急性冠脉综合征患者行心肌肌钙蛋白Ⅰ定性检测的意义及护理

目的掌握心肌肌钙蛋白Ⅰ（cTnI）定性测定的意义及方法，提高急性冠脉综合征（ACS）早期诊断率。方法对怀疑ACS患者在发病〈6h、6～72h、〉72h于床边采血进行cTnI、肌红蛋白（Mb）及肌酸激酶同工酶（CKMB）测定。结果发病≤72h cTnI阳性率低于和显著低于Mb、CK-MB（P〈0．05，P〈0．01），〉72h高于和显著高于Mb、CK-MB（P〈0．05）。结论cTnI为ACS特异性指标，床边cTnI定性测定有利于提高ACS诊断率，行cTnI检测的同时应积极救治患者。     

地震致挤压伤者血清肌酸激酶检测的意义

目的 分析不同血清肌酸激酶（CK）水平地震致挤压伤者的临床特点。方法回顾性分析201例地震致挤压伤者的临床资料。依据血清CK水平将患者分为3组：Ⅰ组（CK〈1000U／L）150例;Ⅱ组（CK1000～10000U／L）31例;Ⅲ组（CK〉10000U／L）20例。比较3组临床特点和血生化指标,并对地震致挤压伤者血清CK水平与各生化指标进行相关性分析。结果Ⅲ组多数为复合伤及有肢体肿胀,40％（8／20）患者行筋膜切开术,35％（7／20）患者接受截肢术,80％（16／20）患者发生急性肾衰竭,65％（13／20）患者行透析治疗,均高于Ⅰ、Ⅱ组。Ⅲ组血清肌酐（SCr）、尿素氮（BUN）、丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、血钾、血磷和乳酸脱氢酶（LDH）较Ⅰ、Ⅱ组升高（P〈0．05）,血钙较Ⅰ、Ⅱ组降低（P〈0．05）。地震致挤压伤者血清CK水平与SCr、BUN、ALT、AST、LDH、血钾及血磷呈正相关（r分别为0．44、0．45、0．54、0．64、0．46、0．48、0．36,P〈0．01）,与血钙呈负相关（r为-0．34,P〈0．01）。结论CK可以作为评估地震致挤压伤严重程度和选择治疗的一个重要指标。     

1，6二磷酸果糖后处理对心脏瓣膜置换术患者围术期心肌酶谱的影响

目的观察1,6二磷酸果糖（FDP）后处理对心脏瓣膜置换术患者围术期心肌酶谱的影响。方法30例择期心脏瓣膜置换术患者随机分为1,6二磷酸果糖后处理组（F组）和对照组（C组）,每组15例。于主动脉开放即刻从体外循环机内F组加入250mg／kg的FDP,C组加入等容积的生理盐水。于切皮即刻（T1）,主动脉开放后0．5h（T2）,主动脉开放后3h（T3）,主动脉开放后24h（T4）时取颈内静脉血测定肌酸激酶（CK）、肌酸激酶-同功酶（CK-MB）、乳酸脱氢酶（LDH）的浓度变化。结果与T1比较,两组CK、CK—MB和LDH含量在,T2、T3、T4时均升高（P〈0．05）,且在T3时达到峰值（P〈0．05）;与C组比较,F组在他、仍、T4时CK、CK．MB和LDH含量均降低（P〈0．05）。结论FDP后处理对瓣膜置换术病人的缺血再灌注心肌有保护作用。     

逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bcl-2,Bax的表达

目的观察逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bcl-2，Bax蛋白表达的变化。方法将26例风湿性心脏病患者分为两组，实验组：14例，阻断主动脉后浅低温逆行灌注持续给予氧合血，使心脏缓慢跳动（40～50次／分）；对照组：12例，中度低温阻断主动脉后根部灌注高钾含血停搏液，待心脏停搏后改为逆行灌注。术中多时点检测血浆肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）的含量；分别于体外循环（CPB）前，CPB后30min留取右心房标本，检测心肌凋亡细胞及免疫组化法测定心肌细胞Bcl-2和Bax蛋白表达。结果与CPB前比较，主动脉阻断30min时两组CK-MB、cTnT和心肌细胞凋亡数明显升高（P〈0．01），Bax表达明显降低（P〈0．01），实验组Bcl-2表达降低不明显（P〉0．05），而对照组Bcl-2表达降低明显（P〈0．01）。与对照组比较，主动脉阻断30min后实验组CK-MB、cTnT和心肌细胞凋亡数明显降低（P〈0．05），Bcl-2表达明显升高（P〈0．01）。结论逆行灌注心脏不停跳双瓣膜置换术与心脏停搏手术相比较，对心肌细胞凋亡的影响较小，可能与维持Bcl-2蛋白表达水平，抑制Bcl-2／Bax基因向Bax偏移等因素有关。     

终末期肾病患者心血管事件与血清胎球蛋白A及冠脉钙化的关系

目的探讨终末期肾病（ESRD）患者心血管事件发生与血清胎球蛋白A及冠脉钙化的关系。方法对38例ESRD初始血液透析患者进行血清胎球蛋白A及相关因素检测，对其中的29例患者进行冠状动脉多层螺旋CT钙化评价研究。所有38例患者随访时间为18个月。22例非ESRD慢性肾脏病（CKDⅡ～Ⅲ期）患者人选对照组。结果38例ESRD初始透析患者在18个月随访期内出现心血管事件30例次，因心血管事件死亡者6例，占15．79％，而非ESRD患者心血管事件仅3例次（P〈0．01）且无一例死亡（P〈0．05）。ESRD血清低胎球蛋白A组心血管事件显著高于ESRD血清高胎球蛋白A组（P〈0．01）。多元逐步回归分析显示，心血管事件与血清胎球蛋白A（P〈0．01）、C反应蛋白（CRP）（P=0．0014）及低密度脂蛋白C（LDL-C）（P=0．008）密切相关。18／29例（62．07％）有冠状动脉钙化。冠状动脉钙化患者心血管事件比无冠状动脉钙化患者显著增多（P〈0．01）。冠脉钙化的ESRD患者血清胎球蛋白A水平较无冠脉钙化的ESRD患者明显下降（P〈0．01）。冠脉钙化与胎球蛋白A下降及高血磷有关（P〈0．01，P〈0．01）。结论ESRD透析患者心血管事件和（或）心血管事件死亡可能与血清胎球蛋白A下降及冠状动脉钙化有关。     

非心脏手术围术期心肌酶谱和肌钙蛋白I的变化

目的观察非心脏手术围术期心肌酶谱和肌钙蛋白I（cTnI）的释放规律。方法30例年龄≥60岁择期全麻手术患者，分别在术前、术中、术毕即刻、术后第1天和第2天测定心肌酶谱，包括谷草转氨酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、肌红蛋白（Myo）、α-羟丁氨酸转氨酶（α-HBDH）、线粒体谷草转氨酶（m-AST）和cTnI的值，同时监测HR、BP和ECG。结果cTnI在非心脏手术围术期未发生心肌缺血或心肌梗死的病例中无显著变化，而心肌酶谱则在术毕和术后第1天均有显著升高（P〈0．05或P〈0．01）或超出参考值上限。结论心肌酶谱在非心脏手术围术期变化显著；cTnI受非心脏手术和麻醉影响较小。     

