Cox Amanda J, Gleeson Maree, Pyne David B, Callister Robin, Hopkins Will G, Fricker Peter A
Department of Physiology, Australian Institute of Sport, Canberra, Australia.
Clin J Sport Med. 2008 Sep;18(5):438-45. doi: 10.1097/JSM.0b013e318181e501.
To characterize the etiology of upper respiratory symptoms in elite athletes presenting to a sports physician for treatment.
Prospective clinical and laboratory investigations.
Sports medicine clinic.
Seventy elite-level athletes.
Physician-recorded symptoms and diagnosis; health/training questionnaires; laboratory investigations of respiratory pathogens, white blood cell differential counts, and immune parameters.
Physicians characterized 89% of presentations as viral or bacterial upper respiratory tract infection. Only 57% of presentations were associated with an identified pathogen or other laboratory parameters indicative of infection. Demographic information, previous illness, and training history did not distinguish between presentations with or without objective measures of infection. Elevated white blood cell and neutrophil counts and lower vitamin D concentrations partially distinguished infectious episodes. The number of systemic symptoms/behaviors at presentation (cough, headache, earache, fatigue, fever/rigors, myalgia/arthralgia, or cessation of training before clinic attendance) had some predictive value for infection: odds ratio per symptom, 1.23 (90% confidence interval: 0.91 to 1.66); probability of infection, 48% with no symptoms to 77% with 6 symptoms. Laboratory investigation identified allergy in a considerable proportion of the cohort (39%).
The discrepancy between physician and laboratory diagnosed infection in elite athletes highlights the need for consideration of alternate diagnostic options when evaluating upper respiratory symptoms in athletes. A considerable proportion of episodes of respiratory symptoms in athletes were not associated with identification of a respiratory pathogen; other potentially treatable causes of upper respiratory symptoms should be considered, particularly in athletes with recurrent symptoms.
明确前往运动医学医生处接受治疗的精英运动员上呼吸道症状的病因。
前瞻性临床和实验室研究。
运动医学诊所。
70名精英级运动员。
医生记录的症状和诊断结果；健康/训练调查问卷；呼吸道病原体、白细胞分类计数及免疫参数的实验室检测。
医生将89%的病例诊断为病毒或细菌性上呼吸道感染。仅有57%的病例与已识别的病原体或其他表明感染的实验室参数有关。人口统计学信息、既往病史及训练史无法区分有无感染客观指标的病例。白细胞和中性粒细胞计数升高以及维生素D浓度降低在一定程度上可区分感染性发作。就诊时全身症状/行为的数量（咳嗽、头痛、耳痛、疲劳、发热/寒战、肌痛/关节痛或就诊前停止训练）对感染有一定预测价值：每个症状的比值比为1.23（90%置信区间：0.91至1.66）；感染概率从无症状时的48%到有6个症状时的77%。实验室检测在相当比例的队列中（39%）发现了过敏。
精英运动员中医生诊断的感染与实验室诊断的感染之间存在差异，这凸显了在评估运动员上呼吸道症状时考虑其他诊断选项的必要性。运动员中相当一部分呼吸道症状发作与未识别出呼吸道病原体有关；应考虑上呼吸道症状的其他潜在可治疗病因，尤其是症状反复出现的运动员。
