The value of serum CK-MB and myoglobin measurements for assessing perioperative myocardial infarction after cardiac surgery

In 41 patients who underwent coronary bypass surgery, creatine kinase (CK)-MB mass concentration was repeatedly measured in serum during and after the intervention using a new two-site immunoenzymetric assay (IEMA). Serum CK-MB activity was determined with the use of four different techniques: immunoinhibition, immunoinhibition-immunoprecipitation, column chromatography and electrophoresis. Myoglobin (Mb) was also measured in each specimen by radioimmunoassay. In the 33 patients who followed a completely uneventful postoperative course, the cumulated CK-MB release was, on the average, 12.2-fold less than after acute myocardial infarction. The CK-MB peak concentrations using the IEMA were 33 +/- 3 micrograms/l (X +/- SEM) and occurred 6.4 +/- 0.5 h after the intervention was started; CK-MB levels had decreased to 2.9 +/- 0.4 micrograms/l at the end of the first postoperative day. The evolution of the CK-MB concentration was parallel to that of the enzyme activity. The serum Mb maximum concentrations (518 +/- 39 micrograms/l) were reached after 3.3 +/- 0.1 h. The other eight patients developed perioperative myocardial infarction (PMI); in this group, the cumulated CK-MB release was higher, and the serum CK-MB postoperative curves were of three different types. The patients with delayed CK-MB peaks (type I pattern) or sustained elevations (type III) of this isoenzyme also showed increased serum Mb levels at the end of the first postoperative day. The PMI patients with early (10 h) CK-MB elevations (type II) did not demonstrate abnormal serum Mb levels.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rapid and sensitive radioimmunoassays for human myoglobin

A radioimmunoassay for quantitation of serum myoglobin in healthy individuals and patients with different diseases is described. Purified myoglobin was labelled by an 125I-labelled ester (N-succinimidyl 3-(-4 hydroxy, 5-[125I]iodophenyl) propionate), a commercially available antiserum was used, and the antigen-antibody complex was precipitated with polyethylene glycol 6000. The rapid assay can be performed within 1 h at 37 degrees C with a detection limit of 45 micrograms/l. Prolonged incubation at 4 degrees C for 18 or 72 h gives a detection limit of 6 and 2 micrograms/l, respectively. The mean coefficient of variation of the routine assay was 11%. In healthy human subjects a significant difference in mean serum myoglobin concentration was found between 43 women (34 +/- 17 micrograms/l) and 51 mean 47 +/- 15 micrograms/l). In twenty patients admitted to hospital with the clinical diagnosis acute myocardial infarction, the serum myoglobin concentration profiles were in close agreement with the final diagnosis. In three patients with myocardial infarction serum samples were taken every 2 h after the acute episode, and serum myoglobin levels were compared with the levels of creatine kinase, lactate dehydrogenase, aspartate aminotransferase and creatine kinase isoenzyme-MB.     

Serum creatine kinase isoenzyme MB concentration after endomyocardial biopsy

Serum total creatine kinase (CK), CK-MB and myoglobin (Mb) were serially determined in 17 patients who underwent endomyocardial biopsy. Mean total CK levels increased from 36 +/- 27 U/l 30 min before biopsy to a maximum of 112 +/- 77 U/l 8 h following the procedure (p less than 0.05). Similarly, Mb concentrations rose from 57 +/- 55 micrograms/l to 119 +/- 57 micrograms/l 30 min after biopsy (p less than 0.05). Normalization of total CK and Mb levels occurred within 16 and 8 h, respectively. A new immunoenzymetric assay (IEMA) was used to measure the mass concentration of the CK-MB molecule. The initial CK-MB levels were 0.2 +/- 0.4 microgram/l; a small but significant elevation was recorded as early as 2 h after biopsy (1.6 +/- 1.5 micrograms/l, p less than 0.05). CK-MB returned to initial concentration 16 h after the beginning of the procedure. Comparison with the maximum CK-MB levels recorded in 16 myocardial infarction patients (258 +/- 172 micrograms/l, range 90-680 micrograms/l) indicated that the modest increase of CK-MB level detected after biopsy probably reflects a limited endomyocardium lesion at the sampling site, excluding any significant myocardial damage. Total CK and Mb, which showed more pronounced elevations than CK-MB, are likely to originate from other sources than the myocardium.     