右侧腋下小切口心脏停跳与不停跳下单纯性房间隔缺损修补术的疗效分析

目的分析右侧腋下小切口心脏停跳与不停跳下单纯性房间隔缺损修补术的临床效果。方法2009年9月至2011年8月,第三军医大学大坪医院野战外科研究所施行右侧腋下小切口单纯性房间隔缺损修补术45例。包括心脏不停跳组22例,其中男13例、女9例,年龄（3．2±2．1）岁,体重（13．1±4．0）kg,房间隔缺损中央型20例,下腔型2例,平均房间隔缺损直径（12．2±5．1）mm;心脏停跳组23例,其中男14例、女9例,年龄（3．5±2．5）岁,体重（12．94±3．3）kg,房间隔缺损中央型18例,上腔静脉窦型3例,下腔型2例,平均房间隔缺损直径（11．64±4．7）mm。测定患者术前、停机时、术后6h和术后24h外周静脉血肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、天门冬氨酸氨基转移酶（AST）和心肌肌钙蛋白I（cTnI）含量。结果全组无术中死亡病例。术后发生右肺不张1例,右侧气胸1例。心脏不停跳组体外循环时间和手术时间均短于心脏停跳组（P〈0．05）,但两组病例在术中输血量、呼吸机辅助通气时间、住ICU时间、术后住院时间、术后24h胸腔引流量以及术后心功能等方面差异无统计学意义（P〉0．05）。两组术前CK、CK-MB、AST和cTnI均在正常范围且差异无统计学意义（P〉0．05）,但体外循环术后均不同程度升高,心脏停跳组上升更快（P〈0．05）;心脏不停跳组术后CK、CK．MB、AST和cTnI均低于心脏停跳组（P〈0．05）。结论对于单纯性房间隔缺损病例,右侧腋下小切口心脏不停跳房间隔缺损修补术是一种安全可靠、切口美观、手术时间短且心肌损伤程度较轻的手术方式。     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

目的探讨心脏型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）早期诊断中的应用价值。方法检测60例疑似AMI患者H—FABP、心肌肌钙蛋白（cTn）T、肌酸激酶同工酶．MB（CK-MB）水平,按发病时间分为〈6h、6～12h两个时段,计算各项指标诊断AMI的灵敏度,同时测定15例非AMI疑似患者及45例健康体检者的H-FABP、cTnT、CK-MB水平,计算各项指标诊断AMI的特异度。结果H-FABP在发病〈6h诊断AMI的灵敏度为94％,明显优于cTnT的50％、CK-MB的56％,差异均有统计学意义（P〈0．05）;在发病6～12h,H—FABP诊断AMI的灵敏度为100％、cTnT为92％、CK-MB为92％,差异无统计学意义。三项指标诊断AMI的特异度比较差异无统计学意义。结论H—FABP对AMI早期诊断有较高的灵敏度和特异度,适用于胸痛患者的筛查及早期诊断AMI。     

缺血预处理在心瓣膜置换术中对心肌保护的作用

目的研究单一周期的缺血预处理（IP）方法在心脏瓣膜手术中对心肌的保护作用。方法2002年8月至2006年4月85例慢性心瓣膜疾病患者在我院行心脏瓣膜手术，将其随机分为两组，IP组（n=47）：主动脉阻断前文行单次缺血2min开放3min的预处理方案，阻断主动脉后采用冷晶体心脏停搏液心肌保护方法；对照组（n=38）：仅采用冷晶体心脏停搏液心肌保护方法。观察两组术前、术后心肌型肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、心电图ST-T改变、室性心律失常及ICU临床指标。结果术后两组血清CK-MB和cTnI均较术前升高；IP组术后24、48和72h的CK-MB测量值，以及术后24和48h cTnI测量值均低于对照组（P〈0．05）。IP组术后使用抗心律失常药物的比率和持续时间明显低于对照组（P〈0．05），术后使用的正性肌力药物种类和ICU停留时间少于／短于对照组（P〈0．05）。结论IP和低温高钾晶体心脏停搏液灌注方法联合使用，可以增强心脏瓣膜手术中对心肌的保护效果，降低术后心肌酶、肌钙蛋白上升水平和术后室性心律失常程度，提高手术效果。     

