Lewis Douglas P, Hoffman Martin D, Stuempfle Kristin J, Owen Bethan E, Rogers Ian R, Verbalis Joseph G, Hew-Butler Tamara D
1Department of Family and Maternal/Child, Via Christi Family Medicine Residency, Via Christi Health System, Wichita, Kansas; 2Department of Physical Medicine and Rehabilitation, VA Northern California Health Care System and University of California Davis Medical Center, Sacramento, California; 3Department of Health Sciences, Gettysburg College, Gettysburg, Pennsylvania; 4Sir Charles Gairdner Hospital, Perth, Australia; 5Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Murdoch, Western Australia; 6Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, District of Columbia; and 7School of Health Science, Oakland University, Rochester, Michigan.
J Strength Cond Res. 2014 Mar;28(3):807-13. doi: 10.1519/JSC.0b013e3182a35dbd.
Salt replacement is often recommended to prevent exercise-associated hyponatremia (EAH) despite a lack of evidence to support such practice. Exercise-associated hyponatremia is known to be a complex process resulting from the interplay of hydration, arginine vasopressin, and sodium balance. Although evidence suggests overhydration is the dominant pathophysiologic factor in most cases, the contributions of sweat sodium losses remain unclear. A theoretical genetic mechanism producing exuberant sweat sodium loss in athletes is the presence of cystic fibrosis (CF) gene. Individuals with CF develop hypovolemic hyponatremia by sodium loss via sweat through a defective chloride ion transport channel, the CF transmembrane conductance regulator (CFTR). Elevated sweat sodium concentrations in CF single heterozygotes suggest that athletes developing EAH may be CFTR carriers. We targeted the 2010 and 2011 Western States Endurance Run ultramarathon, an event where athletes with EAH regularly present in a hypovolemic state, for a cohort maximizing the potential to document such a relationship. A total of 798 runners started the 2010 (n = 423) and 2011 (n = 375) races. Of the 638 finishers, 373 were screened for EAH by blood draw, 60 (16%) were found to have EAH, and 31 (alpha = 0.05 for n = 9) reported their CF result from a saliva-based genetic testing kit. Neither the 31 EAH-positive athletes nor the 25 EAH-negative comparison cohort athletes tested positive for a CF mutation. This null relationship suggests that CFTR mutations are not associated with the development of EAH and that salt supplementation is unnecessary for such a reason.
尽管缺乏证据支持,但人们通常建议补充盐分以预防运动相关性低钠血症(EAH)。运动相关性低钠血症是一个复杂的过程,由水合作用、精氨酸加压素和钠平衡之间的相互作用导致。虽然有证据表明在大多数情况下,水摄入过多是主要的病理生理因素,但汗液中钠流失的作用仍不清楚。一种理论上的遗传机制认为,运动员汗液中钠过度流失是由于存在囊性纤维化(CF)基因。患有CF的个体通过有缺陷的氯离子转运通道——CF跨膜电导调节因子(CFTR),经汗液流失钠,从而发生低血容量性低钠血症。CF单杂合子汗液中钠浓度升高表明,发生EAH的运动员可能是CFTR携带者。我们将目标锁定在2010年和2011年的西部各州耐力跑超级马拉松赛,在这个赛事中,患有EAH的运动员经常以低血容量状态出现,我们以此建立一个队列,以最大限度地记录这种关系。共有798名跑步者参加了2010年(n = 423)和2011年(n = 375) 的比赛。在638名完赛者中,373人通过抽血筛查EAH,其中60人(16%)被发现患有EAH,31人(n = 9时α = 0.05)报告了基于唾液的基因检测试剂盒检测的CF结果。31名EAH阳性运动员和25名EAH阴性对照队列运动员的CF突变检测均未呈阳性。这种无关联关系表明,CFTR突变与EAH的发生无关,因此无需补充盐分。