05）. EPCs increased significantly in training group, with the number of （0.044±0.016）% after training （P=0.015）. VEGF levels in training patients also increased significantly after three months （P〈0.01）. But there were no significant change in control group. The number of EPCs was positively correlated with the level of VEGF （r=56） and the level of VEGF was correlated with the segment score of SPECT（r=0.60）. Conclusion： Isometric handgrip exercise-induced physical ischemia training may promote remote collateral growth in CAD patients through EPCs and VEGF release.