目的 探讨热应激下武装越野对血小板活化及其参数的影响,分析上述变化与心肌损伤的潜在关系。方法 纳入2023-07至2024-07在夏季高温环境下进行10 km武装越野的男性战士93名。对检测受试者训练前和训练结束时的P-选择素和血小板参数,以及训练后4 h和16 h的肌钙蛋白I(cTnI)进行比较。根据cTnI情况分组,采用Spearman相关性分析P-选择素和血小板参数的变化(Δ)与心肌损伤的关联,运用Logistic回归分析心肌损伤的影响因素。结果 86名战士完成训练,均未发生胸闷、心悸、持续发热等症状。训练后4 h有41名出现cTnI升高,训练后16 h cTnI明显下降,与训练后4 h相比,差异有统计学意义(P<0.05)。与训练前相比,训练结束时P-选择素[261.7(198.6, 355.2) vs. 1060.9(808.0, 2740.9) pg/ml]显著升高;血小板计数(PLT)和大血小板数量(P-LCC)明显增加,血小板压积(PCT)同步增高(P<0.05)。经血容量校正,训练结束时的cPLT和cP-LCC亦高于训练前水平。根据训练后4 h cTnI是否升高,受试者分为正常组(n=45)和心肌损伤组(n=41)。与正常组相比,心肌损伤组的ΔP-选择素[628.2(418.7,774.9) vs. 2404.9(1885.7,2900.4) pg/ml]较大,而ΔcPLT和ΔPCT较小(P<0.05)。ΔP-选择素与心肌损伤呈正相关,ΔcPLT和ΔPCT与心肌损伤呈负相关,差异均有统计学意义(P<0.05)。ΔP-选择素为心肌损伤的危险因素,ΔPCT为心肌损伤的保护因素(P<0.05)。结论 热应激下武装越野可引起血小板活化及其参数发生改变,以及可逆性的亚临床心肌损伤,ΔP-选择素(血小板活化程度)是心肌损伤的重要危险因素,ΔcPLT和ΔPCT与心肌损伤显著相关,ΔPCT越小,心肌损伤发生的风险越高。
Abstract
Objective To explore the effects of armed cross-country running under heat stress on platelet activation and its parameters, and to analyze the potential relationship between these changes and myocardial injury. Methods A total of 93 male soldiers who participated in a 10-km armed cross-country running under high-temperature conditions from July 2023 to July 2024 were included. The P-selectin and platelet parameters of the subjects were detected before and after training, as well as 4 hours and 16 hours after training. The changes of related indicators were compared. According to the cTnI levels, the subjects were grouped, and Spearman correlation analysis was used to analyze the changes (Δ) of P-selectin and platelet parameters and their association with myocardial injury. Logistic regression was used to analyze the influencing factors of myocardial injury. Results A total of 86 soldiers completed the training without experiencing symptoms such as chest tightness, palpitations, and persistent fever. 41 participants showed elevated cTnI 4 h after training, which decreased significantly 16 h after training, with a statistically significant difference compared to 4 h after training (P<0.05). Compared with pre-training levels, P-selectin levels at the end of training were significantly elevated [261.7 (198.6, 355.2) vs. 1060.9 (808.0, 2740.9) pg/ml] (P<0.05), platelet count (PLT) and platelet-large platelet count (P-LCC) also increased significantly, as did platelet hematocrit (PCT) (P<0.05). After blood volume correction, cPLT and cP-LCC at the end of training remained elevated compared to pre-training levels. Subjects were divided into a normal group (n=45) and a myocardial injury group (n=41) based on whether cTnI levels were elevated 4 h after training. Compared with the normal group, the myocardial injury group had higher ΔP-selectin levels [628.2 (418.7, 774.9) vs. 2404.9 (1885.7, 2900.4) pg/ml], while lower ΔcPLT and ΔPCT levels (P<0.05). ΔP-selectin was positively correlated with myocardial injury, while ΔcPLT and ΔPCT were negatively correlated with myocardial injury, and the differences were statistically significant (P<0.05). ΔP-selectin was a risk factor for myocardial injury, while ΔPCT was a protective factor (P<0.05). Conclusions Military training under heat stress can cause changes in platelet activation and its parameters, as well as reversible subclinical myocardial injury. ΔP-selectin (platelet activation degree) is an important risk factor for myocardial injury, ΔcPLT and ΔPCT are significantly correlated with myocardial injury, with lower ΔPCT levels associated with a higher risk of myocardial injury.
关键词
热应激 /
军事训练 /
血小板活化 /
血小板参数 /
心肌损伤
Key words
heat stress /
military training /
platelet activation /
platelet parameters /
myocardial injury
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