CAJ | 학술논문

目的：探讨盐酸曲美他嗪对心血管病高危战士军事训练前后应激反应、血管内皮功能和心肌损伤的影响。方法选取某集团军战士960名，采用问卷调查、物理查体和心电图综合调查的方法，筛选出高危人群，将高危人群随机分为盐酸曲美他嗪组和对照组，另选取低危组中年龄相当者作为低危对照组。曲美他嗪组在运动前7 d予盐酸曲美他嗪（20 mg，3次/d，口服），低危对照组和高危对照组不予药物。比较三组运动前后心率、血压和心电图变化以及血浆中肾上腺素、超敏C反应蛋白、一氧化氮和心型脂肪酸结合蛋白浓度的变化。结果三组运动前心率、血压和各项生化指标相似，运动后三组各项指标均不同程度升高。运动后曲美他嗪组较高危对照组心率血压积[（11209.8±154.7）mm Hg?次/min vs.（11514.9±180.4） mm Hg?次/min，P＜0.05]，血浆中肾上腺素[（106.3±10.7）ng/L vs.(111.1±10.3) ng/L，P＜0.05]、超敏C反应蛋白[（30.3±6.5）μg/L vs.（33.9±5.8）μg/L，P＜0.05]和心型脂肪酸结合蛋白[（648.8±60.9）pg/ml vs.(659.1±67.2) pg/ml，P＜0.05]浓度显著降低，同时一氧化氮浓度[（112.7±11.4）μmol/L vs.（108.3±9.7）μmol/L， P＜0.05]显著升高。结论酸曲美他嗪可显著减少心血管病高危患者军事训练后的应激反应，改善血管内皮功能，从而理论上可减少急性心血管病事件乃至心源性猝死的发生。
목적：탐토염산곡미타진대심혈관병고위전사군사훈련전후응격반응、혈관내피공능화심기손상적영향。방법선취모집단군전사960명，채용문권조사、물리사체화심전도종합조사적방법，사선출고위인군，장고위인군수궤분위염산곡미타진조화대조조，령선취저위조중년령상당자작위저위대조조。곡미타진조재운동전7 d여염산곡미타진（20 mg，3차/d，구복），저위대조조화고위대조조불여약물。비교삼조운동전후심솔、혈압화심전도변화이급혈장중신상선소、초민C반응단백、일양화담화심형지방산결합단백농도적변화。결과삼조운동전심솔、혈압화각항생화지표상사，운동후삼조각항지표균불동정도승고。운동후곡미타진조교고위대조조심솔혈압적[（11209.8±154.7）mm Hg?차/min vs.（11514.9±180.4） mm Hg?차/min，P＜0.05]，혈장중신상선소[（106.3±10.7）ng/L vs.(111.1±10.3) ng/L，P＜0.05]、초민C반응단백[（30.3±6.5）μg/L vs.（33.9±5.8）μg/L，P＜0.05]화심형지방산결합단백[（648.8±60.9）pg/ml vs.(659.1±67.2) pg/ml，P＜0.05]농도현저강저，동시일양화담농도[（112.7±11.4）μmol/L vs.（108.3±9.7）μmol/L， P＜0.05]현저승고。결론산곡미타진가현저감소심혈관병고위환자군사훈련후적응격반응，개선혈관내피공능，종이이론상가감소급성심혈관병사건내지심원성졸사적발생。
Objective To investigate the effect of trimetazidine hydrochloride on myocardial injury and endothelial function in high risk populations of cardiovascular disease after military training exercise. Methods In 960 soldiers, using a questionnaire survey (including family history of heart disease, past history, heart disease risk factors and symptoms after exercise), physical examination and electrocardiogram, we selected high-risk populations. High risk groups were randomly divided into trimetazidine group and high risk control group, and the same numbers of solders with equivalent age in low risk were selected as low risk control group. Trimetazidine group were given trimetazidine before exercise 7 days (20 mg, 3 times daily, orally), low risk control group and high risk control group were not given drug. Comparison of heart rate, blood pressure and ECG changes, and plasma epinephrine, nitric oxide and heart-type fatty acid binding protein concentration changes were done between three groups before and after exercise. Results There were no difference between three groups before exercise in heart rate, blood pressure and all kinds of biochemical indices. The indicators of the three groups were increased in different degree after exercise. So heart rate and blood pressure product[(11 209.8±154.7) mm Hg·bpm vs. (11 514.9±180.4) mm Hg·bpm, P<0.05], Plasma concentrations of epinephrine[(106.3±10.7)ng/L vs. (111.1±10.3)ng/L, P < 0.05], concentration of high sensitivity C reactive protein[(30.3±6.5)μg/L vs. (33.9±5.8)μg/L, P<0.05] and concentration of heart-type fatty acid binding protein[(648.8±60.9)pg/ml vs. (659.1±67.2)pg/ml, P<0.05] in Trimetazidine hydrochloride group were all significantly lower than those in high risk control group, and concentration of nitric oxide [(112.7±11.4)μmol/L vs.(108.3±9.7)μmol/L, P<0.05] was higher than that in high risk control group. Conclusion Trimetazidine hydrochloride can significantly reduce stress response, improve endothelial function of solders with high risk of cardiovascular disease, so it can theoretically reduce acute cardiovascular events and even cardiogenic sudden death in military training populations.