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來源：37度醫(yī)學(xué)網(wǎng) The Lab Says Heart Attack, but the Patient Is Fine化驗顯示心臟病發(fā)作，但病人卻安然無恙？ By GINA KOLATA Published: November 26, 2008 THE man was 40 years old and seemed perfectly healthy — he had just run a 10-kilometer race. But he fainted after the race and was rushed to a hospital. There, in the emergency room, his blood was tested. His levels of a heart protein, troponin, were sky-high. It looked as if he was having a heart attack. 40歲男性，看似健康狀況良好，在剛結(jié)束10公里跑步后暈倒，急送入院。急診室內(nèi)進(jìn)行了血化驗。他的心肌蛋白（肌鈣蛋白）異常升高?？磥硭坪跣呐K病發(fā)作了。 The runner ended up in the coronary intensive care unit at Hadassah-Hebrew University Medical Center in Jerusalem. He was in the hospital for four days, undergoing test after test. Yet nothing appeared to be wrong, his doctors — Lior Tolkin, Beth Goldstein and David Rott — report in a recent issue of Cardiology. He had no other symptoms of a heart attack; every test of his heart’s function was normal. And his soaring troponin levels, which can be an indicator of heart muscle damage, went down to normal. 該患者最后被送入耶路撒冷的希伯萊哈大沙大學(xué)醫(yī)療中心的冠心病加護(hù)病房。他入院四天，接受了一次又一次的血化驗，然而沒有發(fā)生異常。他的醫(yī)生：Lior Tolkin 、Beth Goldstein 及David Rott –在近期心臟病學(xué)刊物上報到，該患者無其它心臟病發(fā)作的表現(xiàn)，每一項心臟功能檢查的結(jié)果均正常。他異常升高的肌鈣蛋白水平（肌鈣蛋白可用來診斷心肌損傷）已經(jīng)回復(fù)正常。 A false alarm or a heart attack averted or maybe a lab error? Researchers say the most likely explanation is that the man had been caught up in a poorly understood but surprisingly common phenomenon: blood tested shortly after a long or strenuous bout of exercise is likely to show abnormalities, maybe even indicators of a heart attack or liver failure. But usually the patient is not in danger. Instead, those results are normal and are not a reason for concern. 這是一個錯誤的警告還是心臟病發(fā)作已經(jīng)轉(zhuǎn)歸，又或者是實驗室的失誤造成的呢？研究人員認(rèn)為，最可能的解釋是對該患者的了解不夠，而不是驚奇于一個普通的現(xiàn)象：血化驗在經(jīng)歷長時間或是激烈的運(yùn)動后的短期內(nèi)會出現(xiàn)異常?？赡軙踔林赶蛐呐K病發(fā)作或是肝衰竭。但常常這種患者并不處于危險之中，異常的結(jié)果會回復(fù)正常而不被注意。 While it is unusual to find such effects after a race as short as 10 kilometers, researchers say they are well aware of the general problem. 當(dāng)發(fā)生在10公里的短距離跑步后出現(xiàn)這一個不尋常的影響，研究人員說他們已經(jīng)意識到這是個普遍的問題。 “I can tell you several stories like that,” said Dr. Fred Apple, a professor of laboratory medicine and pathology at the University of Minnesota School of Medicine. 明尼蘇達(dá)大學(xué)醫(yī)學(xué)院實驗室醫(yī)學(xué)和病理學(xué)專家 Fred Apple醫(yī)生說，“我能告訴你好多相似的事情” In one, in fact, he is the center of the story. 事實上，其中一個，就是他自己。 Dr. Apple likes to experiment on himself, so one day, when he was a medical resident at Washington University in St. Louis, he drew his own blood and sent it to the hospital lab for routine tests. Apple醫(yī)生喜歡在自己身上試驗，所以，一天，當(dāng)他還是位于圣路易的華盛頓大學(xué)的一位住院醫(yī)生時，他抽取自己的血液然后送去醫(yī)院的實驗室做常規(guī)檢驗。 