内皮素、N末端脑钠肽水平与急性心肌梗死患者预后的相关性研究

目的探讨急性心肌梗死患者血清内皮素(ET)及N末端脑钠肽(NT-proBNP)的表达及与患者预后的相关性。方法选择120例急性心肌梗死患者为研究对象,检测患者血清ET及NT-proBNP水平,探讨二者与冠状动脉病变、心功能分级及心血管事件发生率的关系。结果冠脉2支以上病变者血清ET及NT-proBNP水平显著高于单支病变者(P<0.05);随着心功能分级的升高,患者血清ET及NT-proBNP水平依次升高(P<0.05);发生心血管事件患者血清ET及NT-proBNP水平显著高于未发生心血管事件者(P<0.05)。结论 ET及NT-proBNP参与急性心肌梗死的发病机制,可作为评估患者病情严重程度及预后的指标。     

冠心病与C反应蛋白的相关性研究

目的探讨冠心病患者血清C反应蛋白(CRP)水平对冠心病发病的临床意义及对病情预测的价值。方法选取90例冠心病患者和同期体检的知情同意的健康体检人25例分别作为实验组和对照组,其中实验组中稳定型心绞痛(SAP组)30例,不稳定型心绞痛患者(UAP组)30例,急性心肌梗死(AMI组)30例。分别在其入院或体检时抽取空腹静脉血,测定血清CRP含量,观察其CRP的变化。结果实验组中UAP、AMI患者CRP含量高于对照组(P<0.05),SAP、UAP及UAP患者CRP水平依次升高且UAP和AMI两组间有显著性差异(P<0.05)。结论CRP水平与冠心病的病变程度有明显的相关性,早期检测CRP水平对于冠心病的早期评估和控制有重要作用,并可减少心血管病患者急性事件的发生。     

急性心肌梗死患者血浆N-末端脑钠肽前体水平检测及其临床意义

目的探讨急性心肌梗死(AMI)患者住院早期血浆N-末端脑钠肽前体(NT-proBNP)水平与梗死面积、心功能及住院期心脏事件的关系。方法采用ELISA法测定41例AMI患者住院后48小时内血浆NT-proBNP水平,并与患者肌酸激酶(CK)和肌酸激酶同功酶(CK-MB)峰值浓度、左室射血分数(LVEF)、住院期主要不良心脏事件(MACE)对比分析。结果AMI患者血浆NT-proBNP水平明显高于正常对照组(699.44±386.28pg/ml vs 41.75±24.26pg/ml,P<0.001)。血浆NT-proBNP水平与CK、CK-MB峰值浓度呈正相关(r=0.817,P=0.001;r=0.772,P=0.001),与LVEF呈负相关(r=-0.661,P<0.01)。住院期发生MACE患者的血浆NT-proBNP水平明显高于未发生MACE者(971.50±367.01pg/ml vs 393.60±261.16pg/ml,P<0.001)。结论AMI患者血浆NT-proBNP水平与CK、CK-MB峰值呈正相关,与LVEF呈负相关。检测血浆NT-proBNP水平可预测AMI患者梗塞面积、心功能及住院期心血管事件。     

老年血清胱抑素C水平与急性心肌梗死相关性研究

目的 观察70岁以上老年心肌梗死急性期血清胱抑素C(cystatin C,CysC)水平,探讨急性心肌梗死后CysC水平变化的意义.方法 顺序入选2010年7月- 2011年7月期间70岁以上急性心肌梗死患者58例及正常对照58例.入选对象均经冠状动脉造影检查确诊或排除诊断,记录急性心肌梗死患者梗死部位和梗死相关血管,...     

老年急性冠脉综合征患者血清淀粉样蛋白A和超敏C反应蛋白水平与冠状动脉病变程度的关系

目的 探究老年急性冠脉综合征(ACS)患者血清淀粉样蛋白A(SAA)、超敏C反应蛋白(hs-CRP)水平与冠状动脉病变程度的关系.方法 选择2018年1月至2019年10月我院收治的122例老年心肌梗死(AMI)、不稳定心绞痛(UA)患者作为研究对象,另择同期于我院住院治疗的50例稳定心绞痛(SAP)患者及健康查体者分...     

