運動對肥胖合併阻塞型睡眠呼吸中止症引發心臟功能損傷之影響：肌肉激素的角色

Effects of Exercise on Cardiac Dysfunction Induced by the Combination of Obesity and Obstructive Sleep Apnoea: The Role of Myokines

黃森芳(Sen-Fang Huang) ； 陳聰毅(Tsung-I Chen)

《大專體育》 135期 (2015/12) Pp. 67-77

https://doi.org/10.6162/SRR.2015.135.06

摘要

肥胖及阻塞型睡眠呼吸中止症夜間睡眠期間之間歇性低氧，對心臟功能損傷都是獨立的危險因子，兩者合併時會產生加乘效果，雖然規律運動有助於降低體脂肪，減少脂肪激素分泌失調造成發炎及心臟功能損傷，但運動時骨骼肌分泌之肌肉激素對預防心臟功能異常中所扮演的角色，目前仍有待進一步探討。本研究之目的為探討運動增加骨骼肌分泌肌肉激素，對減少脂肪激素分泌失調及降低心臟功能損傷的可能性。以學術文獻回顧之研究法論述肥胖與脂肪激素對心臟功能、肌肉激素與脂肪代謝及肌肉激素在運動影響阻塞型睡眠呼吸中止症患者心臟功能中扮演的角色。本文的結語為肥胖者體內堆積過多的脂肪組織，可能引起脂肪激素分泌失調，導致心肌發炎現象上升，造成成左心室功能失常。運動除了可以增加熱量的消耗，亦可能促進肌肉組織分泌肌肉激素，增加脂肪代謝和抑制脂肪激素分泌，減輕心肌發炎現象，避免心臟功能受損。建議未來的研究能更深入瞭解肌肉激素對脂肪代謝功能的影響，包括如何有效地減少體內脂肪的堆積，降低發炎反應，進而將運動時骨骼肌收縮所分泌之肌肉激素視為一種發炎抑制劑，如此，將規律運動應用於降低阻塞型睡眠呼吸中止症肥胖患者心臟功能損傷的說帖上，則更具有說服力。

關鍵字

脂肪激素 ； 發炎反應 ； 纖維化 ； 間歇性低氧

並列摘要

Obesity and intermittent hypoxia (IH) occurring during obstructive sleep apnoea (OSA) are two independent risk factors for impaired ventricular function; moreover, cardiac dysfunction is exacerbated when the two factors co-occur. Regular exercise provides beneficial effects to attenuate cardiac fibrosis by reducing body fat and preventing adipokine dysregulation. However, it is still unclear whether muscle-derived cytokines (myokines) released during exercise play a role in the prevention of IH-induced cardiac dysfunction. The purpose of this paper was to investigate the influence of myokines on the dysregulation of adipokines and reduction of ventricular dysfunction. The role that myokine plays in the effect of exercise on cardiac function in obese OSA patients was discussed within a literature review. The conclusion of this paper is that in obese individuals, excess adipose mass triggers dysregulation of adipokines, which leads to myocardial inflammation resulting in left ventricular dysfunction. Exercise induces an increase in energy expenditure, and also triggers the release of myokine into circulation by skeletal muscles, accelerating lipid metabolism and inhibiting the release of excess adipokines. This process helps alleviate myocardial inflammation and prevent the impairment of ventricular function. This paper suggests that future studies should investigate the effects of myokine on the lipid metabolism, including how to efficiently reduce fat deposition and alleviate inflammation. In effect, muscle-derived cytokines can be considered an anti-inflammatory medication. This provides support for advocating that regular exercise provides cardioprotective effects against the impairment of cardiac function in obese OSA patients.

並列關鍵字

adipokine ； inflammation ； cardiac fibrosis ； intermittent hypoxia

參考文獻

陳聰毅、謝茜茹(2011)。運動對阻塞性睡眠呼吸中止症患者心肌氧化傷害的影響。大專體育。112，62-68。

陳聰毅(2011)。罹患阻塞型睡眠呼吸中止症對運動能力的影響。中華體育季刊。25(1)，1-9。

Al-Daghri, N. M.,Alokail, M. S.,Rahman, S.,Amer, O. E.,Al-Attas, O. S.,Alfawaz, H.,Piya, M. K.(2015).Habitual physical activity is associated with circulating irisin in healthy controls but not in subjects with diabetes mellitus type 2.European Journal of Clinical Investigation.45(8),775-781.

Aldrich, M. S.(1989).Automobile accidents in patients with sleep disorders.Sleep.12(6),487-494.

Anastasilakis, A. D.,Polyzos, S. A.,Saridakis, Z. G.,Kynigopoulos, G.,Skouvaklidou, E. C.,Molyvas, D.,Mantzoros, C. S.(2014).Circulating irisin in healthy, young individuals: Day-night rhythm, effects of food intake and exercise, and associations with gender, physical activity, diet, and body composition.Journal of Clinical Endocrinology and Metabolism.99(9),3247-3255.