慢性肾衰竭患者血CK-MB及cTnI与心血管疾病的相关性

目的：研究肾功能对肌钙蛋白（cTnl）、肌酸激酶心肌同功酶（CK-MB）的影响及其与心血管病的相关性。方法：选取不存在急性心肌梗死、急性冠脉综合征的慢性肾衰竭（CRF）病人，同时、同标本检测血肌酐（Scr）、cTnI、CK-MB。检验血Scr和cTnI、CK-MB的相关性。并根据血Scr值分组；比较两组病人中cTnI、CK-MB超过心肌梗死诊断标准所占的百分比。结果：（1）分别有18％和36％的cTnI、CK-MB值超过心肌梗死诊断标准，cTnI与Scr水平不相关（P〉0.05），与年龄不相关（P〉0.05）；cTnI与CK-MB明显相关（P=0．000）；CK-MB与血Scr负相关（P〈0.05）；CK-MB与年龄不相关（P〉0．05）。（2）轻度损害组74例，中重度损害组50例，cTnI升高分别为15例（20％）和7例（14％），两者无统计学差异（P〉0．05）；CK-MB升高分别为34例（43％）和11例（24％），两者有统计学差异（P〈0．05）。结论：（1）cTnI和CK-MB在CRF中升高主要反映心肌损害，年龄和肾功能无直接影响。（2）cTnI增高的频率较CK-MB低，cTnI更能反映心肌的损害。     

联合使用阿托伐他汀和贝那普利对IgA肾病蛋白尿的影响

目的 探讨阿托伐他汀联合贝那普利治疗对IgA肾病患者蛋白尿的影响。方法 将62例IgA肾病患者随机分为对照组30例,应用贝那普利治疗;治疗组32例,应用阿托伐他汀联合贝那普利治疗;2组疗程均为6个月,比较2组治疗前、后,血压、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、尿蛋白（U-pro）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）等指标的变化情况。结果 治疗组治疗后6个月,TC、LDL-C、L卜Pro等指标明显下降,与对照组比较有统计学差异（P〈0．05）;而2组治疗前、后比较,TG、HDL-C、ALT、AST、CK、CK-MB均无统计学差异（P〉0．05）。结论 阿托伐他汀联合贝那普利,能有效降低IgA肾病患者的TC、LDL-C、U-pro水平。     

血清心型肌酸激酶对判断电损伤后心脏损害的临床价值

目的探讨电损伤后心脏损害的发病情况及判断电损伤后心脏损害的血清酶学指标。方法研究了３２例电接触性损伤患者的心电图、血清肌酸激酶（ＣＫ）和心型肌酸激酶（ＣＫＭＢ）活性。结果１７例患者有心电图异常（Ａ组）,１５例患者心电图基本正常（Ｂ组）。将测定的血清ＣＫＭＢ减１１％总ＣＫ的差定义为ＣＫＭＢ差值。Ａ组ＣＫ、ＣＫＭＢ、ＣＫＭＢ／ＣＫ比率和ＣＫＭＢ差值明显高于Ｂ组（全部：Ｐ＜００５）。Ａ组８８％的患者ＣＫＭＢ差值大于２５Ｕ／Ｌ,Ｂ组为６７％（Ｐ＜００１）。结论（１）心脏损害是电损伤的常见并发症,高压电更易于导致心脏损害;（２）血清ＣＫＭＢ,特别是ＣＫＭＢ差值可用于评价电损伤患者的心脏损害。     

Biochemical markers of myocardial injury in the pericardial fluid of patients undergoing heart surgery

The purpose of this study was to compare cardiac markers in the pericardial fluid and serum in order to evaluate preoperative myocardial injury. Thirty patients were divided into three groups. The first group (AVR; n=10) received an aortic valve replacement. The second group (SA; n=10) included patients with stable angina who underwent elective coronary artery bypass grafting (CABG). The third group (ACS; n=10) included patients with acute coronary syndrome who underwent urgent CABG. Pericardial fluid and venous samples were taken after opening the pericardium and 24 h postoperatively. Serum and pericardial concentration of troponin I (cTnI), creatine kinase (CK), its MB isoenzyme (CK-MB) and myoglobin were determined. Preoperative pericardial cTnI was significantly (P<0.01) higher than in serum in all groups. Preoperative pericardial CK, CK-MB and myoglobin were significantly (P<0.01) lower than in serum in groups AVR and SA. Preoperative pericardial and serum cTnI were significantly higher in the ACS than in AVR and SA groups (P<0.01). Postoperative pericardial concentration of all markers was significantly higher (P<0.01) than in serum in all groups. We conclude that preoperative pericardial accumulation of cTnI may reflect subclinical injury which may not be demonstrated by the usual laboratory tests.     

