心肌损伤标志物在新入伍战士运动性心脏损伤中的预警作用

Warning Effect of Serum Myocardial Damage Markers on Recruits of PLA with Exercise-induced Myocardial Damage

目的观察新入伍战士在负荷训练前后心肌损伤标志物水平的变化,探讨军事训练导致运动性心肌损伤的早期预警方法。方法随机选取某部新入伍战士100名,在高强度训练前及训练后4 h取静脉血,测定血清肌酸激酶(CK)、血清肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、血清肌钙蛋白I(cTnI)、N-末端脑钠肽(NT-pro BNP)。结果训练后cTnI、Mb、CK-MB/CK较训练前升高,CK较训练前降低(P<0.05,P<0.01)。NT-pro BNP和CK-MB训练前后比较差异无统计学意义(P>0.05)。cTnI与CK-MB/CK ROC曲线下面积与参考线下面积比较差异有统计学意义(P<0.05)。将cTnI分界点定在0.0025 ng/ml对心肌损伤诊断的灵敏度为59.4%,特异度为87.5%;CK-MB/CK分界点定在6.5%对心肌损伤诊断的灵敏度为63.0%,特异度为65.8%。训练后cTnI与CK-MB/CK之间无明显相关性(r=0.134,P>0.05)。结论 CK-MB/CK及cTnI增高反映了心肌早期损伤,对早期诊断心肌损伤具有较好的特异性,可以成为心肌早期损伤的预警指标。

Objective To observe the level changes of myocardial damage markers of recruits before and after the high intensity training, and to investigate early warning methods for the myocardial damage induced by military trainings in recruits. Methods A total of 100 recruits were randomly selected in one PLA unit, and the levels of serum creatine kinase （CK）, MB isoeuzyme of creatine kinase （CK-MB）, myoglobin （Mb）, cardiac troponin I （cTnI） and N-terminal brain natriuretic peptide （NT-proBNP） of the recruits were detected before and 4 h after the high intensity by training by taking the venous blood. Results After the training, the cTnI, Mb and CK-MB/CK levels were significantly higher, while CK level was significantly lower than those before the training （P 〈 0.05, P 〈 0. 01）. There were no sig- nificant differences in NT-proBNP and CK-MB levels before and after the training （P 〉 0. 05）. There were significant differences between values of area under the receiver operating curve （ROC） and area under the reference line of cTnI and CK-MB/CK （P 〈 0.05）. When the cut-off value of cTnI was set at 0. 0025 ng/ml, the sensitivity was 59.4% , and the specificity was 87.5% in diagnosis of myocardial damage; when the cut-off value of CK-MB/CK was set at 6.5% , the sensitivity was 63% , and the specificity rate was 65.8% in diagnosis of myocardial damage. There was no significant correlation between cTnI and CK-MB/CK after the training （r = 0. 134, P 〉 0. 05）. Conclusion The increasing values of CK-MB/CK and cTnI reflect early myocardial damage. It has good specificity in early diagnosis of myocardial damage, and can be used as an early warning indicator of myocardial damage.