Ghroubi S, Chaari M, Elleuch H, Massmoudi K, Abdenadher M, Trabelssi I, Akrout M, Feki H, Frikha I, Dammak J, Kammoun S, Zouari N, Elleuch M H
Service de médecine physique et de rééducation fonctionnelle, CHU Habib-Bourguiba, Sfax, Tunisie.
Ann Readapt Med Phys. 2007 Jun;50(5):295-301; 287-94. doi: 10.1016/j.annrmp.2007.03.012. Epub 2007 Mar 30.
We aimed to determine whether diminished cardiorespiratory capacity in patients with coronary artery disease (CAD) is accompanied by impaired skeletal muscle function as measured by isokinetic dynamometry. We also evaluated the correlation between isokinetic strength and aerobic capacity in these patients.
Fifteen CAD patients and 15 age-matched healthy subjects (mean age 60+/-6 vs. 57+/-3.5 years) underwent maximal laboratory exercise testing, a 6-min walking test and an assessment of peripheral skeletal muscle function by use of an isokinetic apparatus. Quadricep and hamstring function was tested at two angular velocities, 150 and 180 degrees s(-1) with simultaneous electrocardiography monitoring. The cardiorespiratory and mechanical parameters (VO(2), ventilatory threshold [VT], heart rate [HR], and power) were measured at VT and at maximal effort.
Quadricep and hamstring peak torque was impaired in CAD patients, with quadriceps peak torque at 180 degrees being 71.13 +/- 14 vs. 91.13 +/- 23 Nm (P<0.01) and hamstring peak torque 46.50+/-10 vs. 59.86+/-12 Nm (P<0.01). CAD subjects presented a deficient aerobic capacity as compared with the healthy subjects at maximal effort. At VT, the VO(2), ventilation, and HR were significantly lower in CAD patients, at 13.77+/-2.33 vs. 17.08+/-3.59 ml min(-1) kg(-1) (P<0.05), 29.64 +/- 664 vs. 37.76 +/- 7.2 ml min(-1) (P<0.05), and 86+/-14 vs. 111+/-15 beats min(-1) (P=0.001), respectively. The 6-min walking distance was significantly shorter for CAD patients than healthy subjects (425.93+/-52.77 vs. 551.46 +/- 57.94 m; P<0.01). In CAD patients quadriceps and hamstring strength was not correlated with VO(2) at maximal effort and at VT. Total distance walked during the 6-min walk and VO(2)max were correlated (r=0.869; P<0.001) but not at VT.
CAD patients showed impaired cardiorespiratory capacity accompanied by increased muscle fatigability as compared with healthy subjects. An isokinetic muscle assessment in these patients must be achieved systematically and seems to have value in cardiovascular rehabilitation.
我们旨在确定冠心病（CAD）患者心肺功能下降是否伴有等速肌力测试所测量的骨骼肌功能受损。我们还评估了这些患者等速肌力与有氧运动能力之间的相关性。
15例CAD患者和15例年龄匹配的健康受试者（平均年龄分别为60±6岁和57±3.5岁）接受了最大实验室运动测试、6分钟步行测试以及使用等速装置评估外周骨骼肌功能。在150和180度每秒（s⁻¹）两个角速度下测试股四头肌和腘绳肌功能，同时进行心电图监测。在通气阈值（VT）和最大努力时测量心肺和力学参数（VO₂、通气阈值[VT]、心率[HR]和功率）。
CAD患者股四头肌和腘绳肌的峰值扭矩受损，股四头肌在180度时的峰值扭矩为71.13±14牛米，而健康受试者为91.13±23牛米（P<0.01）；腘绳肌峰值扭矩为46.50±10牛米，而健康受试者为59.86±12牛米（P<0.01）。与健康受试者相比，CAD受试者在最大努力时的有氧运动能力不足。在VT时，CAD患者的VO₂、通气量和心率显著降低，分别为13.77±2.33对17.08±3.59毫升每分钟每千克（ml min⁻¹ kg⁻¹）（P<0.05）、29.64±6.64对37.76±7.2毫升每分钟（ml min⁻¹）（P<0.05）以及86±14对111±15次每分钟（beats min⁻¹）（P = 0.001）。CAD患者的6分钟步行距离明显短于健康受试者（425.93±52.77对551.46±57.94米；P<0.01）。在CAD患者中，股四头肌和腘绳肌力量在最大努力和VT时与VO₂均无相关性。6分钟步行期间的总步行距离与VO₂max相关（r = 0.869；P<0.001），但与VT时无关。
与健康受试者相比，CAD患者表现出心肺功能受损且肌肉疲劳性增加。对这些患者进行等速肌肉评估必须系统地进行，并且在心血管康复中似乎具有价值。
