Sysmex et l’intérêt des dosages biologiques dans le suivi des phases de récupération et des signes de dégradation musculaire avec la Créatine-phosphokinase (CPK) Le dosage des CPK (créatine phos- phokinase) est une analyse san- guine qui permet de mesurer le taux de cette enzyme dans le sang. Cette enzyme est principalement produite par les muscles et est libérée dans le sang lorsqu'il y a des dommages musculaires. Un cas pratique de dosage des CPK pourrait être le suivi d'un sportif après un effort intense ou match de haut niveau qui affecterait les muscles et qui pourrait entraîner une destruction des fibres mus- culaires. Dans ce cas, le dosage des CPK serait utilisé pour surveiller l'évo- lution des dommages et évaluer l'efficacité de la récupération et d’autres phases d'entraînement. Des dosages réguliers de CPK per- mettraient de suivre la progres- sion du dommage musculaire et déterminer si la récupération est efficace ou non. Si le taux de CPK dans le sang est élevé et continu, cela peut indiquer une aggravation du dommage ou une nouvelle lé- sion musculaire récente. Le dosage des CPK peut également être utilisé pour diagnostiquer d'autres troubles musculaires, tels que la rhabdomyolyse, une mala- die qui se caractérise par la des- truction des fibres musculaires et la libération de CPK dans le sang. Cette analyse sanguine est donc utile pour le suivi d'une pathologie musculaire et pour évaluer l'effica- cité des traitements. Il est impor- tant de noter que d'autres tests et examens médicaux peuvent être nécessaires pour confirmer un diagnostic et évaluer la gravité du dommage. À ce jour, le dosage des CPK est largement utilisé dans le domaine du football professionnel, du rug- by et dans diverses fédérations olympiques par le biais d’une gamme d’analyseurs distribués par Sysmex, tel que le FUJI NX 500/600 basé sur de la chimie sèche ainsi que d’autres analyseurs pour la CRP ultra-sensible (hsCRP) et de biochimie. Ces analyseurs, sont des outils précieux pour mo- nitorer la charge musculaire des sportifs de haut niveau. CPK Poster AS Monaco & FFR 12072023 à télécharger en cliquant ici En utilisant cette mesure régu- lièrement, le staff médical (pré- parateurs physique et médecins) peut ajuster les charges de tra- vail à l’entraînement et adapter la récupération pour prévenir les blessures et optimiser les perfor- mances de chacun. Un poster a par ailleurs été réalisé en collaboration avec l’AS Monaco, la Fédération Française de Rug- by (FFR), l’Institut Biologique de Troyes (IBT) sur l’expérience de l'intégration du biomarqueur CK pour améliorer la performance dans le suivi et la gestion des joueurs de football et de rugby de haut niveau. Experiment on the integration of the CK biomarker to enhance performance in the monitoring and management of top-level football and rugby players. Alexandre Creuze1, Gérard Dine2, Julien Piscione3, Alexis Peeters3, Bertrand Mathieu3, Fabrice Epenoy4 1. AS Monaco, 2. IBT, 3. FFR, 4. Sysmex France Background Creatine Kinase (CK/CPK) is a dimeric globular protein (43 kDa) found in muscles that can be measured in the blood to assess muscle damage. While exercise-induced muscle damage is caused by strong muscle contraction during intense activity and over the duration of exercise, both endogenous and exogenous factors are equally important in understanding CK increase. Direct excessive muscle damage leads to muscular trauma. In multiple sports such as football, rugby, and handball, muscles are often damaged by direct impact. The aim of this study on the use of CK in monitoring players throughout the season was to determine whether this biomarker would be an additional tool for monitoring and analyzing athletes’ performance. Methods Following the acquisition of a biochemistry system (Dry chemistry technology), all the analytical results were carried out on capillary blood taken from the fingertips, thus limiting the standard sampling procedures and requiring only a small volume of blood. The analyses were carried out on the FUJI DRY-CHEM NX500/NX600 systems supplied by SYSMEX France. AS Monaco results and experiences Every morning, before training session, one drop of capillary blood was obtained from each player’s fingertip. We collect the results quickly and we combine these results for the well-being of the players. to have an objective CK is a good parameter assessment of readiness, particularly on muscle damage and muscle fatigue. the player's state of The “normal” value and the response to the load is quite variable according to each of the players. This is why, it is very important to have a lot of data to learn the profile of each player. The first step in the analysis is therefore to compare the data of a player to his own value. Thanks to this, we can detect an abnormal response to load training, so if it is combined with muscle soreness and complaints, we will adapt player’s load individually (Fig. 1). We have observed sometimes an abnormal increase of the results with some sick players. This encourages us to decrease the planned load for this player (Fig. 2). We also