The next thing he knew, he was being paged and escorted to the coronary intensive care unit. His blood test results were terrifying, with levels of an enzyme, creatine kinase MB, 10 times higher than normal. Like the runner in Israel, it looked as if Dr. Apple was having a heart attack. 接下來他所知道的，就是他被呼喚著護(hù)送進(jìn)了心臟病加護(hù)病房。血化驗的結(jié)果異常駭人。血液中的一種酶，肌酸激酶同功酶，高于正常10倍。就如Israel的運(yùn)動者，看起來APPLE醫(yī)生似乎也心臟病發(fā)作了。 His heart was fine. But Dr. Apple had just gone for a long run (he was running 50 to 60 miles a week in those days). 他的心臟是健康的。但是APPLE醫(yī)生剛進(jìn)行了一次長跑（那時他一周跑50到60英里） That experience, in the 1980s, made Dr. Apple curious about lab tests after strenuous exercise, and led him to systematically study the problem, documenting the exercise effect. 在80年代初期的那次的經(jīng)歷，使APPLE醫(yī)生對劇烈運(yùn)動后的實驗室檢查結(jié)果產(chǎn)生了好奇，隨后他對此問題進(jìn)行了系統(tǒng)性的研究，證明了運(yùn)動后的影響。 “I’d say that 5 percent of people who stress their bodies with exercise could bump up some of these levels above the level that signals a heart attack,” Dr. Apple said. apple醫(yī)生說，“我認(rèn)為有5%的人運(yùn)動時給機(jī)體的壓力會導(dǎo)致一些酶水平升高于心臟病發(fā)作時這些酶的水平?！?br>To avoid false alarms, he suggests that patients avoid lab tests within 24 hours of exercise. If not, he said, “you are asking for abnormalities to be detected.” 他建議，為了避免錯誤的警報，運(yùn)動后24小時人們應(yīng)避免實驗室檢查。他說，如果不這樣做，“你在尋求被探察出異常的結(jié)果?！?br>Dr. Malissa Wood, a cardiologist at the Massachusetts General Hospital who is a marathon runner, goes further. “I think it’s a really bad idea to have blood work unless something is wrong,” she said. Malissa Wood醫(yī)生（麻薩諸塞州總院的心臟病學(xué)家）其同時也是一個馬拉松運(yùn)動員，進(jìn)一步說明，“我想如果身體沒有感到不適，進(jìn)行血化驗真不是個好主意?！?br>Dr. Wood and her colleagues have studied runners in the Boston Marathon, testing their blood before and after the race for proteins that can indicate a stroke risk or a heart attack. Wood醫(yī)生和其同事研究了波士頓馬拉松比賽的運(yùn)動員，在比賽前后對他們進(jìn)行血液化驗，測量其中能協(xié)診卒中風(fēng)險和心臟病發(fā)作的蛋白質(zhì)的水平。 “Almost everything we looked at went up,” she said.”我們看到的每一項幾乎都升高了?！彼f。 And it may not take hours of exercise to do it.并且可能不需要數(shù)小時的運(yùn)動就可以做到。 Rob Shave and his colleagues at Brunel University in England recently reported in the Journal of the American College of Cardiology on nine young men who ran a marathon distance on a treadmill. The researchers took blood samples from the men every 30 minutes while they ran and periodically for 24 hours afterward. All had marked increases in troponin within one to two hours after they started running. Everyone’s troponin levels fell within an hour after the run, but in eight of the runners the protein’s levels rose again over the next hours, and five runners had elevated levels 24 hours later. Rob Shave和他在英國Brune大學(xué)的同事最近在心臟病學(xué)美國大學(xué)學(xué)報上報道，9名男孩在跑步機(jī)上進(jìn)行相當(dāng)于馬拉松距離的長跑，研究者在其運(yùn)動時每隔30分鐘在其身上提取血樣，其后每隔24小時提取。在其開始跑步后1—2個小時所有人的肌鈣蛋白升高。跑步后1小時每個人的肌鈣蛋白水平回落。但是其中的8個人在其后數(shù)小時肌鈣蛋白又重新，開始升高。5人升高的水平持續(xù)至24小時以后。 