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급성관상동맥 증후군(ACS) 환자에서 유산소운동과 스타틴 약물이 혈중지질과 hsCRP에 미치는 영향

The Effects of Aerobic Exercise and Statin Therapy on Blood Lipids and hsCRP in Patients with Acute Coronary Syndrome

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본 연구는 급성관상동맥증후군(Acute coronary syndrome; ACS) 환자에 대한 유산소운동과 스타틴약물 요법이 혈중지질과 hsCRP에 미치는 영향을 알아보고자 시행되었다. 연구대상자는 관상동맥증후군으로 입원하여 약물처방 및 경피적 관상동맥 중재술(Percutaneous coronary intervention; PCI)을 받고 운동 프로그램에 의뢰된 환자들로서, 실험군은 스타틴요법과 운동요법을 병행한 병행요법군(n=15)과 운동요법만 시행한 운동요법군(n=14) 그리고 스타틴요법만 시행한 약물요법군(n=8)으로 구성되었다. 실험기간은 병원 내에서 감독 하에 실시한 유산소운동 기간 6주와 자가운동 기간 8주의 총 14주 이었으며 실험기간 동안 지속적인 위험인자 관리 및 운동에 대한 상담을 실시하였다. 실험 전후에 혈중지질(TC, TG, LDL-C, HDL-C) 및 high-sensitivity C-reactive protein(CRP)과 그 밖에 체질량지수(body mass index, BMI), 최대산소섭취량(VO2max) 변화를 확인하기 위하여 연구대상자들에게 실험기간 전후에 각각 채혈, 인체계측, 운동부하검사를 실시하였다. 연구결과 얻어진 자료는 윈도우용 SPSS/PC+version 11.0 통계패키지를 이용하여 처리하였다. 염증반응 지표인 hsCRP를 포함한 혈중지질, BMI, VO2max 변인들의 기간별 집단별 차이를 알아보고자 반복측정에 의한 이원배치 분산분석을 실시하였고, 사후검증으로 t-test와 Bonferroni's 검정을 적용하였다. 연구 결과는 다음과 같다. 실험 전후에 있어서, 병행요법군에서 HDL-C, hsCRP 수치가 유의하게 증가(p<.05), 감소(p<.01)되었고, VO2max 또한 유의하게 향상되었다(p<.01). 운동요법군에서도 HDL-C 수치가 유의하게 증가되었으며(p<.05), VO2max가 유의하게 향상되었으나(p<.05), 약물요법군에서는 혈중지질을 비롯해 hsCRP, BMI, VO2max 모두에서 의미 있는 차이가 나타나지 않았다. 이상의 결과로 보아, 운동요법과 스타틴요법의 병행요법이 향후 심혈관 질환자의 재발 방지에 긍정적인 효과가 있을 것으로 사료된다.

Abstract

This study was designed to evaluate the effect of aerobic exercise and statin therapy on blood lipids and high-sensitivity C-reactive protein (hsCRP) in patients who had undergone successful percutaneous coronary intervention (PCI). Thirty seven male and female patients were studied. All subjects consist of three groups; 1) treated with statin and exercise (SE, n=15), 2) treated only with exercise (EO, n=14), 3) treated only with statin (SO, n=8). All patients were received medication once daily (aspirin and clopidogrel with or without statin) and completely performed supervised aerobic exercise for 6 weeks and home exercise program for 8 weeks. Instruction for diet and exercise was given continuously during experiment. Laboratory measurement includes serum lipids (TC, TG, HDL-C, LDL-C), hsCRP and body mass index (BMI). Cardiopulmonary capacity (VO2max) was assessed by symptom-limited exercise test. All measurements were performed at baseline and after 14 weeks. The results were as follows. In SE, HDL-C (p<.05) and VO2max (p<.01) were significantly improved, and hsCRP (p<.01) was significantly deceased after therapy. And also, HDL-C (p<.05) and VO2max (p<.05) in EO were significantly improved. But there was no alteration of blood lipids, hsCRP, BMI and VO2max in SO. These findings suggested that combination of exercise and statin therapy was the best rehabilitation in patients treated PCI.

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