GPBB、cTnI、CK、CKMB在急性心肌梗死伴糖尿病早期诊断中的临床应用价值

分析心肌梗死伴糖尿病患者血清中糖原磷酸化酶同工酶BB(GPBB)、肌钙蛋白I (cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)水平的变化。结果显示糖尿病组、单纯急性心肌梗死组及急性心肌梗死伴糖尿病组患者血清中GPBB、cTnI、CK、CKMB、BNP及超敏C反应蛋白(Hs-CRP)水平明显升高(P<0.05),且急性心肌梗死伴糖尿病组患者与其他组相比差异均有显著性(P<0.05);与GPBB、cTnI、CK、CKMB单独检测相比,各项目联合检测急性心肌梗死伴糖尿病敏感度和特异性均明显升高(P<0.05)。因此, GPBB、cTnI、CK、CKMB联合检测在急性心肌梗死伴糖尿病早期诊断中具有重要的参考价值。     

Insulin alters cardiac muscle creatine kinase activity

The expression of mRNAs of creatine kinase (CK)-B and CK-M has been show to be affected by insulin, and myocardial CK-MB activity is suppressed in insulin-deficient rats. We investigated the dose-related effect of insulin on CK-MB activity in cardiac and skeletal muscles. Male Wistar rats were divided into three groups: (1) control group, (2) diabetic group, injected with 65 mg/kg streptozotocin for 4 weeks, and (3) atenolol group, administered 30 mg/kg per day atenolol. Each group was further divided into three subgroups and administered either saline, or 20 (Ins 20) or 30 (Ins 30) U/kg per day insulin. After 3 weeks, the isoenzyme activity of CK and lactate dehydrogenase (LDH) in the left ventricle of the heart (LV) and the major pectoral muscle (PM) was measured. Serum insulin increased and plasma glucose decreased in Ins 20 and Ins 30, dose-dependently, in all three groups. Both CK-MB and -BB activity in LV increased dose-dependently with insulin treatment in the control, diabetes, and atenolol groups, although these changes did not occur in skeletal muscles. CK-MB in LV correlated with the serum insulin levels in all rats, while no correlation was found in the skeletal muscles. These findings suggest that insulin possibly regulates the distribution of CK isoenzymes in rat heart muscle, and that the effect of insulin is not due to the sympathetic drive induced by hypoglycemia. Received: November 8, 1999 / Accepted: February 12, 2000     

miR-1-3p在食蟹猴心肌损伤中表达水平及其与CK-MB、cTnI和NT-proBNP的相关性

目的探讨循环miR-1-3p在多柔比星诱导食蟹猴心肌损伤模型中的表达水平和诊断价值。方法选取3~5岁普通级雄性食蟹猴17只,随机分为对照组(7只)和实验组(10只),静脉注射盐酸多柔比星注射液(2.5 mg/kg)4周,收集外周血浆标本和心脏组织标本,应用液相芯片技术测定肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)和NT-proBNP表达水平,且应用实时定量PCR技术测定miR-1-3p表达的水平,并进行相关性分析。结果成功建立药物致食蟹猴心肌损伤模型;两组CK-MB、cTnI和NT-proBNP水平比较差异有统计学意义(P<0.05);实验组miR-1-3p的表达水平在给药4周后较给药前和对照组相比明显升高(P<0.05);miR-1-3p的表达水平与CK-MB、cTnI和NT-proBNP改变呈现了相同的升高趋势,且二者之间具有明显相关性。结论miR-1-3p可作为药物引起心肌损伤的生物学诊断标志物之一。     

生长分化因子15对急性胸痛早期诊断价值分析

目的:探索生长分化因子15（growth differentiation factor15,GDF15）在急性胸痛中的早期诊断价值。方法:回顾性收集2020年1月至11月于解放军总医院海南医院急诊科就诊的急性胸痛患者96名纳入研究。记录患者性别、年龄、入院30 min内患者的肌钙蛋白T、肌酸激酶、肌酸激酶同工酶、GDF15、B型钠尿肽,比较不同组各个指标的差异。绘制ROC曲线,评价GDF15与TnT/BNP对急性冠脉综合征（acute coronary syndrome,ACS）诊断价值。统计各个患者的Gensini评分、左室射血分数、住院滞留天数以及支架植入个数,评价这些指标与GDF15浓度的相关关系。结果:急性胸痛中总的趋势呈现男多女少（72.92 vs. 27.08,%）,年龄最大的组别为UA组,年龄为（64.67±13.87）岁,年龄最小的组别是呼吸心搏骤停组,仅为（47.29±9.99）岁。STEMI组、NSTEMI组、UA组中既往罹患高血压病比例较高,所有组别均未在既往罹患糖尿病中表现出明显优势。所有心肌标记物组间差异均有统计学意义,GDF15在ACS相关性胸痛组浓度更高[（2.360±1.710） ng/mL vs. （1.380±1.040） ng/mL, P<0.01]。GDF15与TnT联合对于诊断ACS相关性胸痛的价值最高,其工作特征曲线下面积（the area under the receiver operating characteristic,AUC）可达0.863。GDF15浓度与心脏射血分数负相关,Gensini评分正相关,植入支架个数正相关,患者住院天数正相关。 结论:GDF15在急性胸痛中具有很好的诊断及预后预测价值。GDF15与TnT联合可提高ACS诊断率。     