Yet, Dr. Wood noted, this study involved healthy people. They were not having heart attacks. “Their hearts were fine,” she said. 并且，Wood醫(yī)生提到，此研究人群為健康人群。他們沒有心臟病發(fā)作，她說“他們的心臟是健康”。 It is not known for sure why exercise can elicit such strange lab results, researchers say. But part of the explanation is thought to be immune system responses involving inflammation, and part is thought to be effects of temporary skeletal muscle injury. 研究人員說，還不知道運(yùn)動引出如此奇怪的實驗室化驗結(jié)果的原因是什么。部分的解釋是可認(rèn)為是免疫系統(tǒng)對炎癥的反應(yīng)。一部分解釋是可認(rèn)為是骨骼肌暫時受損的結(jié)果。 For example, some studies biopsied the muscles of runners before and after marathons. After the race, muscle fibers were broken and dying. But skeletal muscle is very different from heart muscle. When heart muscle dies in a heart attack, it never regenerates. Skeletal muscle does. Within four days, those runners had repaired their skeletal muscle, growing new muscle fibers to replace the ones that had died. 例如，一些研究人員對運(yùn)動馬拉松前后的運(yùn)動員的肌肉做活組織檢查。運(yùn)動之后，肌纖維斷裂、壞死。但骨骼肌與心肌有明顯區(qū)別。當(dāng)在心臟病發(fā)作時心肌發(fā)生壞死，它將不能再生。骨骼肌可以再生。其后四天內(nèi)，這些運(yùn)動員機(jī)體會修復(fù)他們的骨骼肌，長出新的肌纖維來代替已經(jīng)死亡的肌纖維。 An echocardiogram also might be misleading. Vigorous exercise can bring on transient abnormalities in the functioning of the left ventricle. 心臟超聲檢查也可能造成誤導(dǎo)。大劑量的運(yùn)動可造成左室功能暫時的異常。 Further complicating the picture is the huge variation from person to person. 人和人之間的差異很大。 “Everyone responds differently,” Dr. Apple said. “Each person is their own little experiment.” APPLE醫(yī)生說：每個人的反應(yīng)都是不同的?！懊總€人都有自己的實驗室結(jié)果?！?br>Enzyme levels also soar in people with larger muscles, men as compared with women, blacks as compared with whites. Enzyme levels in a black man after a marathon can be twice as high as those in a white woman, Dr. Apple said. Apple醫(yī)生認(rèn)為：在肌肉較多的人酶水平可以異常升高。男性與女性比較，白人與黑人比較，馬拉松運(yùn)動后黑人男性的酶水平可以比白人女性高出2倍。 “I’ll often get a call from a clinic,” asking about lab test results for a black man who recently raced, Dr. Apple said. “I’ll say, ‘That’s normal for a black man.’ ” “我常接到臨床的電話，咨詢一個最近參加過運(yùn)動的黑人男性的實驗室檢查結(jié)果，”apple醫(yī)生說“我會說，對于黑人男性那個水平是正常的?！?br>Dr. Wood said that athletes and doctors should be wary of blood tests that seem at odds with clinical findings. All too often athletes end up in emergency rooms after races because they are breathing hard or they fainted or their chests hurt (typically because their stomachs are upset). Often, she added, those athletes are just fine. Wood醫(yī)生說，運(yùn)動員和醫(yī)生在臨床表現(xiàn)與實驗室血化驗不相符時可能會小心翼翼。經(jīng)常運(yùn)動員在比賽后因為呼吸困難或是暈厥或胸痛而進(jìn)入急診室。（特別是因為他們胃部不適），常常，她補(bǔ)充說，這些運(yùn)動員卻是健康的。 “We recognize that after a long-distance endurance event the body is going through some sort of adjustment,” Dr. Wood said. “Most of it is a blip on the radar screen.” “我們認(rèn)識到在長距離耐力事件后，機(jī)體要經(jīng)歷一些調(diào)整”Wood醫(yī)生說：“多數(shù)這些只是雷達(dá)網(wǎng)上的一個尖頭信號而已?！?nbsp; |
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