马拉松运动对心脏的影响:生理适应和潜在风险

Effects of Marathon on the Heart:Physiological Adaptation and Potential Risks

马拉松作为持续时间较长、强度较高的耐力运动,对心脏的影响是利大还是弊多,对马拉松参赛选手心脏产生哪些生理适应,又对心脏健康存在哪些潜在风险,经常困扰着运动医学研究者和马拉松参赛者。依据目前的国内外研究,全面综述分析了马拉松对心脏各腔室以及冠状动脉结构和功能的影响,深入探讨了马拉松与心肌损伤标志物、心律失常、心肌纤维化和心脏猝死之间的关系。研究结果:1)马拉松会引起心脏发生离心性肥大,心房和心室腔体积均会增大,提升心脏功能。一次马拉松运动后,心房和左右心室收缩与舒张功能均出现了短暂性的下降,舒张功能下降更明显,这是心脏的一种生理适应,数周内可恢复至正常水平;2)尽管马拉松与冠状动脉风险之间的关系仍存在争议,但与同龄和相同心血管风险因素的对照人群相比,马拉松运动员仍具有较低的冠状动脉斑块形成风险;3)马拉松诱导的循环心肌损伤标志物的升高是可逆的,是对剧烈运动的一种暂时生理性应激反应;4)马拉松运动猝死的风险较低,多数马拉松猝死的发生和参赛者遗传的显性或隐性心脏疾病有关。为预防赛场心血管意外,应该建立马拉松赛场心血管意外的预防体系,包括赛前心血管风险评估和筛查程序、增加并合理布置赛中救助力量。

Marathon is a long-lasting,high-intensity endurance exercise.The impact,physiological adaption and potential risks which marathon has to participants have been concerned by the sports medicine researchers and marathon runners.Based on the current domestic and foreign studies,this paper comprehensively summarizes and analyzes the effects of marathon on the structure and function of the heart chambers and coronary arteries,and discusses the relations between marathon and myocardial damage markers,arrhythmia,myocardial fibrosis and sudden cardiac death.Results:1)Marathon will cause centrifugal hypertrophy.The atrium and ventricular cavity volume will increase,which improves the heart function.After a marathon,both the atrium and left and right ventricular contraction and diastolic function show a brief decline,especially in diastolic function,which is a physiological adaptation of the heart.It can be restored to normal levels in the next few weeks;2)although the relations between marathon and coronary artery risk remain controversial,marathon runners still have a lower risk of coronary artery plaque formation than those of the same age and the same cardiovascular risk factors;3)the rise of the mark of myocardial injury in the marathon-induced cycle is reversible,and it is a temporary physiological stress response to vigorous exercise;4)the risk of sudden death in marathons is low,and the occurrence of most marathon sudden death is associated with the genetic explicit or recessive heart disease of the participants.In order to prevent cardiovascular accidents in the field,a prevention system for cardiovascular accidents in the marathon field should be established,including pre-race cardiovascular risk assessment and screening procedures,and the addition and reasonable allocation of the strength of the race.