射频消融术前后心肌损害标志物的变化

目的　探讨血清肌酸激酶同工酶 (CK- MB)、心肌肌钙蛋白 I(c Tn I)、肌红蛋白 (Mb)检测 ,对射频消融术 (RF-CA)所致心肌损伤的诊断价值。方法　选择 30例室上性心动过速患者 ,分别于 RFCA前、电生理检查后、术后即刻、术后 1d、2 d采外周静脉血 ,采用美国德普公司自动免疫化学发光分析仪分别测定血清 CK- MB、 c Tn I、Mb。结果　 CK- MB术后 1d较术前增高 (P<0 .0 1) ;c Tn I与术前相比术后 1d、2 d明显增高 (P<0 .0 5 ) ;与术前相比术后即刻 Mb明显增高 (P<0 .0 1)。结论　 RFCA所造成心肌损伤属微小心肌损伤 ,可使血清心肌损害标志物有不同程度的升高 ,CK- MB、c Tn I、Mb可用于 RFCA对心肌损伤的监测。     

用分子生物学技术分析国内六株旋毛虫分离株

本文首次对来自我国不同地区、不同宿主来源有代表性的6个旋毛虫分离株从基因组DNA的限制性酸切长度多态性、同工酶及可溶性蛋白进行综合研究。核酸结果显示：长春株与其余各地域株的限制性酶切困话间存在着差异，用长春株特异性DNA片段（1．12kb）制成探针，与各株DNA进行Southern杂交，发现各虫株的杂交带型不一，且仅长春株出现1．12kb杂交带。同工酶结果显示：长春株与其余各珠在5种同工酶（GPI、G6PD、HK、6PGDH及AK）酶谱中有显著不同。等电聚焦电泳结果显示：长春株具有一条约4.1PI的特异带。上述结果提示：我国6株旋毛虫分离株间存在着差异，长春株与其余各株差异显著，从而推断我国旅毛虫虫株至少存在2种不同的生物学类型，其间的差异主要与不同的地理分布和／或不同宿主来源有关。     

甲胎蛋白和GGT-Ⅱ联合检测在肝癌患者诊断中的意义

目的：探讨两种肝癌标志物甲胎蛋白（α-fetoprotein,AFP）和γ-谷氨酰转移酶同工酶Ⅱ（γ-glutamyltransferase isoenzymeII,GGT-Ⅱ）单独检测和联合检测原发性肝癌（primaryhepatocellularcar cinoma,PHC）的早期诊断价值。方法：GGT-Ⅱ检测采用聚丙烯酰胺凝胶电泳法,AFP检测采用电化学发光免疫分析法。分别对33例乙型肝炎患者,30例肝炎后肝硬化患者,44例原发性肝癌患者以及35名健康体检者进行GGT-Ⅱ和AFP检测,综合分析2项指标对PHC的诊断价值。结果：PHC组的GGT-Ⅱ和AFP的阳性率均明显高于肝硬化组、肝炎组和健康对照,差异有统计学意义（P〈O．01）,联合检测敏感性高于单一检测指标。结论：血清GGT-Ⅱ及AFP联合检测可提高PHC的诊断灵敏度,提高肝癌的早期检出率。     

Unspecific elevation of plasma troponin‐T and CK‐MB after coronary surgery

Objective—Biochemical markers of myocardial injury are frequently elevated after cardiac surgery. It is generally accepted that release unrelated to permanent myocardial damage explains a proportion of these elevations. However, little is known about the magnitude and temporal characteristics of this diagnostic noise. One way to address this issue would be to study a group without permanent myocardial injury.

