大负荷运动训练致心肌损伤的机制与监测标志物研究进展

Research progress on the mechanism and monitoring markers of myocardial injury caused by high load exercise training

心肌损伤标志物,包括肌酸激酶MB型同工酶(CK-MB)、心肌肌钙蛋白(cTn)和脑钠素(BNP)等,在大负荷运动训练后时常升高。本文旨在通过文献资料法揭示训练致心肌损伤的潜在机制并探讨其临床意义。结果发现,虽然适度规律运动对机体的整体益处毋庸置疑,但最近的研究证实长期大负荷运动训练对心脏可能产生潜在不良影响。在大负荷运动诱导心肌损伤的标志物中,CK-MB升高可能是由骨骼肌中多能卫星细胞分泌,cTn升高与一过性右室收缩和双心室舒张功能障碍相关,BNP可能是右心室功能障碍的敏感标志物。因此,监测训练过程中心肌损伤标志物的变化有助于早起发现并预防心肌损伤,由于CK-MB的特异性不强,故可通过cTn联合BNP的结果来判断是否存在心肌损伤,同时能够更好的鉴别心肌和骨骼肌损伤。

Markers of myocardial injury, including creatine kinase MB isoenzyme(CK-MB), cardiac troponin(cTn), and brain natriuretic peptide(BNP), often increase after high load exercise training. The purpose of this paper is to reveal the potential mechanism of training-induced myocardial injury and to explore its clinical significance. The results show that although there is no doubt about the overall benefits of moderate regular exercise, recent studies have confirmed that long-term high load exercise training may have potential adverse effects on the heart. Among the markers of myocardial injury induced by high load exercise, the increase of CK-MB may be secreted by pluripotent satellite cells in skeletal muscle, the increase of cTn is related to transient right ventricular systolic and biventricular diastolic dysfunction, BNP may be a sensitive marker of right ventricular dysfunction. Therefore, monitoring the changes of myocardial injury markers during training is helpful for early detection and prevention of myocardial injury. Because CK-MB is not specific, the results of cTn combined with BNP can be used to determine whether there is myocardial injury which can also identify myocardial and skeletal muscle injuries.