analyze all the team’s CK to know how the team copes with the load collectively. Thus, with the addition of the analysis of wellbeing and analysis of the external load, we can decide to increase, decrease, or maintain the planned load for the team (Fig. 3). CK is a good parameter to verify and check the effect of the load we planned for the team with a period of work and a period with low load (Fig. 4). FFR results and experiences Figure 1 : normal player profile with games. Red points correspond to match day + 1. You can observe the normal recovery process after the game. Figure 2 : sick player : abnormal increase in CK Figure 3: 2 players not following the team trend Figure 4 : increase in CK for all the team after increase of external load (red square) followed by a good recovery process (green square) Rapport Etat de Forme Equipe : U20 Date : 13/05/16 Hydratation POIDS CMJ QUESTIONNAIRE CPK 1,0214 1,0119 1,0136 1,0086 1,0243 1,0193 1,0151 1,0140 1,0083 1,0173 1,0153 1,0093 1,0059 1,0198 1,0190 1,0156 1,0146 1,0266 1,0075 1,0155 1,0136 1,0154 1,0289 1,0168 Valeur Diff (kg) Valeur 131,2 90,4 133,4 79,9 82,5 80,0 86,3 95,7 109,0 120,6 112,4 84,5 114,9 123,2 81,8 124,5 98,6 75,8 92,6 114,6 97,5 105,6 87,8 103,2 -1,20 -0,48 #N/A 0,50 -0,23 -0,48 0,37 -0,28 0,24 1,12 -0,48 -0,26 0,60 0,34 0,10 -0,62 -0,40 0,66 0,02 -1,20 0,13 -0,95 -0,34 -0,28 3,06 3,77 3,24 3,62 3,76 3,38 3,27 3,64 3,34 3,29 2,74 3,55 3,33 3,18 3,64 3,54 3,27 3,78 3,56 3,40 3,77 3,21 2,99 3,76 ES -0,46 -0,09 -0,56 -0,38 0,02 1,11 -0,84 0,77 -0,93 0,64 -0,60 #DIV/0! 0,26 -1,52 0,08 0,06 -0,68 -0,23 -0,91 -0,03 -0,57 -1,15 -0,56 -0,47 Valeur 20 21 18 23 22 18 20 22 19 18 20 18 28 21 18 23 19 20 21 21 17 24 23 19 ES -0,60 0,14 -0,69 0,16 0,22 -0,94 -0,25 0,59 -0,69 -0,82 0,20 -1,88 0,62 -0,55 0,00 1,23 0,05 -1,55 -0,22 -0,02 -1,53 -0,52 0,44 -0,75 Valeur 233 1040 586 686 199 332 1660 660 1400 2030 735 - 795 393 194 931 268 1790 931 356 737 723 371 215 ES 0,45 1,50 0,49 0,50 -0,39 0,78 1,34 0,90 0,85 1,77 0,71 - 0,45 0,39 0,38 0,06 0,19 1,02 1,07 0,61 0,83 0,16 0,89 -0,72 Poids Perte Poids Prise Poids CMJ QUESTIONNAIRE CPK Variation Positive Variation Trivial Variation faible Variation Positive Variation Trivial Variation faible Variation Trivial Variation faible Variation modérée Variation modérée Variation modérée Variation Forte Variation Forte Variation Forte Variation très Forte As part of the monitoring of players during the preparation phases and international championships, various points are monitored in order to anticipate and prevent any injuries and to monitor the general condition of the players. In order to obtain and evaluate CK results, it is important to define a solid baseline at times when the player is supposed to be in the best shape, i.e. outside matches. This baseline is made up of around ten of the most relevant CK data points. The set of data used to define the best physical condition is used at the start of each selection meeting and 36 to 48 hours after the match to obtain the most relevant information, in order to adjust the training load or decision if a certain player is ready and fit enough for a match. BRENNAN BUROS LOMBE UILLOUD VILLE CK measurement and monitoring complements hydration monitoring corresponding to urine density measured with a refractometer, weight monitoring, vertical jumping (CMJ) for neuromuscular assessment, and a 'Hooper' type questionnaire to assess general fitness, sleep quality, physical pain, anxiety and general mood. Each parameter measured and assessed in this way is compared and expressed in Effect Size (ES) in order to limit excessive variations. PESENTI UZIN LOFUA In the case of CK monitoring, if we take as an example the second line of the "Fitness monitoring chart” (Fig. 5), the player's CK level is higher than normal compared to his baseline and he does not express through his questionnaire a particular perception of fatigue and his neuromuscular performance. However, this makes it possible to focus on the questionnaire and to initiate a more in-depth discussion on the CROS RMON CRON ALLO DUFOUR L FAKIR LIBERT LINGAR ACLAYAT PORTE AUVAKA LLET ANDEBE COUE UBERTI VERHAEGHE Collecting process during world U20 championship Discussion player's feelings and the way in which he should take charge of his training, with adjustments to weight training, for example, so as not to add to muscular deterioration, and above all to get him out of any training contact if there were to be any. Figure 5 : Fitness monitoring chart [ 8 ] Juillet - Août - Septembre 2024 - Sysmex Mag #14 Sommaire The use of the CK biomarker is a complementary tool for monitoring the well-being of players throughout their physical efforts. It is a parameter that can be used to check and monitor the effect of workload in preparation for and after matches. The extent of muscle damage and the increase in CK levels are related to both the intensity and duration of exercise, with intensity playing the main role. The decrease in CK levels depends on the period of rest after exercise. FE - July 2023 CPK Poster AS Monaco & FFR 12072023