Semi-quantitative estimation of serum myoglobin by a rapid latex agglutination method: an emergency screening test for acute myocardial infarction

The present study reports the evaluation of a new latex agglutination test for serum myoglobin (SMb). The time of agglutination of the latex particles coated with antibodies to myoglobin was measured in 172 serum specimens with known concentration of myoglobin quantitated by a radioimmunoassay (RIA), collected from myocardial infarction (MI) patients, subjects suffering from various diseases, and normal controls. Myoglobin levels in the samples were found to decrease exponentially with time of agglutination. Agglutination occurring within 1 min (result coded as + + + +) corresponded to 761 +/- 366 micrograms/l of myoglobin; between 1 and 2 min (+ + +), to 285 +/- 101 micrograms/l; between 2 and 3 min (+ +), to 85 +/- 47 micrograms/l; between 3 and 4 min (+), to 51 +/- 38 micrograms/l; and after more than 4 min (-), to 31 +/- 16 micrograms/l. Blood samples were serially drawn from 24 MI patients with short hospitalization delays; the rapid agglutination which was obtained in the specimens taken upon admission (20 results coded as + + + + and four as + + +) actually corresponded to markedly increased SMb levels. In contrast, serum creatine kinase (CK) activities were still less than 150 U/l in four patients (16.6%); CK-MB was less than 5 U/l in five cases (20.8%). Positive agglutinations for SMb were also obtained 4 and 8 h following admission in all subjects, confirming that the latex test is an early and very sensitive indicator for MI.(ABSTRACT TRUNCATED AT 250 WORDS)     

血清同型半胱氨酸检测在冠心病患者中的临床应用

目的分析冠心病患者血清中同型半胱氨酸的水平,探讨其与冠心病的关系。方法用酶法测定67例冠心病患者和30例健康对照者血清同型半胱氨酸浓度,并对结果进行统计学处理。结果冠心病心肌梗死组、冠心病心绞痛组血清同型半胱氨酸浓度明显高于健康对照组（P〈0.01）,且冠心病心肌梗死组与冠心病心绞痛组比较,血清同型半胱氨酸浓度差异有显著性（P〈0.01）。结论血清同型半胱氨酸水平的升高是冠心病的一个危险因素,随着病情加重,升高更明显。     

阿托伐他汀早期干预对非ST抬高型急性冠脉综合征患者血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平的影响

目的:探讨阿托伐他汀早期干预治疗对非ST抬高型急性冠脉综合征患者血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平的影响。方法:采用酶联免疫吸附法测定不稳定型心绞痛患者(UAP组)、急性心肌梗死患者(AMI组)、稳定型心绞痛患者(SAP组)和健康体检者的高敏C反应蛋白和妊娠相关血浆蛋白-A水平。同时将急性冠脉综合征患者(包括UAP和AMI组)随机分为常规治疗组和阿托伐他汀干预组(阿托伐他汀20 mg/d),并于治疗前后分别测定血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平。结果:(1)高敏C反应蛋白和妊娠相关血浆蛋白-A水平在UAP组、AMI组比SAP组、正常对照组显著升高(P<0.05)。(2)2周后,阿托伐他汀干预组血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平较治疗前明显降低,且较常规治疗组治疗2周后亦有显著降低。结论:阿托伐他汀干预可以减少急性冠脉综合征患者动脉粥样硬化斑块的炎症反应,具有稳定斑块的作用。     

Serum matrix metalloproteinase-9 and venous bypass graft occlusion

OBJECTIVE: The primary results after coronary artery bypass grafting are good, but early clinical events as a result of graft occlusion are still a problem. Early occlusions are thought to be due to thrombosis or fibrointimal hyperplasia superimposed by thrombosis, but the etiology of these phenomena is not fully understood. Matrix metalloproteinase-9 has been suggested to have a role in graft occlusion ex vivo. MATERIAL AND METHODS: We investigated whether the level of serum matrix metalloproteinase-9 reflects its proposed role in occlusion of vein grafts. The study population consisted of 30 men with a history of myocardial infarction and 31 men without myocardial infarction who had undergone coronary artery bypass grafting. All the men were asymptomatic. RESULTS: Among the patients with no previous myocardial infarction, serum matrix metalloproteinase-9 level was significantly higher in those with graft occlusion than in those without occlusion (54.0+/-11.0 microg/L and 41.7+/-10.4 microg/L, respectively, p = 0.006), and it correlated positively with the number of occluded grafts (R = 0.55, p = 0.001). In the patients with myocardial infarction, this effect was not detected. CONCLUSIONS: Serum matrix metalloproteinase-9 reflected the occurrence of vein graft occlusion in subjects with no previous history of myocardial infarction.     

