筛选高强度军事训练致急性肾损伤高危人群的临床研究

Clinical research on screening high risk groups of high intensive military training induced acute kidney injury

目的筛选高危人群并早期干预是防治急性肾损伤的重要手段,探讨未参加过训练、训练前未培训、不良心理情绪(紧张、焦虑)、平时体育活动频率少(<3次/周)这4个危险因素能否筛选高强度军事训练致急性肾损伤的高危人群。方法根据问卷调查结果将参加武装越野5 km的战士分为无危险因素组(组1)、1个危险因素组(组2)、2个危险因素组(组3)、3个危险因素组(组4)、4个危险因素组(组5),分别留取训练后6、24 h的尿标本,比较尿蛋白、尿潜血、尿微量白蛋白(m ALB)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)等肾损伤指标。结果随着危险因素的增加,各组训练后6 h尿蛋白阳性的发生率增加(2=101.8,P<0.001),训练后6 h的m ALB、NAG水平明显升高(F=133.3,P<0.001;F=67.71,P<0.001)。对中高危组(3、4、5组)的分析提示训练后24 h尿m ALB、NAG水平亦随着危险因素增加而增加,以组5的均值最高。结论未参加过训练、训练前未培训、不良心理情绪(紧张、焦虑)、平时体育活动频率少(<3次/周)是发生肾损伤的独立危险因素,可用于筛选高强度军事训练致急性肾损伤高危人群。

Objective No related training experience,no systematic training before military training,psychological negative emotions（ tension and anxiety） and low frequency of physical activities（ less than three times a week） have been considered as crucial risk factors of high intensive military training induced acute kidney injury. This paper aims to discuss whether these risk factors can be used for screening high risk groups. Methods Soldiers were divided into 5 groups based on the questionnaire survey： Group1 had no risk factor,Group2 had 1 risk factor,Group3 had 2 risk factors,Group4 had 3risk factors,and Group5 had 4 risk factors. Urine samples were collected after 6 h and 24 h of 5 km armed military training. Kidney injury indicators were compared such as urine protein,urine occult blood test,urine micro-albumin（ m ALB）,urine N-acetyl-β-D-glucosaminidase（ NAG） among different groups. Results As the risk factors increased,the incidence of positive urinary protein 6 h after training increased（ 2= 101. 8,P 0. 001）,and the levels of m ALB and NAG of urine samples were elevated as well. The analysis among moderate and high risk groups（ Group3- 5） showed that the levels of m ALB and NAG of urine samples 24 h after training increased with the number of risk factors. The mean value of these injury indicators reached to the maximum in Group 5. Conclusion No related training experience,no systematic training before military training,psychological negative emotions（ tension and anxiety） and low frequency of physical activities（ less than three times a week） are independent risk factors of high intensive military training induced acute kidney injury,which can be used for screening high risk individuals during training.