急进高原和高原习服两种状态对心肌损伤指标的影响

The influence of two states of rapid entry to altitude and altitude acclimatization on myocardial injury index

目的探讨男性官兵急进高原和高原习服后两种暴露状态下心肌损伤指标的变化情况,为高原心肌损伤的研究提供依据。方法将急进高原(海拔4300 m)和高原习服后(海拔4300 m)的新疆某部队57名官兵纳入到试验组,同时将世居平原(海拔43 m)的42名官兵纳入到对照组,利用化学发光和免疫比浊法检测试验组和对照组心肌损伤指标:肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、超敏心肌肌钙蛋白I(hs-cTnI)、C反应蛋白(CRP)和超敏C反应蛋白(hs-CRP)的变化情况。结果人们急进高原状态时血液中CK、CK-MB、MYO、hs-cTnI、CRP和hs-CRP的中位数分别为:168.20 ng/L、1.20 ng/L、39.80 ng/L、1.00 pg/L、0.70 mg/L和0.75 mg/L;高原习服状态分别为:135.70 ng/L、0.90 ng/L、38.80 ng/L、1.00 pg/L、0.50 mg/L和0.40 mg/L,二者的CK、CK-MB和hs-CRP具有显著统计学差异(P<0.01)。与平原对照组相比较,急进状态下的各指标均具有显著统计学差异(P<0.01);而习服状态下的CK、CK-MB、MYO和hs-cTnI具有显著统计学差异(P<0.01)。结论当机体急性暴露于高原环境导致其心肌标志物升高。而经过高原习服后炎性指标有所改善,但依然会导致其心肌标志物升高,心肌酶的升高提示心肌损伤应注意心肌保护;同时该研究为机体急进高原和高原习服心肌损伤的研究提供依据。

Objective To investigate the changes of myocardial injury indexes of male officers and soldiers under the two exposure states of rushing into the plateau and the altitude acclimatization,so as to provide a basis for the research of high altitude myocardial injury.Methods A total of 57 officers and soldiers from a Xinjiang military unit after rush entry into plateau(altitude 4300 meters)and plateau acclimation(altitude 4300 meters)were included in the experimental group,while 42 officers and soldiers who had been living in the plain(altitude 43 meters)were included in the control group.Chemiluminescence and immunoturbidimetric methods were carried out to detect theindexes of myocardial injury in both groups,including creatine kinase(CK),creatine kinase isoenzyme(CK-MB),myoglobin(MYO),hypersensitivity changes in cardiac troponin I(hs-cTnI),C-reactive protein(CRP)and hypersensitive C-reactive protein(hs-CRP).Results The median blood levels of CK,CK-MB,MYO,hs-cTnI,CRP,and hs-CRP were 168.20 ng/L,1.20 ng/L,39.80 ng/L,1.00 pg/L,0.70 mg/L and 0.75 mg/L when people rapidly entered into the plateau state,and the levels in control group were 135.70 ng/L,0.90 ng/L,38.80 ng/L,1.00 pg/L,0.50 mg/L and 0.40 mg/L.There was a statistically significant difference at the levels of CK,CK-MB and hs-CRP between two groups(P<0.01).Compared with the control group,the indicators in the rapid state had significant statistical differences(P<0.01);while the CK,CK-MB,MYO and hs-cTnI in the acclimatized state had significant statistical differences(P<0.01).Conclusion When the body was acutely exposed to the altitude environment,its myocardial markers were increased.However,the inflammatory index was improved after the plateau acclimatization,but it still caused the increase of myocardial markers.The increase of myocardial enzymes suggested that the attention should be paid to myocardial protection after myocardial injury.At the same time,this study provided a basis for the study of myocardial injury in patients with acute plateau and plateau acclimatization.