中文摘要

研究目的：本研究旨在探讨太极心康方案对冠心病患者炎症因子和黏附分子的影响，并与常规运动康复方案进行比较。以期阐明太极心康方案在冠心病的典型病理特征——低度慢性炎症反应方面的独特作用，为太极心康方案的临床获益提供科学依据。

研究方法：（1）受试者招募：在北京朝阳区安贞社区服务中心、山东淄博万杰康复医院共同招募受试者。于2020年10月至2021年11月共计招募46名冠心病患者，年龄为62.96 ± 9.296岁，其中男性32名，女性14名，按1:1比例随机分为实验组（n=23）和对照组（n=23）。（2）干预方案：采用太极心康方案干预实验组，采用常规运动康复方案干预对照组。每周干预3次，每次60min，共计干预12周，其中包括4周医院院内康复和8周远程线上的居家康复。（3）测试指标：在干预前后检测炎症因子和黏附分子。采用SPSS21.0软件处理实验数据，采用origin2021软件进行绘图分析。

研究结果：（1）太极心康方案对冠心病患者炎症因子的影响结果：太极心康方案干预后，促炎因子C-反应蛋白（CRP）、白介素6（IL-6）较干预前有非常显著性差异（P＜0.01）；抗炎因子白介素10（IL-10）较干预前有非常显著性差异（P＜0.01）。促炎/抗炎因子CRP/IL-10、IL-6/IL-10较干预前有非常显著性差异（P＜0.01），TNF-α/IL-10较干预前有显著性差异（P＜0.05）。太极心康方案组与常规运动康复方案组组间比较各指标均无显著性差异（P＞0.05）。（2）太极心康方案对冠心病患者黏附分子的影响结果：太极心康方案干预后，血管细胞黏附分子（VCAM-1）较干预前有非常显著性差异（P＜0.01），细胞间黏附分子（ICAM-1）较干预前有显著性差异（P＜0.05）。干预前太极心康方案组与常规运动康复方案组组间比较各指标均无显著性差异（P＞0.05），干预后太极心康方案组VCAM-1显著低于常规运动康复方案组（P＜0.05）。（3）太极心康方案组炎症因子与黏附分子的相关性分析：太极心康方案组促炎因子CRP、IL-6与ICAM-1呈正相关，具有显著性差异（P＜0.05）；促炎因子TNF-α与VCAM-1呈正相关，具有显著性差异（P＜0.05）。促炎/抗炎因子CRP/IL-10、TNF-α/IL-10与ICAM-1呈正相关，具有显著性差异（P＜0.05）；TNF-α/IL-10与VCAM-1呈正相关，具有显著性差异（P＜0.05）。

研究结论：（1）12周太极心康方案干预可有效降低冠心病患者促炎因子CRP、IL-6、TNF-α水平，提高抗炎因子IL-10水平，对改善冠心病患者机体抗炎能力，调控促炎与抗炎平衡具有积极效果。（2）12周太极心康方案干预能有效降低冠心病患者黏附分子VCAM-1、ICAM-1水平，对改善冠心病患者血管内皮抗黏附功能具有积极作用。（3）12周太极心康方案和常规运动康复方案干预，均能有效改善冠心病患者促炎因子和黏附分子，但相比常规运动康复方案，太极心康方案干预更有利于调控患者机体促炎与抗炎平衡，能显著降低患者黏附分子VCAM-1的表达，对改善冠心病患者机体抗黏附能力具有更积极的效果。

ABSTRACT 

Purpose: The purpose of this study was to investigate the effects of Tai Chi Cardiac Rehabilitation Programme on inflammatory factors and adhesion molecules in patients with coronary heart disease, and to compare it with conventional exercise rehabilitation program.  To clarify the unique role of Tai Chi Cardiac Rehabilitation Programme in low-grade chronic inflammatory response-the typical pathological feature of coronary heart disease, and provide scientific basis for the clinical benefits of Tai Chi Cardiac Rehabilitation Programme.

