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.
Key words
heat stress /
military training /
platelet activation /
platelet parameters /
myocardial injury
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References
[1] Crandall C G, Gonzalez-Alonso J. Cardiovascular function in the heat-stressed human[J]. Acta Physiol (Oxf), 2010,199(4):407-423.
[2] Epstein Y, Charkoudian N, DeGroot D W, et al. Exertional heat illness: international military-oriented lessons learned and best practices for prevention and management[J]. Front Physiol, 2025,16:1456984.
[3] Xia R, Sun M, Li Y, et al. The pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury[J]. Front Pharmacol, 2023,14:1286556.
[4] 殷惠梅, 童华生. 血小板损伤与中暑发病机制的研究进展[J]. 临床急诊杂志, 2017,18(5):342-344.
[5] 宁 波, 宋 青. 《部队热习服指南》解读[J]. 空军医学杂志, 2018,34(4):276-278.
[6] 全军热射病防治专家组. 暑期部队高强度训练预防中暑专家共识[J]. 空军医学杂志, 2019,35(4):283-288.
[7] 杨彦文, 张 静, 毛玉玲, 等. 高温高湿环境下重度中暑模型猪的建立[J]. 中国组织工程研究, 2022,26(17):2678-2684.
[8] Chen G D, Fan H, Zhu J H. Salidroside pretreatment protects against myocardial injury induced by heat stroke in mice[J]. J Int Med Res, 2019,47(10):5229-5238.
[9] Aengevaeren V L, Baggish A L, Chung E H, et al. Exercise-induced cardiac troponin elevations: from underlying mechanisms to clinical relevance[J]. Circulation, 2021,144(24):1955-1972.
[10] Hausfater P, Doumenc B, Chopin S, et al. Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwave[J]. Crit Care, 2010,14(3):R99.
[11] Mandel J, Casari M, Stepanyan M, et al. Beyond hemostasis: platelet innate immune interactions and thromboinflammation[J]. Int J Mol Sci, 2022,23(7):3868.
[12] Fang J, Sun X, Liu S, et al. Shear stress accumulation enhances von Willebrand factor-induced platelet P-selectin translocation in a PI3K/Akt pathway-dependent manner[J]. Front Cell Dev Biol, 2021,9:642108.
[13] Wang J. Intense exercise increases shear-induced platelet aggregation in men through enhancement of von Willbrand factor binding, glycoprotein IIb/IIIa activation, and P-selectin expression on platelets[J]. Eur J Appl Physiol, 2004,91(5-6):741-747.
[14] Gader A M, Al-Mashhadani S A, Al-Harthy S S. Direct activation of platelets by heat is the possible trigger of the coagulopathy of heat stroke[J]. Br J Haematol, 1990,74(1):86-92.
[15] 宋景春, 宋 青, 张 伟, 等. 中国热射病诊断与治疗指南(2025版)[J]. 解放军医学杂志, 2025,50(4):367-386.
[16] Iba T, Helms J, Levi M, et al. The role of platelets in heat-related illness and heat-induced coagulopathy[J]. Thromb Res, 2023,231:152-158.
[17] Iba T, Connors J M, Levi M, et al. Heatstroke-induced coagulopathy: biomarkers, mechanistic insights, and patient management[J]. EClinicalMedicine, 2022,44:101276.
[18] Scherlinger M, Richez C, Tsokos G C, et al. The role of platelets in immune-mediated inflammatory diseases[J]. Nat Rev Immunol, 2023,23(8):495-510.
[19] Khodadi E. Platelet function in cardiovascular disease: activation of molecules and activation by molecules[J]. Cardiovasc Toxicol, 2020,20(1):1-10.
[20] Wang F, Chen Z, Liu P, et al. Heatwave increases the risk of ischemic stroke by promoting platelet activation[J]. Ecotoxicol Environ Saf, 2025,303:118814.
[21] Pogorzelska K, Kretowska A, Krawczuk-Rybak M, et al. Characteristics of platelet indices and their prognostic significance in selected medical condition-a systematic review[J]. Adv Med Sci, 2020,65(2):310-315.
[22] 龙雪蛟, 洪绍彩, 贝俊杰. 血小板参数在心血管疾病中的研究进展[J]. 心血管病学进展, 2023,44(10):945-948.
[23] 娄云鹏, 林慧艳, 王洪萍, 等. 热射病心肌损害的研究进展[J]. 中华危重病急救医学, 2019,31(10):1304-1306.
[24] Schilder F P M, de Weijer A D, Levels K, et al. The effects of acute operational stress and passive heat stress on physiological and subjective stress responses in military personnel[J]. Int J Psychophysiol, 2025,208:112491.
[25] 张 昕, 沈 建, 宿永康, 等. 高强度训练对新兵横纹肌和重要脏器的影响及其干预效果[J]. 武警医学, 2023,34(7):577-581.
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