Transient increase in serum creatine kinase isoenzyme BB activity after prostatectomy in a patient with massive benign prostatic hyperplasia

The activity of creatine kinase isoenzyme BB (CK-BB) in serum is rarely abnormally high (i.e., detectable). An increase in immunoreactive CK-BB or CK-BB activity in patients with prostatic disease has been proposed as an indication of prostatic adenocarcinoma. Here we report the case of an elderly man with massive benign prostatic hyperplasia but no clinical or pathological evidence of prostatic adenocarcinoma, whose serum CK-BB activity was found by agarose gel electrophoresis to be 1 U/L (normal: 0%), 10% of his total CK activity. Serum CK-BB activity was further increased to 16 U/L (20% of total CK activity) 1 h after prostatectomy, but became undetectable by the second day after the operation. The findings suggest that: (a) the source of the serum CK-BB activity was the enlarged prostate gland; (b) abnormally high CK-BB activity in serum of men with prostatic disease does not necessarily indicate the presence of prostatic adenocarcinoma; and (c) myocardial injury could be erroneously diagnosed postoperatively in prostatectomy patients if CK isoenzyme methods are used that do not consistently separate "heart-specific" CK-MB from CK-BB.     

The presence of creatine kinase bb isoenzyme in patients with prostatic cancer

Creatine kinase BB isoenzyme (CK-BB) was detected in abnormal amounts in serum samples from 11 of 46 patients with Stage D carcinoma of the prostate by electrophoresis. Thirteen of 46 Stage D patients had elevated acid phosphatase values and 10 of these 13 had elevated CK-BB. CK-BB elevations were less frequent in earlier stages of prostatic cancer; Stage C: 0 of 35, Stage B: 1 of 26, Stage A: 0 of 3 and none in a group of 35 with BPH, prostatitis and bladder cancer. Results of CK-BB by a specific radioimmunoassay correlated well with those obtained by electrophoresis in most cases. Several patients were followed over time and data on CK-BB is presented for this interval. The origin of the CK-BB is still unclear. The BB isoenzyme predominates in prostatic tissue and CK-BB is the fetal form of the enzyme in human muscle and myocardium. The increase in serum CK-BB may be related to increased release of the isoenzyme, either from the prostate itself or from a metastatic lesion, or may represent a release of the fetal form of the enzyme from dedifferentiated tumor tissue.     

Creatine kinase and its isoenzymes in neoplastic disease

The CK-BB isoenzyme is ubiquitous in neoplastic tissue, but with low activity. Accordingly, it might be a nonspecific and insensitive tumor marker. Evaluation of BB isoenzyme in serum might indicate the extent of diseases or the response to therapy. The presence of CK-MB in patients with cancers may cause confusion with AMI. Serial determinations of both CK and lactate dehydrogenase isoenzymes are of great help in differential diagnosis. The presence of mit-CK is a poor prognostic sign in patients with malignancy. The greatest clinical significance of CK-BB and macro-CK isoenzyme lies in their effect on various assays for CK-MB. Macro-CK types 1 and 2 are much more heat stable than are CK-MB and CK-BB, and so by heating samples for 20 min at 45 degrees C the presence of thermostable macro types can be demonstrated. Macro-CK type 2 has a much higher activation energy than macro-CK type 1. If macro-CK is present, determination of the activation energy easily differentiates between types 1 and 2. CK-Bi seems to be glycosylated protein, and it is thought that glycosylation may be a general way of enzyme inactivation. If inactivation inside the cell is postulated, it has to be shown that enzymes indeed pass into the cell compartments where glycosylating enzymes are located. Another possible mechanism is within the circulation. Whether malignant cells themselves produce Ck-Bi or if inactivation occurs in the blood is still unknown. In this connection, one finding is that in plasma of cancer patients, CK-Bi can be reactivated to CK-BB by mercaptoethanol to 95%, whereas in plasma of normal persons there is no reactivation of the much lower CK-Bi concentrations.     

