化验显示心脏病发作，但病人却安然无恙？
2009-05-26 20:36:34 来源： 作者： 评论：0 点击：
The Lab Says Heart Attack, but the Patient Is Fine
化验显示心脏病发作，但病人却安然无恙？
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岁男性，看似健康状况良好，在刚结束10公里跑步后晕倒，急送入院。急诊室内进行了血化验。他的心肌蛋白（肌钙蛋白）异常升高。看来他似乎心脏病发作了。
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.
该患者最后被送入耶路撒冷的希伯莱哈大沙大学医疗中心的冠心病加护病房。他入院四天，接受了一次又一次的血化验，然而没有发生异常。他的医生：Lior Tolkin 、Beth Goldstein 及David Rott –在近期心脏病学刊物上报到，该患者无其它心脏病发作的表现，每一项心脏功能检查的结果均正常。他异常升高的肌钙蛋白水平（肌钙蛋白可用来诊断心肌损伤）已经回复正常。
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.
这是一个错误的警告还是心脏病发作已经转归，又或者是实验室的失误造成的呢？研究人员认为，最可能的解释是对该患者的了解不够，而不是惊奇于一个普通的现象：血化验在经历长时间或是激烈的运动后的短期内会出现异常。可能会甚至指向心脏病发作或是肝衰竭。但常常这种患者并不处于危险之中，异常的结果会回复正常而不被注意。
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.
当发生在10公里的短距离跑步后出现这一个不寻常的影响，研究人员说他们已经意识到这是个普遍的问题。
“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.
明尼苏达大学医学院实验室医学和病理学专家 Fred Apple医生说，“我能告诉你好多相似的事情”
In one, in fact, he is the center of the story.
事实上，其中一个，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医生喜欢在自己身上试验，所以，一天，当他还是位于圣路易的华盛顿大学的一位住院医生时，他抽取自己的血液然后送去医院的实验室做常规检验。
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.
接下来他所知道的，就是他被呼唤着护送进了心脏病加护病房。血化验的结果异常骇人。血液中的一种酶，肌酸激酶同功酶，高于正常10倍。就如Israel的运动者，看起来APPLE医生似乎也心脏病发作了。
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).
他的心脏是健康的。但是APPLE医生刚进行了一次长跑（那时他一周跑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年代初期的那次的经历，使APPLE医生对剧烈运动后的实验室检查结果产生了好奇，随后他对此问题进行了系统性的研究，证明了运动后的影响。
“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医生说，“我认为有5%的人运动时给机体的压力会导致一些酶水平升高于心脏病发作时这些酶的水平。”
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.”
他建议，为了避免错误的警报，运动后24小时人们应避免实验室检查。他说，如果不这样做，“你在寻求被探察出异常的结果。”
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医生（麻萨诸塞州总院的心脏病学家）其同时也是一个马拉松运动员，进一步说明，“我想如果身体没有感到不适，进行血化验真不是个好主意。”
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医生和其同事研究了波士顿马拉松比赛的运动员，在比赛前后对他们进行血液化验，测量其中能协诊卒中风险和心脏病发作的蛋白质的水平。
“Almost everything we looked at went up,” she said.”我们看到的每一项几乎都升高了。”她说。
And it may not take hours of exercise to do it.并且可能不需要数小时的运动就可以做到。
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和他在英国Brune大学的同事最近在心脏病学美国大学学报上报道，9名男孩在跑步机上进行相当于马拉松距离的长跑，研究者在其运动时每隔30分钟在其身上提取血样，其后每隔24小时提取。在其开始跑步后1—2个小时所有人的肌钙蛋白升高。跑步后1小时每个人的肌钙蛋白水平回落。但是其中的8个人在其后数小时肌钙蛋白又重新，开始升高。5人升高的水平持续至24小时以后。
Yet, Dr. Wood noted, this study involved healthy people. They were not having heart attacks. “Their hearts were fine,” she said.
并且，Wood医生提到，此研究人群为健康人群。他们没有心脏病发作，她说“他们的心脏是健康”。
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.
研究人员说，还不知道运动引出如此奇怪的实验室化验结果的原因是什么。部分的解释是可认为是免疫系统对炎症的反应。一部分解释是可认为是骨骼肌暂时受损的结果。
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，一些研究人员对运动马拉松前后的运动员的肌肉做活组织检查。运动之后，肌纤维断裂、坏死。但骨骼肌与心肌有明显区别。当在心脏病发作时心肌发生坏死，它将不能再生。骨骼肌可以再生。其后四天内，这些运动员机体会修复他们的骨骼肌，长出新的肌纤维来代替已经死亡的肌纤维。
An echocardiogram also might be misleading. Vigorous exercise can bring on transient abnormalities in the functioning of the left ventricle.
心脏超声检查也可能造成误导。大剂量的运动可造成左室功能暂时的异常。
Further complicating the picture is the huge variation from person to person.
人和人之间的差异很大。
“Everyone responds differently,” Dr. Apple said. “Each person is their own little experiment.”
APPLE医生说：每个人的反应都是不同的。“每个人都有自己的实验室结果。”
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医生认为：在肌肉较多的人酶水平可以异常升高。男性与女性比较，白人与黑人比较，马拉松运动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.’ ”
“我常接到临床的电话，咨询一个最近参加过运动的黑人男性的实验室检查结果，”apple医生说“我会说，对于黑人男性那个水平是正常的。”
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医生说，运动员和医生在临床表现与实验室血化验不相符时可能会小心翼翼。经常运动员在比赛后因为呼吸困难或是晕厥或胸痛而进入急诊室。（特别是因为他们胃部不适），常常，她补充说，这些运动员却是健康的。
“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.”
