Kałka Dariusz, Sobieszczańska Małgorzata, Kopka Lech, Marciniak Wojciech, Zawadzka-Bartczak Eliza, Bak Arystofanes, Popielewicz-Kautz Aleksandra, Korzeniowska Jolanta, Janczak Jacek, Adamus Jerzy
Centrum Medycyny i Rehabilitacji "Medar" we Wroclawiu, Dział Rehabilitacji Kardiologicznej.
Pol Merkur Lekarski. 2007 Feb;22(128):101-6.
Dyslipidemia worsens a prognosis in patients with chronic heart ischemic disease, who underwent myocardial infarction. Therefore, new methods, besides drugs, are being sought, for optimizing a serum concentration of lipid fractions.
An effect of 6-month of ambulatory long-term cardiac rehabilitation on the lipidogram fractions concentration in patients with chronic heart ischemic disease treated with simvastatin, as well as a correlation between lipids changes and cardiac training intensity was assessed.
Rehabilitation was performed in 66 patients with previous myocardial infarction treated invasively (27 CABG and 39 PTCA), who constituted group I. A control group (group II) consisted of 32 patients with previous myocardial infarction also treated invasively (24 CABG and 8 PTCA), but not subjected to rehabilitation. The two analyzed groups did not differ significantly from each other as to age, applied drug regimen, current clinical status, echocardiographic parameters and BMI values. Group I was subjected to 6-month cardiac rehabilitation program, comprising 45-minute training on cycle ergometer (three times per week) and generally improving exercises (2 times per week). Blood concentration of lipidogram fractions was assessed: total cholesterol (TC), HDL- and LDL-cholesterol, and triglicerides (TG) at the onset and upon completion of the rehabilitation cycle.
The both patient groups were comparable concerning the initial concentration of the lipid fractions. After finishing the rehabilitation program, in the group I, a statistically significant reduction of TC, LDL and TG concentration was found out. In addition, a significant increase of HDL concentration was noted. In contrary, in the group II (without rehabilitation), the only significant change concerned a concentration of HDL fraction, which decreased. Furthermore, in the group I, it was noted a negative, statistically significant correlation between intensity of cardiac training, expressed by training workload and delta of work, and a difference in blood concentration of triglicerides, measured just before the training onset and after the program was finished.
It was revealed that long-term ambulatory cardiac rehabilitation has a profitable effect on serum concentration of the all lipid fractions in patients with chronic heart ischemic disease cured with simvastatin, regardless of training intensity. It was also ascertained that an extent of changes in triglicerides serum concentration was related to an intensity of the cardiac training applied to the patients.
血脂异常会使经历过心肌梗死的慢性心脏缺血性疾病患者的预后恶化。因此，除了药物之外，人们正在寻找优化血脂成分血清浓度的新方法。
评估为期6个月的门诊长期心脏康复对接受辛伐他汀治疗的慢性心脏缺血性疾病患者血脂谱成分浓度的影响，以及血脂变化与心脏训练强度之间的相关性。
对66例曾接受侵入性治疗（27例行冠状动脉旁路移植术和39例行经皮冠状动脉腔内血管成形术）的心肌梗死患者进行康复治疗，这些患者构成第一组。对照组（第二组）由32例同样接受侵入性治疗（24例行冠状动脉旁路移植术和8例行经皮冠状动脉腔内血管成形术）但未接受康复治疗的心肌梗死患者组成。两个分析组在年龄、应用的药物治疗方案、当前临床状况、超声心动图参数和体重指数值方面彼此无显著差异。第一组接受为期6个月的心脏康复计划，包括在自行车测力计上进行45分钟训练（每周三次）和一般的改善运动（每周两次）。在康复周期开始时和结束时评估血脂谱成分的血液浓度：总胆固醇（TC）、高密度脂蛋白和低密度脂蛋白胆固醇以及甘油三酯（TG）。
两组患者在血脂成分的初始浓度方面具有可比性。完成康复计划后，在第一组中，发现TC、LDL和TG浓度有统计学意义的降低。此外，还注意到HDL浓度显著增加。相反，在第二组（未接受康复治疗）中，唯一显著的变化涉及HDL成分的浓度，其降低了。此外，在第一组中，注意到以训练工作量和工作量增量表示的心脏训练强度与训练开始前和计划完成后测量的甘油三酯血液浓度差异之间存在负的、统计学意义的相关性。
结果显示，长期门诊心脏康复对接受辛伐他汀治疗的慢性心脏缺血性疾病患者的所有血脂成分血清浓度有有益影响，且与训练强度无关。还确定甘油三酯血清浓度的变化程度与应用于患者的心脏训练强度有关。
