运动负荷试验对他汀类药物相关性肌病的预测

Forecasting study of treadmill stress test in statin - related myopathy

目的研究运动负荷试验对他汀类药物相关性肌病的预测作用,并探索热休克蛋白家族是否与该病发生相关。方法选取他汀药物口服适应证患者57例,签订知情同意书。运动负荷试验标准:参试者在一定条件下(心率达到最大心率的65%±5%),进行3次踏车运动,每次持续15 min,每两次运动之间休息10 min。所有参试者在未口服他汀类降脂药物及服药5 d后的运动前后以及服药10 d后分别采血,所有步骤均在清晨空腹完成。检测患者肝功能、血脂、CK、HSP25、HSP70及Cry-αB血清水平。随访服药6个月内出现不能归因于其他疾病的肌肉易疲劳、肌痛、CK升高等症状者纳入他汀类药物相关性肌病组,否则为非肌病组。使用SPSS 16.0分析肌病组与非肌病组之间数据相关性。结果肌病组服药5 d运动后的CK值比未服药运动前的CK值升高(46.08±5.61)U/L,非肌病组升高(14.98±2.44)U/L,差异具有统计学意义(P<0.05);肌病组服药5 d运动后的HSP70水平较未服药运动前升高(0.16±0.04)ng/ml,非肌病组升高(0.02±0.03)ng/ml,差异具有统计学意义(P<0.05);两组间HSP25、Cry-αB在服药前后及运动前后均无明显变化(P>0.05)。结论运动负荷试验对他汀类药物相关性肌病的发生有一定的预测作用,HSP70可能与他汀类药物相关性肌病的发生有关。

Objective To investigate the predictive function of treadmill stress test in statin - related myopathy （ SRM）, and to study whether the heat shock protein family would be the predictive factors for SRM. Methods Fifty - seven patients who were eligible for statins signed informed consents. The treadmill stress test was done as follows： patients treaded at a certain condition （reach 65% ±5% of their maximum heart rate） for three 15 -minnte periods with 10 minutes of rest between exercise bouts. Before, 5 days and 10 clays after statin administration, blood sampling was done before and immediately after treadmill stress test. All the procedures were performed fasting in the morning. Then the serum levels of liver function, lipids, CK, HSP25, HSP70 and Cry - ctB in the blood sam- ples were tested. All the patients were followed up for 6 months. Patients who had the symptoms that could not be explained by other causes were divided into the SRM group, while the rest into the non - SRM group. The correlation between SRM group and non - SRM group was analysed with SPSS 16.0. Results Compared with CK before treadmill stress test without statin administration, CK after treadmill stress test with statin administration for 5 days CK increased by （46.08±5.61 ） U/L in SRM group, which was much higher than that in non- SRM group （14.98±2.44） U/L, with significant difference （P 〈 0.05 ）. HSP70, after treadmill stress test with statin administration for 5 days increased by （0.16 ±0.04） ng/ml, compared with that before treadmill stress test without statin ad- ministration in SRM group, while it only increased by （0.02±0.03 ） ng/ml in non - SRM group, and the difference between the two groups was significant（ P 〈 0.05 ）. However, the changes in HSP 25 and Cry - αB at different time points between the two groups were not significantly diffcrent（ P 〉 0.05 ）. Conclusions The treadmill stress test may predict the statin - related myopathy to some extent, and HSP 70 may be associated with SRM.