胸、腹水与血清癌胚抗原检测对良恶性胸、腹水鉴别诊断的价值

目的评价胸、腹水与血清癌胚抗原(CEA)水平及其比值对良恶性积液鉴别诊断的价值。方法应用ELECSYS-2010型全自动电化学发光免疫分析系统定量检测胸、腹水与血清中的CEA水平。结果恶性组胸、腹水与血清的CEA显著高于良性组(P<0.001);恶性胸、腹水中CEA水平显著高于本组血清(P<0.001),恶性组胸、腹水/血清比值显著高于良性组(P<0.01)。结论与单纯测定血清或胸、腹水中的CEA相比,同时测定胸、腹水和血清CEA及其比值对良恶性肿瘤鉴别诊断具有更重要的价值。     

肿瘤标志物在良恶性胸水鉴别诊断中的应用

[目的]通过对胸水和血清中癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原19—9（CA19—9）、神经特异性烯醇化酶（NSE）和细胞角蛋白19片段（CYFRA21—1）的检测,探讨各指标在对伴胸水的肺部良、恶性疾病鉴别诊断中的价值。[方法]采用化学发光法对40例肺癌患者和42例结核患者的胸水、血清进行了免疫蛋白定量分析。[结果]肺癌组血清CEA,NSE和CYFRA21—1胸水CEA,CA19—9CYFRA及21—1明显高于结核组。胸水CEA和血清CEA、CYFRA21—1的ROC曲线下面积最大,诊断价值最高。联合检测血清CYFRA21—1＋CEA鉴别恶性胸水的特异性为100％,敏感度为90．5％。[结论]检测血清及胸水的肿瘤标志物对鉴别良、恶性肺部疾病有重要价值。     

Reassessment of creatine kinase BB as a marker for cancer of the prostate, breast, and lung

We used an enzyme-linked immunoabsorbent assay to measure creatine kinase (CK; EC 2.7.3.2) BB in the sera of 58 cancer patients. A pre-incubation step with an anti-CK-M antibody-coated bead removed M chain components, and CK-BB was quantified with use of an anti-CK-B antibody-coated tube. No cross reactivity was observed with mitochondrial CK or CK-MM; CK-MB cross reacted slightly (1.6%). Macro CK type 1 was measured as CK-BB. Average analytical recovery of purified CK-BB added to serum was 97.7%. Although the enzyme activity of CK-BB is labile, our studies show that this protein is antigenically stable for 12 months when stored frozen. The upper limit of normal for CK-BB concentration was 0.3 micrograms/L (95th percentile, n = 25). Of the 20 cases of breast cancer of various stages, none showed any increases of serum CK-BB. Only two of 18 patients with prostatic carcinoma (stage D), and two of 10 patients with oat-cell carcinoma of the lung had increased concentrations of CK-BB in the serum. Ten patients with squamous cell cancer of the lung had normal concentration of the enzyme. Thus the CK-BB isoenzyme is not frequently increased in cancers of the prostate, lung, and breast, and it has little apparent value as a tumor marker for these diseases.     

探讨渗出性胸腔积液ADA、CEA对良恶性胸腔积液的诊断价值

目的 探究渗出性胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)对良恶性胸腔积液的诊断价值.方法 选择2017年1月至2020年8月本院收治的106例渗出性胸腔积液患者,将患者分为恶性组(n=36)和良性组(n=70).对两组患者胸水ADA、胸水CEA、血清CEA水平进行比较,采用单因素、多因素Logistic回归分析...     

肿瘤标志物对老年恶性胸腔积液诊断价值探讨

目的 探讨糖类抗原(CA50.CA19—9.CA125),癌胚抗原(CEA)对老年恶性胸腔积液的诊断价值。方法 测定老年良性、恶性胸腔积液患者血清和胸水中CEA、CA50、CA19—9、CA125水平,比较其敏感性、特异性、准确性。结果 恶性胸腔积液患者血清中CEA、CA50、CA19—9、CA125和胸水中CEA、CA50、CA19—9水平显著高于良性胸腔积液患者,且CEA和CA50、CA19—9、CA125联合检测准确性高于单项检测。结论 CEA、CA50、CA19—9、CA125检测对老年恶性胸腔积液诊断有意义,联合检测意义更大。     

CEAmRNA、CEA蛋白检测在良恶性胸腹水中鉴别诊断的价值

目的　评价检测CEAmRNA ,CEA蛋白对良恶性胸腹水鉴别诊断的价值。方法　采用RT PCR方法对 37例胸水和 31例腹水CEAmRNA进行检测 ;CEA蛋白用时间分辨免疫荧光分析法测定。结果　恶性胸水组中CEAmRNA ,CEA蛋白阳性率明显高于良性胸水组 (P <0 .0 1)。CEAmRNA ,CEA蛋白检测胸水的敏感性分别是 78.9% ,6 8.4 % ,特异性都是 94 .4 %。恶性腹水组中CEAmRNA阳性率是 35 .7% ,与良性组间无显著差异。结论　胸水中CEAmRNA ,CEA蛋白测定可作为鉴别诊断恶性胸水的重要方法 ,但在腹水中无良好鉴别作用。     

