目的观察长时间大负荷军事训练前后血浆生化标志物的变化,为及时发现亚临床运动性横纹肌溶解症(exertional rhabdomyolysis ,ERM)及预防并发症提供依据。方法选取30名武装行军士兵,由于训练中途退出7名队员(感染、外伤等),因此最终的样本量为23名。分别测定训练前安静时、训练后即刻和次日晨血钾、血钠、血浆晶体渗透压、血浆肌酸激酶(CK)、血浆肌红蛋白(Mb)和血浆游离DNA(cf-DNA)。结果血钾、血钠和血浆晶体渗透压渗透压在训练后即刻稍有增加(P<0.05或P<0.01),在次日晨即恢复至训练前水平。训练后即刻CK升高了58.4%,Mb升高了2倍,次日晨CK达到训练前的5倍,差异有统计学意义(P<0.01),Mb则明显下降,但仍稍高于训练前水平,差异有统计学意义(P<0.05) 。cf-DNA在训练后明显升高(P<0.01),次日晨则恢复至训练前水平。结论长时间大负荷军事训练中常发生亚临床性横纹肌溶解症(subclinical exertional rhabdomyolysis,SERM),应加强医务监督工作,监测血浆生化标志物对早期发现ERM并预防并发症具有积极意义。

Objective To study the effects of prolonged strenuous military training on plasma biological markers and provide evidence of screening subclinical exertional rhabdomyolysis (ERM) and preventing occurrence of complication. Methods Twenty-three soldiers had a march in battle gear; and heart rate (HR), blood lactic acid (LA), blood potassium, blood sodium, plasma crystal osmotic pressure, creatine kinase (CK), myoglobin (Mb) and cell-free plasma DNA (cf-DNA) were determined on pre-training at rest, immediately post-training and in the next morning at rest. Results Blood potassium, blood sodium and plasma crystal osmotic pressure post-training slightly rose (P＜0.05 or P＜0.01) and recovered in next morning (P>0.05). CK and Mb post-training increased by 58.4% (P＜0.05) and 200% (P＜0.01),respectively, while in next morning, CK level reached 5 times that pre-training (P＜0.01) and Mb reduced significantly (P＜0.01) but was still higher than pre-training (P＜0.05). Cf-DNA elevated obviously post-training (P＜0.01) and restored to pre-training level in next morning (P>0.05). Conclusions Prolonged strenuous military training usually causes subclinical ERM and medical supervision should be enhanced before and after training. It is significant to monitor plasma biological markers for early detection of ERM and prevention of ERM complication.