| Abstract | Uvod: Rekreacijsko ronjenje s komprimiranim plinskim smjesama (engl. self-contained underwater breathing apparatus, SCUBA) poseban je oblik tjelesne aktivnosti koja, zbog specifičnih uvjeta okoline predstavlja stres za organizam. Dosadašnje su studije, pokušavajući objasniti odgovor organizma na SCUBA ronjenje, prepoznale važnost njegovog učinka na kardiovaskularni sustav, no molekularni mehanizmi koji dovode do tog učinka još uvijek nisu u potpunosti razjašnjeni.
Cilj rada: Cilj je ovog istraživanja bio pridonijeti razumijevanju promjena kardiovaskularnog, mišićnog i imunosnog sustava izazvanih rekreacijskim SCUBA ronjenjem na molekularnoj razini praćenjem specifičnih biokemijskih biljega.
Ispitanici i metode: U tu je svrhu jedna skupina ronilaca (N=16) izvela 1 neovisan, a druga skupina (N=14) 5 susljednih zarona kako bi se procijenio jednokratni, odnosno kumulativni učinak SCUBA ronjenja na kardiovaskularni sustav. Plazmatske koncentracije Gal-3, hs-TnI, NT-proBNP, mioglobina, hs-CRP, IL-6 VEGF i ET-1 te serumske koncentracije CRP, CK, CK-MB i LD, kao i ukupan broj leukocita određene su u različitim vremenskim točkama odgovarajućim analitičkim postupcima.
Rezultati: Analizom dobivenih rezultata studije učinka jednokratnog SCUBA ronjenja utvrđeni su statistički značajni porasti Gal-3, hs-TnI, NT-proBNP, mioglobina i VEGF te pad koncentracije ET-1 odmah nakon ronjenja u odnosu na vrijednosti prije ronjenja. Koncentracija hs-CRP se nije značajno mijenjala. Vršne koncentracije, uz povratak na bazalne vrijednosti 6 sati nakon ronjenja, mioglobin i VEGF postigli su odmah nakon zarona, dok je za Gal-3 to ostvareno 3 sata nakon zarona. hs-TnI i NT-proBNP kontinuirano su rasli kroz cijeli period praćenja. Nakon inicijalnog pada, konc. ET-1 3 sata nakon ronjenja počinje rasti, međutim do 6. sata ne vraća se na svoju bazalnu vrijednost. Studijom kumulativnog učinka SCUBA ronjenja potvrđene su sve promjene koncentracija nakon ronjenja utvrđene studijom jednokratnog učinka SCUBA ronjenja. Međutim, uočeni kumulativni učinak na kardiovaskularni i mišićni sustav očituje se kontinuiranim padom koncentracija Gal-3, hs-TnI, mioglobina i VEGF te porastom koncentracija NT-proBNP, IL-6 i ET-1 kroz promatrani period praćenja od mjesec dana. Studijom je utvrđena i klinička značajnost promjene hs-TnI, Gal-3, NT-proBNP i mioglobina koja se odvija unutar fizioloških mehanizama prilagodbe kardiovaskularnog sustava rekreacijskom SCUBA ronjenju.
Zaključak: Rekreacijsko SCUBA ronjenje u uvjetima studije jednokratnog učinka uzrokuje blago oštećenje srčanog mišića, narušavanje integriteta membrane skeletnog mišića te prilagodbu vaskularnog endotela. Opetovanim ronjenjem jednom tjedno u periodu od mjesec dana, dolazi do aktivacije mehanizama prilagobe koji taj učinak čine blažim za organizam. |
| Abstract (english) | Background: Recreational SCUBA (self-contained underwater breathing apparatus) diving is a special form of physical activity which due to specific environmental conditions represents a stress for the organism. In order to explain this response, previous studies have recognized the importance of changes in cardiovascular system (CVS). However, the molecular mechanisms that lead to these changes are still unclear.
Aim of the study: The aim of this study is to contribute to the understanding of (pato)physiological changes in CVS caused by recreational SCUBA (rSCUBA) diving at molecular level by monitoring specific biochemical markers.
Participants and Methods: For this purpose, one group of divers (N=16) performed 1 independent dive, while the other group (N=14) performed 5 dives in series after 5 months of non-diving to evaluate the single and cumulative effect of rSCUBA diving on CVS, respectively. In the single dive effect study blood samples were collected in 4 time-points, while in cumulative effect study in 6 time-points. Gal-3, hs-TnI, NT-proBNP, myoglobin, hs-CRP, IL-6 VEGF, and ET-1 plasma concentrations, CK, CK-MB, LD serum catalytic concentrations as well as total leukocyte count were determined using appropriate analytical methods.
Results: In single dive effect study, statistically significant increases in NT-proBNP, hs-TnI, VEGF, myoglobin, and Gal-3 plasma concentrations were detected immediately after the dive compared with pre-dive concentrations. ET-1 significantly decreased immediately after the dive then increased 3 h after diving continuing to rise at 6 h after the dive, but it did not reach its initial pre-dive value. hs-TnI and NT-proBNP remained elevated during the whole recovery period. Myoglobin, VEGF, and Gal-3 returned to their initial values 6 h after diving. Clinically significant change for hs-TnI and NT-proBNP during recovery as compared to the pre-dive period was observed. Gal-3 was clinically significantly higher in its peak value as compared to pre-dive. In cumulative effect study first dive induced statistically significant changes for all biomarkers except for total leukocyte count, CRP, hs-CRP, CK-MB, and LD. Myoglobin, hs-TnI, NTproBNP, VEGF, Gal3, IL-6, and CK significantly increased, while ET1 decreased immediately after the first dive. Third and fifth dive caused the same significant changes in all biomarkers, including the increase for total leukocyte count, CRP, hsCRP, CK-MB, and LD after the dive. There is also a significant change in all biomarkers if comparing pre-dive 3 and 5 values to the pre-dive 1 values; hsCRP, IL-6, NTproBNP, and ET1 concentrations increased significantly by each preformed dive, while myoglobin, hsTnI, VEGF, and Gal3 values decreased. If comparing all postdive values, only ET1 did not changed significantly.
Conclusion: The single dive study showed that rSCUBA diving (30 m, 30 min) is followed by plasma level changes of hs-TnI, NT-proBNP, Gal-3, myoglobin, ET-1, and VEGF that reflect adverse but reversible consequences on cardiovascular function and integrity. However, under challenging environmental conditions, stress forces organisms to adapt to the rapidly changing surroundings. Therefore, in cumulative effect study, we showed that repeatedly performed rSCUBA diving (five dives, one per week) triggered activation of an adaptive response of the cardiovascular, muscular, and immune systems that were reflected in changes in the specific biomarkers. |