Reactivation of serum creatine kinase isoenzyme BB in patients with malignancies

Reactivation of serum creatine kinase isoenzyme BB (CK-BB) with 2-mercaptoethanol and EDTA increased the electrophoretic detection rate of CK-BB from 34% to 78% in 58 hospitalized patients with various malignancies. Patients with solid tumors showed the largest and patients with hematologic malignancies the smallest percentage increase in CK-BB after reactivation. For serum from 50 hospitalized patients without cancer, reactivation resulted in detectable CK-BB in two patients; the CK-BB band was never seen in 15 healthy adults. For reasons unknown, five of eight patients with senile dementia of the Alzheimer's type showed CK-BB in serum after reactivation, as did two of five patients suspected of having this disorder. Serum CK-BB may be a useful tumor marker if reactivation with a thiol and EDTA is used immediately after collection.     

肿瘤标志物在鉴别伴有胸水的良恶性肺部疾病中的应用价值

目的:通过对胸水和血清中糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、鳞癌抗原(SCC)、神经特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)的检测及胸水脱落细胞学检查,探讨各指标在对伴胸水的肺部良、恶性疾病鉴别诊断中的价值。方法:应用化学发光微粒子免疫测定法和电化学发光免疫测定法对26例肺癌患者、41例良性肺部疾病患者的胸水和血清标本及30名正常体检者的血清标本进行6种肿瘤标志物测定,同时对患者胸水标本进行脱落细胞学检查,并根据受试者工作特性(ROC)曲线建立合理的临床判断临界值。结果:胸水CEA及血清CYFRA21-1对肺癌的辅助诊断价值最高。CEA含量在胸水与血清中的比值(P/S)与其他5种肿瘤标志物P/S值相比其辅助诊断价值最高。胸水标本脱落细胞学检查的灵敏度和特异度分别为69.23%和100%;而其与胸水CEA联合检测后灵敏度和特异度分别为100%和97.56%。结论:检测胸水CEA、血清CYFRA21-1对鉴别良、恶性肺部疾病有重要价值,胸水CEA与脱落细胞学联合检测可提高辅助诊断的灵敏度。     

108例胸腔积液的临床分析

目的探讨胸腔积液的主要病因和诊断。方法对108例胸腔积液患者的临床资料进行回顾性分析。结果在108例患者中,良性胸腔积液58例(53.70%),其中以结核性胸腔积液最多,共34例(31.48%),恶性胸腔积液40例(37.04%)。恶性胸腔积液的血癌胚抗原(CEA)、胸腔积液CEA、胸腔积液CEA/血清CEA指标显著高于良性者。胸腔积液腺苷脱氨酶对结核性胸腔积液诊断的灵敏度为90.91%,特异度为85.00%,受试者工作特征曲线下面积为0.888。结论胸腔积液的病因以肿瘤和结核为主。血CEA、胸腔积液CEA以及胸腔积液CEA/血CEA是鉴别诊断良、恶性胸腔积液的可靠方法。胸腔积液腺苷脱氨酸对结核性胸腔积液的临床诊断价值很高。     

A novel CK isoenzyme migrating between CK-MB and CK-BB

A CK isoenzyme migrating between CK-MB and CK-BB was detected in the serum of three patients with metastatic prostatic carcinoma. CK-BB was detected in the serum of all three patients and mitochondrial CK in two of the patients. Total CK activity was either normal or elevated, and the atypical CK isoenzyme, CK-BB and the mitochondrial CK isoenzyme were present in serum for up to 1.5 months. This atypical CK isoenzyme was not CK-MB, an albumin-ligand complex, or adenylate kinase, and was not bound to an immunoglobulin. This atypical CK isoenzyme did not contain immunologically normal CK-M subunits but had some CK-B subunits and could be a variant CK-BB or CK-MB isoenzyme. Its appearance in serum could be indicative of a serious illness.     

神经元特异性烯醇化酶、细胞角质蛋白19片断、癌胚抗原联合LDH、ADA检测对良、恶性胸腔积液鉴别的意义

目的探讨血清、胸水中神经元特异性烯醇化酶（NSE）、细胞角质蛋白19片断（CYFRA21—1）、癌胚抗原（CEA）对良、恶性胸腔积液的鉴别价值。方法对40例经病理确诊的胸腔积液患者按胸水的性质分为恶性胸水组（23例）和良性胸水组（17例）。2组患者均采用电化学发光法检测血清及胸腔积液中NSE、CYFRA21—1、CEA的含量．生化检测胸腔积液中乳酸脱氢酶（LDH）和腺苷脱氨酶（ADA）。结果恶性胸水组的血清NSE、CYFRA21—1及CEA均显著高于良性胸水组（P=O,02、0．02及0．01）;胸水CYFRA21—1及CEA均明显高于良性胸水组（严如．01或P=0．04）,ADA显著低于良性胸水组（P=0．01）。2组胸水NSE、LDH比较差异无统计学意义（均P〉O．05）。结论血清、胸腔积液中NSE、CYFRA21—1、CEA和ADA联合检测,对良、恶性胸腔积液的鉴别诊断有重要价值,能提高准确率。     