Method: (1) Subject recruitment: Subjects will be recruited at Anzhen Community Service Center, Chaoyang District, Beijing and Wanjie Rehabilitation Hospital, Zibo, Shandong. A total of 46 CHD patients aged 62.96±9.296 years were recruited from October 2020 to November 2021, including 32 males and 14 females, and random 1:1 ratio into experimental group (n=23) and control group (n=23). (2) Intervention program: The Tai Chi cardiac rehabilitation programme was used to intervene in the experimental group and the conventional exercise rehabilitation program was used to intervene the control group with. The intervention was performed 3 times per week for 60min each time for a total of 12 weeks, including 4 weeks of hospital rehabilitation and 8 weeks of home rehabilitation of remotely online. (3) Test indicators: Inflammatory factors and adhesion molecules were detected before and after intervention. SPSS21.0 software was used to process the experimental data, and Origin2021 software was used for mapping analysis.

Result: (1) Results of Tai Chi cardiac rehabilitation programme on inflammatory factors in patients with coronary heart disease: After the intervention, the pro-inflammatory factor C-reactive protein (CRP) and interleukin 6 (IL-6) were very significantly different(P< 0.01).The anti-inflammatory factor interleukin 10 (IL-10) is very significant different(P<0.01). The pro-inflammatory / anti-inflammatory factors CRP / IL-10 and IL-6 / IL-10 and TNF-α / IL-10 were significant. There was no significant difference in each index between Tai Chi cardiac rehabilitation programme and conventional exercise rehabilitation group (P>0.05).(2) Results of Tai Chi cardiac rehabilitation programme on Adhesion molecules in patients with coronary heart disease: After the intervention , vascular cell adhesion molecules (VCAM-1) and intercellular adhesion molecules (ICAM-1) were significantly decreased(P<0.01). There was no significant difference in all indexes between Tai Chi cardiac rehabilitation programme group and conventional exercise rehabilitation group before intervention (P>0.05), and the VCAM-1 of Tai Chi cardiac rehabilitation programme was significantly lower than that of conventional exercise rehabilitation group after intervention (P<0.05). (3) Correlation analysis of inflammatory factors and adhesion molecules in Tai Chi cardiac rehabilitation programme group: Pro-inflammatory factors CRP and IL-6 were positively correlated with ICAM-1 in Tai Chi cardiac rehabilitation programme, and the difference was significant P<0.05; The pro-inflammatory factor TNF-α was positively correlated with VCAM-1, and the difference was significant P<0.05. Pro-inflammatory/anti-inflammatory factors CRP/ IL-10, TNF-α /IL-10 were positively correlated with ICAM-1, and the difference was significant P<0.05. TNF-α /IL-10 was positively correlated with VCAM-1, and the difference was significant P<0.05.

Conclusion: (1) The 12-week Tai Chi cardiac rehabilitation programme intervention can effectively reduce the levels of pro-inflammatory factors CRP, IL-6, TNF-α and up-regulate the levels of anti-inflammatory factors IL-10 in patients with coronary heart disease, which has positive effects on improving the anti-inflammatory ability and regulating the balance between pro-inflammatory and anti-inflammatory in patients with coronary heart disease. (2) The 12-week Tai Chi cardiac rehabilitation programme intervention can effectively reduce the levels of adhesion molecules VCAM-1 and ICAM-1 in patients with coronary heart disease, and has a positive effect on improving the anti-adhesion function of vascular endothelial in patients with coronary heart disease. (3) The 12-week Tai Chi cardiac rehabilitation programme and conventional exercise rehabilitation intervention, can effectively improve coronary heart disease patients promote inflammatory factors and adhesion molecules, but compared with conventional exercise rehabilitation program, Tai Chi cardiac rehabilitation programme intervention is more conducive to regulate coronary heart disease body promote inflammatory and anti-inflammatory balance, can significantly reduce the adhesion molecule VCAM-1, to improve patients with coronary heart disease adhesion has a more positive effect.