肌酸激酶同工酶和乳酸以及白细胞计数联合检测在手足口病诊疗中的应用

目的：检测手足口病（HFMD）患者的血浆肌酸激酶同工酶（CK-MB）的水平、乳酸含量和外周血液WBC计数的变化。方法随机选取50例手足口病儿童为手足口病组,选择50例同期进行健康体检的儿童为对照组。分别使用COBASE411化学发光仪检测血浆肌酸激酶同工酶,通过VITROS 350自动干化学分析仪检测血浆乳酸,使用 XS-1000i型全自动血液分析仪检测外周血液中白细胞数量。结果手足口患者的血浆肌酸激酶同工酶、乳酸水平均显著高于对照组（P ＜0.01）,且WBC计数也高于对照组（P ＜0.05）。手足口病患者CK-MB与乳酸（LAC）呈正相关（r =0.198,P=0.048）。结论 CK-MB、LAC和WBC计数联合检测有助于HFMD的诊断,且助于HFMD并发症的预测和诊断。     

Release Patterns of Pregnancy Associated Plasma Protein A (PAPP-A) in Patients with Acute Coronary Syndromes

Objective : Pregnancy associated plasma protein A (PAPP-A) has recently been shown to be associated with acute coronary syndromes (ACS). The goal of this study was to investigate its release patterns in patients with ACS. Design : PAPP-A concentrations in plasma samples serially collected after admissions from 15 patients with ACS were measured. The levels of PAPP-A were compared with a reference range determined from 80 normal subjects. The associations between PAPP-A and myoglobin (Mb), C-reactive protein (CRP), fatty-acid-binding protein (FABP) and creatine kinase MB (CK-MB) were determined. Results : Various release patterns were observed with 2-10-fold changes of PAPP-A in the different patients. Increases in PAPP-A levels above the reference range could appear early at 2 h or late at 30 h after onset of chest pain. Only in 4 of the 15 cases were significantly elevated PAPP-A levels detected before 6 h after onset. Elevations early after admission showed rapid decline whereas later elevations were more persistent. No associations between PAPP-A and Mb, CRP, FABP and CK-MB were found. However, a weak but significant association to cardiac troponin I (cTn I) was found. Conclusion : PAPP-A is an additional marker for ACS, but does not seem to be a useful early marker for acute myocardial infarction (AMI). The possible clinical utility of PAPP-A calls for extensive studies of chest pain patients using serial sampling combined with short- and long-term outcome studies.     

Release patterns of pregnancy associated plasma protein A (PAPP-A) in patients with acute coronary syndromes

OBJECTIVE: Pregnancy associated plasma protein A (PAPP-A) has recently been shown to be associated with acute coronary syndromes (ACS). The goal of this study was to investigate its release patterns in patients with ACS. DESIGN: PAPP-A concentrations in plasma samples serially collected after admissions from 15 patients with ACS were measured. The levels of PAPP-A were compared with a reference range determined from 80 normal subjects. The associations between PAPP-A and myoglobin (Mb), C-reactive protein (CRP), fatty-acid-binding protein (FABP) and creatine kinase MB (CK-MB) were determined. RESULTS: Various release patterns were observed with 2-10-fold changes of PAPP-A in the different patients. Increases in PAPP-A levels above the reference range could appear early at 2 h or late at 30 h after onset of chest pain. Only in 4 of the 15 cases were significantly elevated PAPP-A levels detected before 6 h after onset. Elevations early after admission showed rapid decline whereas later elevations were more persistent. No associations between PAPP-A and Mb, CRP, FABP and CK-MB were found. However, a weak but significant association to cardiac troponin I (cTn I) was found. CONCLUSION: PAPP-A is an additional marker for ACS, but does not seem to be a useful early marker for acute myocardial infarction (AMI). The possible clinical utility of PAPP-A calls for extensive studies of chest pain patients using serial sampling combined with short- and long-term outcome studies.     

