旨在探讨马拉松运动性中暑(EH)患者心肌损害与炎症反应的关系。

采用回顾性研究方法随机选取年龄相仿的2014至2017年扬州国际半程马拉松赛同期到达终点的42例马拉松运动员作为对照组，选择我院收治的EH患者46例，分为轻症EH组(35例)和重症EH组(11例)，同时记录所有研究对象肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)的变化。并使用酶联免疫吸附试验(ELISA)检测三组血清中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及IL-4。

轻症和重症EH组较对照组血清cTnI、CK、CK-MB、LDH及AST均明显升高，重症组较轻症组各项指标明显升高。轻重EH组血清中TNF-α及IL-6较对照组明显增高且IL-4明显降低。与轻症EH组相比，重症EH组TNF-α及IL-6较高，IL-4则下降。EH患者血清cTnI与TNF-α、IL-6、IL-4呈相关性，差异均有统计学意义(P<0.05)。

EH患者心肌损伤指标随着中暑程度的加重而增加明显，致炎因子TNF-α及IL-6高表达和抑炎因子IL-4低表达可能参与了心肌损害的进程。

To explore the relationship between myocardial injury and inflammation in marathon exertional heatstroke (EH) patients.

Using retrospective study method, we randomly selected the 42 cases of marathon runners as control group who were about the same age and reached the finish line in the same period in Yangzhou International Half-Marathon from 2014 to 2017. The 46 cases of EH patients from our hospital were divided into mild heatstroke group (35 cases) and severe heatstroke group (11 cases). At the same time, we recorded the experimental results in the blood myocardial injury index from all the research object, including troponin I (cTnI), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). We also detected tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6) and IL-4 in the serum from three groups using enzyme-linked immunosorbent assay (ELISA). The above data were compared and statistically analyzed.

The serum levels of cTnI, CK, CK-MB, LDH and AST were significantly increased in groups of mild and severe EH compared with the control group, and the indicators in the severe group were obviously higher than in the mild group. Meanwhile the serum TNF-α and IL-6 was significantly increased in the mild and severe EH groups, but IL-4 observably reduced. Compared with mild group, TNF-α and IL-6 were higher and IL-4 was lower in the severe group. The serum level of cTnI was correlated with the levels of TNF-α, IL-6 and IL-4 in EH patients. The above differences were statistically significant (P<0.05).

The myocardial injury index of EH patients increased with the severity of heat stroke, and the high expression of proinflammatory factor TNF-α and IL-6 and the low expression of inflammatory cytokines IL-4 may be involved in the process of myocardial damage.