König Daniel, Schumacher York Olaf, Heinrich Lothar, Schmid Andreas, Berg Aloys, Dickhuth Hans-Hermann
Center for Internal Medicine, Department of Rehabilitation, Prevention and Sports Medicine, Freiburg University Hospital, Hugstetter Strasse 55, D-79106 Freiburg im Breisgau, Germany.
Med Sci Sports Exerc. 2003 Oct;35(10):1679-83. doi: 10.1249/01.MSS.0000089248.37173.E7.
Based on the determination of cardiac troponin (cTnT), brain natriuretic peptide (BNP), and echocardiographic measurements, recent investigations have reported myocardial damage and reversible cardiac dysfunction after prolonged endurance exercise in apparently healthy subjects. In the present study, we investigated the myocardial stress reaction in professional endurance athletes after strenuous competitive physical exercise.
Eleven highly trained male professional road cyclists (age 27 +/- 4 yr; .VO2peak 67 +/- 5 mL.kg-1.min-1; training workload 34,000 +/- 2,500 km.yr-1) were examined. The following parameters were determined before and after one stage of a 5-d professional cycling race: BNP, cTnT (third-generation assay that shows no cross reactivity with skeletal TnT), creatine kinase (CK), creatine kinase MB (CKMB), myoglobin (Myo), and urea. All participants were submitted to a careful cardiac examination including echocardiography and stress ECG.
None of the athletes showed pathological findings in the cardiac examination. CK (P < 0.01), CKMB (P < 0.05), and Myo (P < 0.01) were increased after the race. Normal postexercise cTnT levels indicate that the increase in CK, CKMB, and Myo was of noncardiac origin. In contrast, BNP rose significantly from 47.5 +/- 37.5 to 75.3 +/- 55.3 pg.mL-1 (P < 0.01). Pre- and postexercise values of BNP as well as the individual exercise-induced increase in BNP were significantly correlated with age (R2 = 0.68, R2 = 0.66, and R2 = 0.58, respectively; P < 0.05).
Strenuous endurance exercise in professional road cyclists does not result in structural myocardial damage. The rise in BNP in older athletes may reflect a reversible, mainly diastolic left ventricular dysfunction. This needs to be confirmed by larger trials including different intensities, sports, and age groups.
基于心肌肌钙蛋白（cTnT）、脑钠肽（BNP）的测定以及超声心动图测量，近期研究报告称，在看似健康的受试者进行长时间耐力运动后，会出现心肌损伤和可逆性心脏功能障碍。在本研究中，我们调查了职业耐力运动员在剧烈竞技体育锻炼后的心肌应激反应。
对11名训练有素的男性职业公路自行车运动员（年龄27±4岁；峰值摄氧量67±5 mL·kg⁻¹·min⁻¹；训练工作量34000±2500 km·年⁻¹）进行了检查。在为期5天的职业自行车比赛的一个阶段前后，测定了以下参数：BNP、cTnT（与骨骼肌TnT无交叉反应的第三代检测法）、肌酸激酶（CK）、肌酸激酶同工酶MB（CKMB）、肌红蛋白（Myo）和尿素。所有参与者都接受了包括超声心动图和运动心电图在内的仔细心脏检查。
在心脏检查中，没有一名运动员出现病理结果。比赛后CK（P<0.01）、CKMB（P<0.05）和Myo（P<0.01）升高。运动后cTnT水平正常表明CK、CKMB和Myo的升高并非源于心脏。相比之下，BNP从47.5±37.5显著升至75.3±55.3 pg·mL⁻¹（P<0.01）。运动前后BNP值以及个体运动诱导的BNP升高与年龄显著相关（分别为R² = 0.68、R² = 0.66和R² = 0.58；P<0.05）。
职业公路自行车运动员的剧烈耐力运动不会导致结构性心肌损伤。老年运动员中BNP的升高可能反映了一种可逆的、主要为舒张期的左心室功能障碍。这需要通过包括不同强度、运动项目和年龄组的更大规模试验来证实。
