中国夏季奥运会项目优秀运动员运动诱发性支气管痉挛的流行病学调查

Exercise-Induced Bronchoconstriction in Chinese Elite Athletes from Olympic Summer Sports:An Epidemiological Study

目的:通过对我国夏季奥运会项目运动员的运动诱发性支气管痉挛(exercise-inducedbronchoconstriction,EIB)问题进行流行病学调查,掌握我国夏季奥运会项目优秀运动员的EIB发病情况,比较不同运动项目、类型、人群之间EIB发病差异,分析EIB运动员的呼吸道炎症、通气功能等关键指标的特点。方法:招募15个运动项目的优秀运动员411人(女235人,男176人;国际级运动健将19人,运动健将148人,一级运动员244人),根据运动环境特点分为室内(泳池、陆上)和室外(公路、场地)项目,根据专项特征分为耐力、技巧、速度力量和团体项目。通过问卷调查获取所有运动员的运动呼吸不适症状、家族哮喘史和EIB病史等信息;通过支气管运动激发实验获取肺功能相关参数,并通过FEV1下降率进行EIB诊断;通过采集分析空腹静脉血评估所有运动员的炎症反应情况。采用卡方检验、独立样本t检验和重复测量方差分析进行统计学检验。结果:曾有3名运动员被确诊患有EIB,占比2.7%。研究样本中EIB阳性人数为109人(女71名,男38名),整体发病率为26.5%。游泳(51.5%)、曲棍球(40.7%)、花样游泳(40.0%)、橄榄球(38.5%)和田径(33.3%)项目运动员的发病率分列前5位,柔道(11.1%)、艺术体操(10.5%)、羽毛球(9.5%)、举重(9.5%)和摔跤(6.5%)项目运动员分列末5位。女性发病率显著高于男性(30.2%vs 21.3%,P=0.049);耐力项目运动员发病率显著高于力量速度项目(37.3%vs 20.0%,P=0.038);室外项目运动员发病率显著高于室内项目(33.1%vs 21.6%,P=0.05),且室内泳池项目运动员发病率显著高于陆上项目(47.2%vs 14.2%,P<0.001),但室外场地项目和公路项目无显著差异。另外,EIB运动员各项肺功能指标均显著下降,且低于健康运动员;相关血液指标(嗜酸性粒细胞、中性粒细胞、白介素-6、白介素-8和CC16水平)均显著高于健康运动员。结论:我国夏季奥运会项目优秀运动员的EIB问题严峻,相比健康运动员,EIB运动员表现出明显的肺通气功能障碍及呼吸道炎症反应症状。我国运动员、教练员及体育主管部门应高度重视EIB问题,及早部署,建议通过监测相关炎症因子(如白介素-8、克拉式细胞蛋白16)来预测EIB,并通过各种非药物性措施(如无氯泳池、防霾场馆及营养补剂等)进行预防和治疗。

Objective:To investigate the incidence of exercise-induced bronchoconstriction(EIB)in Chinese elite athletes from Olympic Summer Games,and then analyse the characteristics of key indicators related to respiratory inflammation and ventilatory function in EIB athletes.Methods:411 athletes(female 235,male 176;19 high level athletes,148 elite athletes and 244 sub-elite athletes)were recruited from 15 different summer sports,and they were divided into indoor(pool-or land-based)or outdoor sport group(road-or venue-based)according to sports environment,and they were also categorized into endurance,skill,speed&strength,or team sport discipline according to sport characteristics.The respiratory symptoms during exercise,asthma history and EIB information were obtained through questionnaire.Pulmonary function data(i.e.,forced expiratory volume in the first second(FEV1),maximum ventilation,forced vital capacity,expiratory peak air flow rate,etc.)were collected during bronchial exercise provocation test,and the reduction rate of FEV1 was used to diagnose EIB.The inflammatory responses were evaluated through venous blood sample.The chi-square test,independent sample t-test and repeated measures method were used to do data analysis.Results:Three athletes(2.7%)have been diagnosed EIB before participation,and a total of 109 athletes(female 71,male 38)were diagnosed with EIB in this study,the overall incidence rate was 26.5%.The top 5 EIB incidence sports was swimming(51.5%),hockey(40.7%),synchronized swimming(40.0%),rugby(38.5%)and track and field(33.3%),and judo(11.1%),rhythmic gymnastics(10.5%),badminton(9.5%),weightlifting(9.5%)and wrestling(6.5%)were ranked in the last five.The EIB incidence rate was higher in female athletes than that of male athletes(30.2%vs 21.3%,P=0.049);the endurance event was higher than speed&strength event(37.3%vs 20.0%,P=0.038);the outdoor event was higher than indoor event(33.1%vs 21.6%,P=0.05),and the indoor swimming pool-based event was higher than land-based event(47.2%vs 14.2%,P<0.001),but there was no significant difference between the venue-and road-based events in outdoor environment.In addition,all pulmonary function parameters were significantly decreased in EIB athletes,which were lower than healthy athletes.The blood indictors including eosinophil count,neutrophil count,IL-6,IL-8 and CC16 levels were higher in EIB athletes than that of healthy athletes.Conclusions:The Chinese elite athletes from Olympic Summer Games are suffering from severe EIB problems,and the reduced lung ventilation and severe airway inflammation are observed in EIB athletes.All athletes,coaches,and sports authorities are recommended to pay highly attention to EIB problems,and it is suggested that the inflammatory factors(i.e.,IL-8,CC16)and non-pharmacological measures(i.e.,chlorine-free swimming pool,anti-haze venue,nutritional supplements)can be sued to prevent and treat EIB.