Nickel concentrations in serum of patients with acute myocardial infarction or unstable angina pectoris

Nickel was measured, by electrothermal atomic absorption spectrophotometry, in sera from (a) 30 healthy adults, (b) 54 patients with acute myocardial infarction, (c) 33 patients with unstable angina pectoris without infarction, and (d) five patients with coronary atherosclerosis who developed cardiac ischemia during treadmill exercise. Mean (and SD) concentrations in Group a were 0.3 (0.3) microgram/L (range less than 0.05-1.1 microgram/L). Within 72 h after hospital admission, hypernickelemia (Ni greater than or equal to 1.2 microgram/L) was found in 41 patients of group b (76%) and in 16 patients of group c (48%). Hypernickelemia was found before and after exercise in one patient of Group d (20%). Peak values averaged 3.0 micrograms/L (range 0.4-21 micrograms/L) in Group b, 1.5 microgram/L (range less than 0.05-3.3 micrograms/L) in Group c. In Group b, the mean time interval between the peak values for creatine kinase activity and for nickel was 18 h. Serum nickel concentrations were unrelated to age, sex, time of day, cigarette smoking, medications, clinical complications, or outcome. Mechanisms and sources of release of nickel into the serum of patients with acute myocardial infarction or unstable angina pectoris are conjectural, but hypernickelemia may be related to the pathogenesis of ischemic myocardial injury.     

急性冠脉综合征患者血清胆红素水平的相关研究

目的探讨人血清胆红素水平与急性冠脉综合征患者病变程度的关系。方法以80例行冠脉造影的患者为研究对象,其中确诊为急性冠脉综合征的67例为试验组,包括ST段抬高型心肌梗死29例,非ST段抬高型心肌梗死18例,不稳定型心绞痛20例;造影结果为阴性的非冠心病患者13例为对照组,包括X综合征患者8例,心血管神经症患者5例。所有研究对象均依据Gensini评分而分为4组,同时检测患者胆红素及各项生化指标。结果(1)急性冠脉综合征患者各组血清直接胆红素、间接胆红素与总胆红素水平均低于正常对照组(P<0.05)。随冠状动脉狭窄程度加重,胆红素水平逐渐下降。(2)血清胆红素水平与冠状动脉的狭窄程度、低密度脂蛋白、甘油三酯呈负相关(P<0.05),与高密度脂蛋白呈正相关。结论血清胆红素水平随冠状动脉狭窄程度的加重呈进行性下降,低胆红素血症可能是急性冠脉综合征发生发展的独立危险因素。     

The relation of amino-terminal propeptide of type III procollagen and severity of coronary artery disease in patients without myocardial infarction or hibernation

OBJECTIVES: The association of cardiac fibrosis and coronary artery disease (CAD) in patients without infarction or hibernation is unclear. We investigated the relationship between serum concentrations of procollagen propeptides and severity of CAD in such patients. DESIGN AND METHODS: Forty-six patients (32 men; mean age 64 years) with chest pain were enrolled. All patients received stress thallium-201 single photon emission computed tomography (SPECT) and analysis of the serum levels of the amino-terminal propeptide of type I and III procollagen (PINP and PIIINP). RESULTS: In patients with thallium-201 perfusion defects, the number of diseased vessels was associated significantly with PIIINP (p=0.024) rather than PINP (p=0.613). Follow-up serum PINP and PIIINP levels after coronary intervention (mean 84 days) revealed no significant decrease. CONCLUSIONS: Serum PIIINP level is significantly associated with the severity of CAD in patients without myocardial infarction or hibernation.     

血清超敏C反应蛋白与急性心肌梗死关系的临床研究

目的探讨血清高敏C-反应蛋白(hs-CRP)水平与急性心肌梗死(AMI)病情及预后的关系。方法测定42例AMI患者(观察组)入院时血清hs-CRP含量,与同期46例健康体检人员(对照组)血清hs-CRP含量进行对照。并分析治疗前后hs-CRP水平的差异;且将血清hs-CRP水平与心肌肌钙蛋白(cTnI)、肌酸激酶同工酶-2(CK-MB)水平进行相关性分析。结果观察组患者血清hs-CRP含量明显高于对照组,差异有统计学意义(P0.01)。患者血清hs-CRP水平与入院时cTnI、CK-MB呈显著正相关比较差异有统计学意义(P0.05)。hs-CRP水平在治疗前后比较差异有统计学意义(P0.01),说明心肌梗死病灶越大,血清hs-CRP水平越高,心肌功能缺损程度越重。结论血清hs-CRP水平是评价心肌梗死严重程度和预后的一个重要生物学指标。     