Diagnostic Significance of Serum Ck-Mb Elevations Following Surgical Damage to Skeletal Muscles

Total creatine kinase (CK) and its isoenzyme MB (CK-MB) were studied in the serum of 14 patients following thoracotomy, mostly for pulmonary surgery, and in various thoracic muscles from another 9 patients subjected to the same procedure. CK-MB consistently appeared in the serum and was present in all muscle samples examined. CK-MB as a percentage of total CK (the CK-MB/CK ratio) was of similar order in serum and muscle, approximately 1.5%. Compared with previous findings after cardiopulmonary bypass surgery, maximum serum CK-MB activity occurred later, and the CK-MB levels as well as the CK-MB/CK ratio were considerably lower after non-cardiac thoracic surgery. It is suggested that the CK-MB/CK ratio 24 hours after operation may be used in the diagnosis of peri-operative myocardial infarction, particularly in non-cardiac surgery. After thoracotomy, this ratio was below 2.2%. In a series of patients with acute myocardial infarction, reported previously, the ratio was above 5.4%. Secondary rises of serum CK-MB following cardiac surgery should, apparently, also be analysed in relation to the simultaneous total CK level.     

Creatine kinase MB in skeletal muscle and serum of spine-fusion patients

The low specificity of creatine kinase (CK) MB elevations for myocardial infarction was confirmed by a prospective analysis of paraspinal muscle and postoperative serum levels of CK-MB. Eleven of 30 patients had serum elevations of CK-MB without myocardial infarction. Elevated CK-MB was not specific for myocardial infarction after spine surgery. CK-MB was found in paraspinal muscle of 93% of patients. CK-MB may be a pathologic marker in patients with spinal disease.     

Cardiac troponin I versus creatine kinase-MB in the detection of postoperative cardiac events after coronary artery bypass grafting surgery

AIM: Several studies suggest that postoperarive concentrations of cardiac troponin-I (cTnI) may increase in patients undergoing aorto-coronary bypass grafting (CABG). The degree and pattern of release appears to be associated with perioperative myocardial damage. METHODS: This was a prospective observational study with serial sampling conducted at the Departments of Cardiothoracic Surgery and Anesthesiology, University Hospital of Ioannina, Ioannina, Greece. The levels of cTnI and creatine kinase-MB (CK-MB) preoperatively, upon admission to the intensive care unit and at 12, 24, 36 and 48 hours after surgery, as well as daily from postoperative days 3-7 were determined in 41 consecutive patients (33 males and 8 females, aged 64.8+/-6.1 years) who underwent CABG with cardiopulmonary bypass. The Authors compared the patterns and variation of cTnI and creatine kinase (CK)-MB after CABG in patients with or without postoperative cardiac events (PCEs). RESULTS: Eleven patients experienced a PCE (postoperative ventricular and supraventricular arrhythmia, need for intra-aortic balloon pump (IABP) for >12 hours, or postoperative myocardial infarction, [MI]). In patients without PCE the elevation of cTnI peaked at 24 hours after surgery, while in patients with PCE maximal values of cTnI occurred after 36 hours. CTnI levels correlated with CK-MB after the procedure. Receiver-operating characteristic (ROC) curve analysis indicated that cTnI is superior to CK-MB with regard to PCE diagnosis following CABG (area under the ROC curve, 0.73, 95% CI (0.53-0.93) versus 0.54, 95% CI, (0.25-0.83). CONCLUSION: CTnI seems to be more valuable compared to CK-MB in the detection of PCEs in patients undergoing coronary surgery.