Design—The unique release kinetics of troponin‐T (permanent myocardial injury causes a sustained release of structurally bound troponin) were used to identify patients with no or minimal permanent myocardial injury. Blood was sampled from patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) before surgery, 3 and 8?h after unclamping the aorta, and each morning until postoperative day 4, for analysis of enzymes and troponin‐T. From 302 consecutive patients a subgroup was identified that fulfilled the following criteria: (a) normalized troponin‐T levels ≤postoperative day 4; (b) no ECG changes indicating myocardial injury.

Results—Seventy‐seven patients fulfilled the criteria above and in this subgroup troponin‐T (2.08?±?1.42?μg/l; range 0.35–8.99?μg/l) peaked at the 3?h recording and creatine kinase monobasic (CK‐MB) (28.6?±?11.3?μg/l; range 11.9–86.0?μg/l) peaked at the 8?h recording after unclamping the aorta.

Conclusion—Substantial early elevations of plasma CK‐MB and troponin‐T occurred in patients with no or minimal permanent myocardial injury after CABG. Unspecific release was most pronounced during the timeframe that is usually studied to evaluate myocardial protective strategies or to compare revascularization procedures.     

急性心肌梗死患者血清lncRNA p21表达水平及临床意义

目的 探究急性心肌梗死(AMI)患者血清lncRNA p21表达水平及临床意义。方法 选取河南科技大学第一附属医院心外科2019年1月至2021年1月收治的92例AMI患者(AMI组),根据冠脉病变程度分为轻度病变组(n=29)、中度病变组(n=43)和重度病变组(n=20);同期选择本院体检健康者92例为对照组。AMI患者在经皮冠状动脉植入术(PCI)术后随访24个月,将患者分为心血管不良事件(MACE)组(n=22)和非MACE组(n=70)。采用实时荧光定量聚合酶链式反应检测研究对象血清中lncRNA p21表达水平。采用Pearson法分析AMI患者血清lncRNA p21水平与肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平的相关性。采用受试者工作特征(ROC)曲线评价血清lncRNA p21水平预测AMI的价值。结果 与对照组相比,AMI组血清lncRNA p21相对表达水平较低(P＜0.05),CK-MB及cTnI水平较高(P＜0.05)。与轻度病变组相比,中度病变组、重度病变组血清lncRNA p21相对表达水平较低(P＜0.05),CK-MB、cTnI水平较高(P＜0.05);与中度病变组相比,重度病变组血清lncRNA p21相对表达水平较低(P＜0.05),CK-MB、cTnI水平较高(P＜0.05)。AMI患者血清lncRNA p21水平与cTnI、CK-MB水平均呈负相关(P＜0.05)。ROC曲线显示,lncRNA p21水平预测AMI的曲线下面积(AUC)为0.861,其灵敏度、特异度分别为70.70%、89.10%;lncRNA p21联合cTnI、CK-MB预测AMI的AUC为0.956,其灵敏度、特异度分别为89.10%、94.60%。与非MACE组相比,MACE组治疗前血清lncRNA p21相对表达水平较低(P＜0.05)。结论 AMI患者血清lncRNA p21表达水平下降,lncRNA p21对AMI具有一定的诊断价值。     

CK-MB在儿童支气管肺炎辅助检查中的临床意义

目的 探讨血清磷酸肌酸同工酶(CK-MB)检测在儿童轻症支气管肺炎辅助检查中的临床意义,以期指导临床诊治.方法 收集2015年1~8月85例本院收治的轻症支气管肺炎患儿,分为学龄期组(7~14岁) 6例、学龄前期组(4~6岁) 22例和婴幼儿期组(0~3岁) 57例,入院时常规检测患儿CK-MB的数值,分析其在不同年龄组中的变化情况.结果 85例住院患儿中男性49例,女性36例,婴幼儿组11例患儿CK-MB升高(19%),学龄前期患儿组1例升高(5%),学龄期组患儿无一例CK-MB升高.男性患儿CK-MB数值为(2.40±1.76) ng/ml,女性患儿为(2.93±1.96) ng/ml,两者比较差异无统计学意义(P>0.05).婴幼儿组患儿CK-MB为(3.23±1.84) ng/ml,学龄前期组为(1.58±1.27) ng/ml,学龄期组为(0.75±0.57) ng/ml,婴幼儿组支气管肺炎患儿血液CK-MB数值较学龄前期和学龄期患儿显著升高,差异均有统计学意义(P<0.05).结论 CK-MB是目前临床判断患儿心肌受损的经典检测指标,婴幼儿支气管肺炎轻症合并心肌受损的发生概率相对较高,血清CK-MB的检测应作为婴幼儿支气管肺炎的常规检查,可以使患儿得到更好的诊治.对于学龄前期和学龄期轻症支气管肺炎患儿,血清CK-MB可不作为临床常规的辅助检查.