“我们认识到在长距离耐力事件后，机体要经历一些调整”Wood医生说：“多数这些只是雷达网上的一个尖头信号而已。”
化验显示心脏病发作，但病人却安然无恙？
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岁男性，看似健康状况良好，在刚结束10公里跑步后晕倒，急送入院。急诊室内进行了血化验。他的心肌蛋白（肌钙蛋白）异常升高。看来他似乎心脏病发作了。
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.
该患者最后被送入耶路撒冷的希伯莱哈大沙大学医疗中心的冠心病加护病房。他入院四天，接受了一次又一次的血化验，然而没有发生异常。他的医生：Lior Tolkin 、Beth Goldstein 及David Rott –在近期心脏病学刊物上报到，该患者无其它心脏病发作的表现，每一项心脏功能检查的结果均正常。他异常升高的肌钙蛋白水平（肌钙蛋白可用来诊断心肌损伤）已经回复正常。
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.
这是一个错误的警告还是心脏病发作已经转归，又或者是实验室的失误造成的呢？研究人员认为，最可能的解释是对该患者的了解不够，而不是惊奇于一个普通的现象：血化验在经历长时间或是激烈的运动后的短期内会出现异常。可能会甚至指向心脏病发作或是肝衰竭。但常常这种患者并不处于危险之中，异常的结果会回复正常而不被注意。
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.
当发生在10公里的短距离跑步后出现这一个不寻常的影响，研究人员说他们已经意识到这是个普遍的问题。
“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.
明尼苏达大学医学院实验室医学和病理学专家 Fred Apple医生说，“我能告诉你好多相似的事情”
In one, in fact, he is the center of the story.
事实上，其中一个，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医生喜欢在自己身上试验，所以，一天，当他还是位于圣路易的华盛顿大学的一位住院医生时，他抽取自己的血液然后送去医院的实验室做常规检验。
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.
接下来他所知道的，就是他被呼唤着护送进了心脏病加护病房。血化验的结果异常骇人。血液中的一种酶，肌酸激酶同功酶，高于正常10倍。就如Israel的运动者，看起来APPLE医生似乎也心脏病发作了。
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).
他的心脏是健康的。但是APPLE医生刚进行了一次长跑（那时他一周跑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年代初期的那次的经历，使APPLE医生对剧烈运动后的实验室检查结果产生了好奇，随后他对此问题进行了系统性的研究，证明了运动后的影响。
“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医生说，“我认为有5%的人运动时给机体的压力会导致一些酶水平升高于心脏病发作时这些酶的水平。”
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.”
他建议，为了避免错误的警报，运动后24小时人们应避免实验室检查。他说，如果不这样做，“你在寻求被探察出异常的结果。”
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医生（麻萨诸塞州总院的心脏病学家）其同时也是一个马拉松运动员，进一步说明，“我想如果身体没有感到不适，进行血化验真不是个好主意。”
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医生和其同事研究了波士顿马拉松比赛的运动员，在比赛前后对他们进行血液化验，测量其中能协诊卒中风险和心脏病发作的蛋白质的水平。
“Almost everything we looked at went up,” she said.”我们看到的每一项几乎都升高了。”她说。
And it may not take hours of exercise to do it.并且可能不需要数小时的运动就可以做到。
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和他在英国Brune大学的同事最近在心脏病学美国大学学报上报道，9名男孩在跑步机上进行相当于马拉松距离的长跑，研究者在其运动时每隔30分钟在其身上提取血样，其后每隔24小时提取。在其开始跑步后1—2个小时所有人的肌钙蛋白升高。跑步后1小时每个人的肌钙蛋白水平回落。但是其中的8个人在其后数小时肌钙蛋白又重新，开始升高。5人升高的水平持续至24小时以后。
Yet, Dr. Wood noted, this study involved healthy people. They were not having heart attacks. “Their hearts were fine,” she said.
并且，Wood医生提到，此研究人群为健康人群。他们没有心脏病发作，她说“他们的心脏是健康”。
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.
研究人员说，还不知道运动引出如此奇怪的实验室化验结果的原因是什么。部分的解释是可认为是免疫系统对炎症的反应。一部分解释是可认为是骨骼肌暂时受损的结果。
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，一些研究人员对运动马拉松前后的运动员的肌肉做活组织检查。运动之后，肌纤维断裂、坏死。但骨骼肌与心肌有明显区别。当在心脏病发作时心肌发生坏死，它将不能再生。骨骼肌可以再生。其后四天内，这些运动员机体会修复他们的骨骼肌，长出新的肌纤维来代替已经死亡的肌纤维。
An echocardiogram also might be misleading. Vigorous exercise can bring on transient abnormalities in the functioning of the left ventricle.
心脏超声检查也可能造成误导。大剂量的运动可造成左室功能暂时的异常。
Further complicating the picture is the huge variation from person to person.
人和人之间的差异很大。
“Everyone responds differently,” Dr. Apple said. “Each person is their own little experiment.”
APPLE医生说：每个人的反应都是不同的。“每个人都有自己的实验室结果。”
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医生认为：在肌肉较多的人酶水平可以异常升高。男性与女性比较，白人与黑人比较，马拉松运动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.’ ”
“我常接到临床的电话，咨询一个最近参加过运动的黑人男性的实验室检查结果，”apple医生说“我会说，对于黑人男性那个水平是正常的。”
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医生说，运动员和医生在临床表现与实验室血化验不相符时可能会小心翼翼。经常运动员在比赛后因为呼吸困难或是晕厥或胸痛而进入急诊室。（特别是因为他们胃部不适），常常，她补充说，这些运动员却是健康的。
“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.”
“我们认识到在长距离耐力事件后，机体要经历一些调整”Wood医生说：“多数这些只是雷达网上的一个尖头信号而已。”
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