超敏C反应蛋白及白细胞计数对冠心病的评估价值

目的 探讨血清超敏C反应蛋白(hs-CRP)的浓度及外周血的白细胞计数(WBC)对冠心病危险程度的评估价值.方法 采用胶乳增强免疫透射比浊法测定55例稳定型心绞痛(SAP) 患者,38例不稳定型心绞痛(UAP)患者,33例急性心肌梗死(AMI)型心绞痛患者血清中hs-CRP的浓度,同时用贝克曼血液分析仪测定患者外周血的WBC.结果 心肌梗死患者血清hs-CRP平均浓度及外周血WBC均数明显高于健康人.根据冠状动脉病变程度采用随机方差分析:hs-CRP浓度及WBC在健康对照组、SAP组、UAP组、AMI组依次增高,两种比较差异均有统计学意义,与冠脉病变程度呈正相关.结论 冠心病患者血清hs-CRP及外周血WBC比健康人高,根据血清hs-CRP及外周血WBC升高评估冠心病危险性程度.     

血清心肌肌钙蛋白对心肌损伤的临床诊断价值

目的　探讨定量分析肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)对心肌损伤程度评价的临床意义。方法　对80例心肌梗死患[急性心肌梗死(AMI)50例、陈旧性心肌梗死(OMI)30例]、100例心脏手术患、60例非心脏手术患和20例健康人进行了血清cTnT、cTnI、肌酸激酶同工酶(CK—MB)和肌酸激酶(CK)检测。结果　(1)血清cTnT、cTnI、CK—MB和CK检测心肌损伤的敏感度和特异性分别为cTnT(72.4％，100.0％)、cTnI(81.8％，100.0％)，CK—MB(54.6％，87.5％)和CK(64.8％，62.2％)。(2)AMI和心脏手术组cTnT、cTnI、CK—MB和CK四项指标浓度均显高于正常对照组(P＜0.01)。(3)急性心肌梗死组、心脏手术组3h内cTnT和cTnI阳性检出率分别为(50％，56％)和(44％，45％)，明显高于CK—MB(24％，22％)和CK(20％，28％)；急性心肌梗死组、心脏手术组5d后cTnT和cTnI阳性检出率为(70％，66％)和(66％，61％)，而CK—MB仅为(4％，6％)，CK仅为(8％，10％)。结论　血清cTnT、cTnI能确切反映急性心肌梗死、心脏手术等心肌损伤程度，具有较宽的诊断窗口时间，是心肌损伤较敏感和特异的血清标志物。     

急性冠状动脉综合征患者血清纤维连接蛋白的变化

目的观察急性冠状动脉综合征不同类型患者血清纤维连接蛋白(Fn)水平的变化,探讨其在急性冠状动脉综合征发病中的作用和临床意义。方法急性冠状动脉综合征患者分为急性心肌梗死组50例、不稳定型心绞痛组17例,另设健康对照组13例,采用双抗体夹心固相酶联免疫吸附法测定血清Fn的水平。结果急性冠状动脉综合征组血清Fn的水平显著低于健康对照组[(233.38±119.15)μg/ml,(296.46±65.44)μg/ml,P<0.05];急性心肌梗死组与不稳定型心绞痛组血清Fn的水平差异无统计学意义。血清Fn的水平在不同的冠状动脉病变程度之间的差异无统计学意义[单支血管病变(226.83±112.35)μg/ml,双支病变(231.15±128.06)μg/ml及三支病变(277.32±139.61)μg/ml,F=0.825,P=0.445]。结论急性冠状动脉综合征患者血清Fn的水平显著低于健康对照组,与冠状动脉病变的程度无相关性。     

男性急性冠状动脉综合征患者血清睾酮与血管性假血友病因子改变的关系

目的:观察不同类型男性冠心病患者血清睾酮、游离睾酮与血管性假血友病因子水平改变及互相间相关关系,进一步探讨睾酮与血管性假血友病因子在男性急性冠脉综合征发病中的作用。方法:冠心病患者分为急性心肌梗死组(AMI)、不稳定型心绞痛组(UAP)、稳定型心绞痛组(SAP),每组30例患者,另设健康对照组30例,比较各组间血清睾酮、游离睾酮与血管性假血友病因子水平差异并分析其相关性。结果:AMI组和UA组血清游离睾酮与血管性假血友病因子水平与对照组差异有统计学意义(P<0.01)。结论:血清游离睾酮与血管性假血友病因子水平改变与急性冠脉综合征的发生有关,可作为评价冠状动脉粥样硬化斑块稳定性与病变严重程度的一个参考指标,并为临床预防和治疗急性冠脉综合征开辟了新的途径。