某战区作训人员力竭性心脏损伤的临床研究

The clinical study of exhaustive heart damage in a military region for training staff

目的研究力竭性运动致心脏损伤的发病情况及临床特点，发现敏感性和特异性较高的检测指标，对其临床分型、诊断标准进行初步探讨。方法对某战区6家总医院及中心部队医院2000年1月至2010年12月因力竭性运动入住心内科的88例作训人员资料进行分析，观察心肌酶、心电图、心脏超声等相关检查指标，记录治疗前后症状、体征及相关检查指标的变化。结果力竭性运动可引起胸闷、心悸、胸痛、头晕、气短、乏力、晕厥等症状，心脏听诊异常；治疗后天冬氨酸转氨酶〔AST（U/L）：20.34±6.33比35.43±25.25〕、α-羟丁酸脱氢酶〔α-HBDH（U/L）：130.47±9.04比168.93±62.69〕、乳酸脱氢酶〔LDH（μmol？s-1？L-1）：2.48±0.62比3.58±1.34〕、肌酸激酶〔CK（U/L）：125.58±67.56比556.42±381.89〕、肌酸激酶同工酶〔CK-MB（U/L）：11.20±4.08比23.09±15.61〕均较治疗前明显降低（P＜0.05或P＜0.01）；5例患者检测了心肌肌钙蛋白T （cTnT），治疗后较治疗前明显降低（μg/L：0.07±0.05比1.26±0.78，P＜0.05）。心电图异常主要表现为窦性心动过缓（16例）、窦性心律不齐（13例）、室性期前收缩（早搏，11例）。心脏超声发现异常者18例，主要表现为瓣膜反流、心功能减低、心脏增大等，其中以瓣膜反流最为常见，均为少量反流。根据临床表现和检查结果，将力竭性心脏损伤初步分为普通型（20例）、心律失常型（56例）、心力衰竭型（2例）、猝死型（10例）。结论力竭性心脏损伤可以表现为不同临床类型，心肌酶、心电图及心脏超声的异常变化是其有力的证据，对其防治应当引起重视。

Objective To investigate the incidence and clinical characteristics and look for assay or examination indexes or indicators with higher sensitivity and specificity of heart damage induced by exhaustive exercise in order to establish its preliminary clinical classification and diagnostic criteria. Methods In a military region for training staff,the clinical data of 88 soldiers who were admitted to the departments of cardiology in 6 general or central hospitals because of exhaustive exercise from January 2000 to December 2010 were analyzed. The myocardial enzyme, electrocardiogram（ECG）,echocardiography and other related examination indexes or indicators were observed,and the changes of symptoms,signs and other relevant assay and examination indexes before and after treatment were recorded. Results Exhaustive exercise could cause the symptoms such as chest tightness,palpitations,chest pain, dizziness,shortness of breath,fatigue,syncope and other symptoms,as well as cardiac auscultation abnormalities. After treatment, aspartate aminotransferase〔AST（U/L）：20.34±6.33 vs. 35.43±25.25〕,α-hydroxybutyrate dehydrogenase〔α-HBDH（U/L）：130.47±9.04 vs. 168.93±62.69〕,lactate dehydrogenase〔LDH（μmol？s-1？L-1）：2.48±0.62 vs. 3.58±1.34〕,creatine kinase〔CK（U/L）：125.58±67.56 vs. 556.42±381.89〕,creatine kinase isoenzyme〔CK-MB（U/L）：11.20±4.08 vs. 23.09±15.61〕were significantly lower than those before treatment（P〈0.05 or P〈0.01）;cardiac troponin T（cTnT）was detected in 5 patients,its level after treatment was significantly lower than that before treatment（μg/L：0.07±0.05 vs. 1.26±0.78,P〈0.05）. The ECG abnormalities included primarily sinus bradycardia （16 cases）,sinus arrhythmia （13 cases） and premature ventricular contractions （11 cases）. Echocardiographic abnormalities appeared in 18 cases,they were chiefly as follows：valvular regurgitation, cardiac dysfunction,cardiac enlargement,etc,among which the most common one was valvular regurgitation（all the refluxes were of small amount）. Based on the above clinical manifestations and examination results,the exhaustive cardiac injuries were preliminarily divided into common type（20 cases）,arrhythmia type（56 cases）,heart failure type（2 cases）and sudden death（10 cases）. Conclusions The clinical manifestations of exhaustive heart damage may appear in different types. Abnormal changes of myocardial enzymes,ECG and echocardiography are the strong evidences for the damage. Clinicians should pay attention to its prevention and treatment.