BMJ Open：马拉松比赛前摄入止痛药存在潜在患病风险

近期BMJ Open上发表的一项研究表明，在马拉松以及其它一些耐力型运动前服用止痛药是不明智的，会造成严重的副作用反应。为了研究止痛药物可能对运动员产生的影响，Michael Küster教授向参加2010年波恩马拉松及半程马拉松的运动员发出调查问卷，其中采集了药物史及比赛前后症状等各类信息。最后，7048名参赛选手中，56%（<4000）提交了网上问卷，其中大多数人（87%）以前参加过马拉松运动。

在赛前服用过止痛药的选手中，20%表示他们也曾在训练中用止痛药来缓解疼痛；10%的选手有赛前疼痛症状。然而，所有选手中仅1%的选手从未服用过止痛药。半数以上的止痛药的购买时都勿需医生处方，所涉及的药物包括双氯芬酸、阿司匹林和布洛芬。

止痛药的使用与否对退赛选手的数量未产生明显作用差异。但在服用止痛药的选手中，因胃肠道症状而退出比赛者明显更多；同时，尽管肌肉痉挛引起退赛的情况很少见，但服用止痛药会使此类情况增多。另外，出现包括胃痉挛、心血管问题、肠胃道出血、血尿、关节和肌肉疼痛的风险是不服药者的5倍。两者的总体风险差异达13%。并且风险几率和服药剂量呈正相关。

十分之一的布洛芬拥趸者每日用量超过100mg；使用排名第二的布洛芬，43%的服用者每天用量达到或超过800mg（两倍于推荐剂量）。实际上，参与调查的这些选手们几乎都没有意识到在耐力型运动中止痛药所带来的风险。服药的选手中有9名最后接受了住院治疗：3名因服用布洛芬造成急性肾损伤；4名出现消化道溃疡出血（与阿司匹林相关）；2名因出现心肌梗死住院（阿司匹林相关）；其中有1人因脚痛服用了500mg的阿司匹林。未服用止痛药的选手均无须送院治疗。

止痛药，主要是抑制环氧化酶（COX）在发挥作用，由此抑制了花生四烯酸转化为前列腺素这一通路，从而达到止痛效果。而前列腺素诱发炎症，引起疼痛症状以及保护胃黏膜方面的作用是显而易见的。本文作者的观点是，当机体处于巨大压力下时（例如耐力运动），前列腺素还可以保护机体组织。至于是否应在赛前赛中禁用止痛药，尚需进一步的研究证实。

与止痛药相关的拓展阅读：

• 止痛药成瘾：横扫美国的大灾难
• IJC:用止痛药布洛芬或可减少膀胱癌风险
• AJE：止痛药可能导致女性耳聋风险增加
• Cancer：常用止痛药有预防皮肤癌功效
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Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study
Objectives
To prevent pain inhibiting their performance, many athletes ingest over-the-counter (OTC) analgesics before competing. We aimed at defining the use of analgesics and the relation between OTC analgesic use/dose and adverse events (AEs) during and after the race, a relation that has not been investigated to date.
Design
Prospective (non-interventional) cohort study, using an online questionnaire.
Setting
The Bonn marathon 2010.
Participants
3913 of 7048 participants in the Bonn marathon 2010 returned their questionnaires.
Primary and secondary outcomes
Intensity of analgesic consumption before sports; incidence of AEs in the cohort of analgesic users as compared to non-users.
Results
There was no significant difference between the premature race withdrawal rate in the analgesics cohort and the cohort who did not take analgesics (‘controls’). However, race withdrawal because of gastrointestinal AEs was significantly more frequent in the analgesics cohort than in the control. Conversely, withdrawal because of muscle cramps was rare, but it was significantly more frequent in controls. The analgesics cohort had an almost 5 times higher incidence of AEs (overall risk difference of 13%). This incidence increased significantly with increasing analgesic dose. Nine respondents reported temporary hospital admittance: three for temporary kidney failure (post-ibuprofen ingestion), four with bleeds (post-aspirin ingestion) and two cardiac infarctions (post-aspirin ingestion). None of the control reported hospital admittance.
Conclusions
The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted AEs that increase with increasing analgesic dose. Analgesic use before endurance sports appears to pose an unrecognised medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.