L型钙通道阻滞药对冠心病患者运动康复前后钙磷代谢和骨密度的影响

关键词：钙通道阻断药  冠心病  骨代谢  运动心脏康复

Keywords:calcium channel blocker  coronary heart disease  bone metabolism  exercise-based cardiac rehabilitation

摘要：

      摘要 目的：探讨L型钙通道阻滞药对运动康复前后冠心病患者血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)和骨密度(BMD)的影响，为临床冠心病患者的安全用药提供参考依据。 方法：30例女性冠心病患者，根据是否服用L型钙通道阻滞药被分为服药组（13例）和未服药组（17例）。首先测定受试者的Ca、P、ALP和BMD，然后她们在跑台上进行递增负荷运动实验为制定运动处方提供依据。之后进行为期12周的运动康复训练，康复训练后再次测量上述各指标。 结果：①两组运动康复后均呈血钙增加、血磷降低，与运动康复前相比有显著性差异(P＜0.05)，碱性磷酸酶未服药组运动康复后呈显著升高(P＜0.05)；②运动康复后未服药组的血钙比服药组显著增高(P＜0.05)；③两组运动康复后双股骨和L2—L4的BMD、Z值与运动康复前比较均有增加趋势，但未达到显著性水平(P＞0.05)；④运动康复前后两组间双股骨和L2—L4的BMD、Z值无显著性差异(P＞0.05)。 结论：①12周的运动康复可以使血钙升高，钙通道阻滞药对运动引起的升钙作用有拮抗作用；②服用20周的L型钙通道阻滞药对冠心病患者的骨密度未见明显影响。

Abstract:

      Abstract Objective: To examine the effect of L-type calcium channel blockers management on serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and bone mineral density (BMD)， to provide an evidence based reference for safe medication management in coronary heart disease patients during rehabilitation. Method: Thirty female coronary heart disease patients were divided into blockade group（n=13， took L-type calcium channel blockers therapy) and non-blockade group（n=17， didn't take blockers）. The patients' calcium(Ca), posphorus(P), alkaline phosphatase(ALP) and bone mineral density(BMD) were measured. After that, they performed a graded exercise test on a motorized treadmill to obtain useful information for establishing exercise prescription. Then, the patients undertook a 12-week exercise based rehabilitation programme and were retested all the above-mentioned indices as pretraining at the end of the programme. Result: ① After the exercise rehabilitation, significant changes were observed, Ca increased and P decreased in both groups, and ALP increased in non-blockade group, compared with those pre training(P＜0.05); ②After exercise rehabilitation significant higher elevation Ca were observed in non-blockade group compared with the blockade group (P＜0.05); ③ There was an increasing tendency for BMD and Z value of dual femur and L2—L4 in both groups post exercise rehabilitation, but the differences did not reach statistical significant level compared with those pre-training(P>0.05); ④ There was no significant difference between the two groups in terms of BMD and Z value of dual femur and L2—L4 both pre and post exercise training (P＞0.05). Conclusion: ①Serum calcium level of patients increased through 12-week exercise rehabilitation, and the calcium channel blocker had antagonizing effect on the rising of calcium induced by exercise; ②The 20-week L-type calcium channel blockers management showed no side effect on BMD in patients with coronary heart disease.