Diagnostic value of the combined determination of carcinoembryonic antigen (CEA) in pleural effusion and serum with an enzyme immunoassay (EIA). Sensitivity, specificity and relation to tumor type

Measurement of carcinoembryonal (CEA) levels in pleural fluid are suggested to improve the unsatisfactory sensitivity of pleural cytology in the differential diagnosis of malignant pleural effusions. We evaluated simultaneously determined pleural and serum CEA levels in 117 patients with pleural effusions of different aetiology (74 malignant, 30 inflammatory exudates and 13 transudates) by use of an enzyme immunoassay (EIA). Despite considerable scatter, pleural levels of CEA in malignant effusions were significantly higher (p less than 0.001) than the values in benign effusions. Using a cut off level of 5 ng/ml, 41% (= sensitivity) of malignant pleural effusions showed elevated concentrations of CEA. Only one out of 43 benign effusions showed a level of 5 ng/ml, which is equivalent to a specificity of 98%. However, malignant effusions due to small cell lung cancer, pleural mesothelioma and metastasising ovarian carcinoma never showed elevated levels of CEA. Highest pleural values of CEA were observed in cases of alveolar cell or adenocarcinoma of the lung or metastasising breast cancer. Although pleural and serum CEA levels correlated significantly (rs = 0.77), the evaluation of serum CEA levels alone yielded a lower sensitivity (36%) and specificity (93%) than pleural levels. 77% of cases with malignant pleural effusions showing elevated pleural CEA levels were characterized by an increased ratio Pleura/Serum greater than 1, particularly in effusions due to lung cancer. The CEA ratio was significantly higher (p less than 0.05) in patients with malignant than with benign effusions. EIA appears to be more specific by avoiding false positive results in benign effusions as compared with determination by conventional RIA. In conclusion, evaluation of pleural CEA levels in patients with malignant effusions by using an EIA because of its high specificity is a valuable adjunct to pleural cytology in improving the diagnosis of malignant effusions. However, a normal CEA level in either pleural effusion or in serum is of no clinical significance. Simultaneous measurement in pleural effusion and serum is of greater value.     

TSGF、CEA、LDH检测在良恶性胸腔积液鉴别诊断中的应用

目的探讨肿瘤特异性生长因子（TSGF）、癌胚抗原（CEA）及乳酸脱氢酶（LDH）三项指标检测在良、恶性胸腔积液鉴别诊断中的应用。方法选择2012年1月至2013年9月住院的108例胸腔积液患者（恶性胸腔积液63例,良性胸腔积液45例）为研究对象。采用全自动生化分析仪和全自动免疫电化学发光仪分别对108例良、恶性胸腔积液及对应的患者血清进行TSGF、CEA和LDH同步检测。结果胸腔积液、血清TSGF、CEA和LDH水平,恶性组均高于良性组（P均〈0.05）;恶性胸腔积液TSGF、CEA和LDH含量均高于血清（P均〈0.05）;胸腔积液、血清单项检测诊断恶性胸腔积液的敏感度及特异度由高到低均依次为TSGF、CEA和LDH。结论胸腔积液、血清TSGF、CEA、LDH检测对鉴别良、恶性胸腔积液有重要临床价值,TSGF的特异度和敏感度均优于CEA和LDH。     

