Siegel Arthur J
McLean Hospital, Belmont, Mass; Harvard Medical School, Boston, Mass.
Am J Med. 2015 Oct;128(10):1070-5. doi: 10.1016/j.amjmed.2015.03.031. Epub 2015 Apr 22.
Cerebral edema due to exercise-associated hyponatremia and cardiac arrest due to atherosclerotic heart disease cause rare marathon-related fatalities in young female and middle-aged male runners, respectively. Studies in asymptomatic middle-aged male physician-runners during races identified inflammation due to skeletal muscle injury after glycogen depletion as the shared underlying cause. Nonosmotic secretion of arginine vasopressin as a neuroendocrine stress response to rhabdomyolysis mediates hyponatremia as a variant of the syndrome of inappropriate antidiuretic hormone secretion. Fatal hyponatremic encephalopathy in young female runners was curtailed using emergent infusion of intravenous hypertonic (3%) saline to reverse cerebral edema on the basis of this paradigm. This treatment was arrived at through a consensus process within the medical community. An increasing frequency of cardiac arrest and sudden death has been identified in middle-aged male runners in 2 studies since the year 2000. Same-aged asymptomatic male physician-runners showed post-race elevations in interleukin-6 and C-reactive protein, biomarkers that predict acute cardiac events in healthy persons. Hypercoagulability with in vivo platelet activation and release of cardiac troponin and N-terminal pro-brain natriuretic peptide were also observed post-race in these same subjects. High short-term risk for atherothrombosis during races as shown by stratification of biomarkers in asymptomatic men may render nonobstructive coronary atherosclerotic plaques vulnerable to rupture. Pre-race aspirin use in this high-risk subgroup is prudent according to conclusive evidence for preventing first acute myocardial infarctions in same-aged healthy male physicians. On the basis of validated clinical paradigms, taking a low-dose aspirin before a marathon and drinking to thirst during the race may avert preventable deaths in susceptible runners.
运动相关性低钠血症所致脑水肿和动脉粥样硬化性心脏病所致心脏骤停分别导致年轻女性和中年男性马拉松运动员罕见的相关死亡。对无症状中年男性医生跑步者在比赛期间的研究发现，糖原耗竭后骨骼肌损伤引起的炎症是共同的潜在原因。精氨酸加压素的非渗透性分泌作为对横纹肌溶解的神经内分泌应激反应，介导低钠血症，这是抗利尿激素分泌不当综合征的一种变体。基于这一范例，通过紧急输注静脉高渗（3%）盐水来逆转脑水肿，减少了年轻女性跑步者致命的低钠性脑病。这种治疗方法是通过医学界的共识过程得出的。自2000年以来的两项研究中，已发现中年男性跑步者心脏骤停和猝死的频率增加。同龄无症状男性医生跑步者赛后白细胞介素-6和C反应蛋白升高，这些生物标志物可预测健康人的急性心脏事件。在这些受试者赛后还观察到体内血小板激活以及心肌肌钙蛋白和N末端脑钠肽前体释放导致的高凝状态。无症状男性生物标志物分层显示比赛期间动脉粥样硬化血栓形成的短期风险较高，这可能使非阻塞性冠状动脉粥样硬化斑块易于破裂。根据预防同龄健康男性医生首次急性心肌梗死的确凿证据，在这个高危亚组中赛前使用阿司匹林是谨慎的。基于经过验证的临床范例，在马拉松比赛前服用低剂量阿司匹林并在比赛期间口渴时饮水，可能避免易感跑步者可预防的死亡。
