运动猝死研究:基于德国全国数据

Data from a Nationwide Registry on Sports-related Sudden Cardiac Deaths in Germany

(1)背景:与运动有关的心源性猝死(猝死大致分三类,心源性、脑源性和其它,这里一般指心源性运动猝死。下同),不仅经常发生在高水平运动员身上,还频见于非高水平体育竞赛参与者群体。2012年5月,本研究在德国开展,通过对全国范围内运动猝死事件的调查,来分析其主要诱因。(2)方法:采用前瞻性研究,通过网络平台搜集、记录并分析案例,并辅以15家法医机构和媒体监测到的案例作为补充。在本研究中,运动相关心源性猝死被界定为:在参与体育运动期间或停止后1小时内出现的死亡(无论复苏成功与否)。研究对象包括不同级别赛事中不同水平的运动员,以及日常体育锻炼参与者。(3)结果:经过30个月的观察,本研究搜集并分析了144个运动猝死样本(平均年龄46.816.2岁)。研究发现,德国运动猝死的总体发病率为每年每百万人1.2至1.5例,其中97%为男性。大多数猝死出现在非高水平体育比赛赛场。足球和跑步是事故发生最多的体育项目。年龄在三十五岁及以下的所有猝死案例中,心肌炎是最常见诱因。年龄在三十五岁以上的的体育参与者猝死中,冠状动脉疾病是主要诱因,也有少量心肌病导致的运动猝死被发现。(4)结论:在德国,运动猝死最大的比例出现于"参与非高水平体育比赛或进行日常体育锻炼的中年男性"群体。欧洲各国运动猝死的主要诱因有所不同。本研究揭示了对参与者进行心脏筛查的重要性。尤其是在非高水平体育竞赛项目开赛之前,应筛查并确认青少年参与者是否患有心肌炎。

Background：Prospective national registries examining the incidence and aetiology of sports-related sudden cardiac death（SrSCD）not only in competitive athletes but also in recreational sports participants are uncommon.In May 2012,aprospective registry on SrSCD was installed to examine the incidence and particularly the aetiology of such events in the general population in Germany.Methods：The registry consists of a web-based platform to record SrSCD cases.Media-monitoring and cooperation with 15 institutes of forensic medicine complemented the search.SrSCD was defined as death occurring during sports activity or up to 1hour after its cessation,regardless of successful resuscitation.We included subjects at all levels of competition as well as recreational athletes.Results：After 30 months of observation,144 SrSCDs were recorded（mean age 46.816.2years）.The overall incidence was1.2-1.5/million/year,with 97% being male.Most of the cases occurred in the context of non-elite competitive or recreational sports.Football and running were the most common disciplines.In subjects 35 years,myocarditis prevailed,whereas in athletes 35 years,CAD predominated by far.Few cardiomyopathies were observed.Conclusions：In Germany,the largest proportion of SrSCDs occurs in middle-aged men during recreational sports or non-elite competitive sports.The distribution of cardiac diseases responsi-ble for SrSCD seems to vary among European countries.Our findings may indicate the need for a larger focus on myocarditis prevention in the young as well as widening the screening scope to younger athletes below the‘elite＇level and to senior athletes.