内科胸腔镜胸膜活检术与血清肿瘤标志物在不明原因胸腔积液中的诊断价值*

目的探讨内科胸腔镜下胸膜活检术和肺部肿瘤标志物对不明原因胸腔积液的临床应用价值。方法回顾性分析该院2014年1月-2016年3月76例不明原因胸腔积液的患者,采用内科胸腔镜进行胸膜活检送病理,且在入院时即采集患者静脉血10 ml送检,查血清肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、胃泌素释放肽前体(Pro GRP)、细胞角蛋白19片段(CYFRA21-1)]进行测定。结果 76例不明原因胸腔积液的患者中有良性病变32例(肺结核14例,炎性病变9例,肉芽肿性炎6例,脓胸2例,错构瘤1例);恶性病变44例(腺癌18例,鳞癌13例,小细胞肺癌6例,腺鳞癌3例,间皮瘤2例,大细胞癌1例,胸腺瘤1例)。检测血清肿瘤标志物发现,血清中CEA、SCC-Ag、Pro GRP、CYFRA21-1水平在恶性胸腔积液组与良性胸腔积液组之间差异具有统计学意义(P=0.021、P=0.006、P=0.003和P=0.010),恶性胸腔积液患者血清各项肿瘤标记物水平明显高于良性胸腔积液的患者。根据病理结果将44例恶性胸腔积液中非肺癌所致胸腔积液的患者剔除(即2例间皮瘤及1例胸腺瘤患者),将剩下的41例肺癌所致胸腔积液患者,根据病理类型分为非小细胞肺癌(NSCLC)与小细胞肺癌(SCLC)。分析结果显示CEA、Pro GRP和CYFRA21-1水平在NSCLC与SCLC中差异具有统计学意义(P=0.036,P=0.005,P=0.008),而SCC-Ag差异无统计学意义(P=0.811)。结论内科胸腔镜在不明原因胸腔积液中具有检出率高、准确性高的特点,尤其是对胸膜转移瘤的恶性胸积液的诊断具有重要的意义。但血清学指标可以在病理结果出来之前为医师提供重要的参考价值,是临床诊断肺癌所致恶性胸腔积液的一种重要的手段,值得在临床推广应用。     

Stability and electrophoretic characteristics of creatine kinase BB extracted from human brain and intestine

Creatine kinase (CK; EC 2.7.3.2) isoenzyme BB extracted from brains of rats reportedly undergoes modification at 37 degrees C, leaving an electrophoretic variant that accounts for most of the residual CK activity. This variant, called CK-BB', migrates on electrophoresis similarly to creatine kinase isoenzyme MB. Using electrophoresis and immunoinhibition with antiserum to creatine kinase isoenzyme MM, we found CK-BB to be the only identifiable cytoplasmic isoenzyme in surgical samples from human brain and intestine. In contrast, we found that some samples of brain obtained at autopsy contain CK-BB'. We also found that CK-BB extracted from human brain was converted to CK-BB' upon incubation in serum or plasma at 37 degrees C. We found a similar development of CK-BB' in incubation mixtures of serum or plasma containing CK-BB obtained from surgical samples of human intestine. The development of CK-BB' during infarction of the gastrointestinal system may thus be a source of false-positive CK-MB in the laboratory verification of myocardial infarction when electrophoresis is used as the only method to identify CK isoenzymes.     

Pharmacokinetics of mezlocillin in pleural fluid

Mezlocillin concentrations in the pleural fluid and serum of six patients with malignant pleural effusion were determined following administration of 10 g mezlocillin over 30 minutes as a rapid infusion. Thirty minutes and eight hours after the infusion had been completed, concentrations of the active ingredient in the pleural fluid were 36.44 micrograms/ml and 112 micrograms/ml respectively; in the serum the respective values were 777.89 micrograms/ml and 44.22 micrograms/ml. The concentrations of active ingredient in the pleural fluid exceed the MIC for clinically significant pathogenic germs. The elimination half-life of mezlocillin in malignant pleural effusion is prolonged.     

Bioluminescence assay of creatine kinase and its isoenzymes in serum and cerebrospinal fluid.

We examined the sensitivity of bioluminescence for the determination of very low concentrations of creatine kinase brain-type subunit (CK-BB) in serum and in cerebrospinal fluid. To optimize the sensitivity of CK-isoenzyme assays and eliminate possible sources of error, we separated the isoenzyme fractions by using inhibiting anti-MM and precipitating anti-MM and anti-BB antibodies. The results with the bioluminescence assay correlated with spectrophotometric values such that r = 0.97 for the total CK activity and r = 0.98 for the CK-B activity. The reproducibility of the present method was comparable with the spectrophotometric method and was even better at low enzyme activities. The within-series precision for assay of total CK activity at 2 U/L corresponded to a CV of 9%; at 13 U/L the CV was 5.8%. All the assays were carried out at 25 degrees C. Even at this low temperature, CK activities as low as 0.2 U/L could be determined. In eight patients without any evidence of cerebral cell damage, total CK activity in cerebrospinal fluid was x = 1.05 +/- 0.6 U/L, and CK-BB activity was x = 0.7 +/- 0.4 U/L. In sera of these patients CK-BB activity was x = 0.6 +/- 0.5 U/L. Differences in CK and CK-BB activities in four patients with transient or progressive brain-cell damage are discussed.