心肌肌钙蛋白Ⅰ与肌酸激酶同工酶在儿童心肌损害诊断中的比较

目的:了解各病理状况对心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)的影响,并比较其诊断价值。方法:对4组儿童进行血清cTnI、CK-MB测定。A组为健康儿童54例;B组为一般状况可的非心血管疾病患儿53例;C组为病情稳定的先天性心脏病患儿12例;D组为急性心肌炎患儿14例。结果:A组cTnI值均<0.25"g/mL,各年龄组之间差异无显著性,CK-MB升高1例(1.9%)。A、B、C组cTnI值之间差异无显著性。B组cTnI升高1例(1.9%),CK-MB升高9例(16.9%);C组cTnI均不升高,CK-MB升高1例(8.3%);D组cTnI升高11例(78.6%),平均值较A组显著增高(P<0.01)。结论:cTnI可用来诊断儿童心肌损害,无心血管系统受累的患儿cTnI值不升高,心血管系统以外的疾病可影响CK-MB值。     

Diagnostic utility of new immunoassays for the cardiac markers cTnI, myoglobin and CK-MB mass

OBJECTIVES: We investigated the diagnostic value of a new system, the Innotrac Aio! immunoassays for troponin, myoglobin and CK-MB, in 270 samples from patients with ACS, after bypass surgery (CABG) or with stable heart failure in comparison to the respective Roche assays. RESULTS: The values of the cardiac markers assessed by the respective assays correlated (cTnT/cTnI Rho = 0.94, myoglobin Rho = 0.87, CK-MB Rho = 0.84). If values were dichotomised, we found a high concordance of test positive and negative classified patients by troponins with the respective assays. CONCLUSION: There is strong evidence that the Innotrac Aio! system for cTnI measurement can be used reliably.     

microRNA与心肌缺血损伤研究新进展

背景:研究发现多种microRNA在心肌缺血缺氧时表达明显异常,它们对心血管疾病的发生和发展起着重要作用。目的:介绍近5年来microRNA对心肌缺血损伤的影响、作用机制及可能的治疗方案。方法:分别以"microRNA、心肌、缺血、缺氧"为检索词,应用计算机检索PubMed数据库和ISIWeb of Knowledge平台检索近5年有关文章,排除与研究目的无关和内容重复者,保留42篇文献做进一步分析。结果与结论:microRNA是一类具有转录后调节活性的内源性小分子RNA,通过与靶mRNA的3`端非编码区结合负性调控基因的表达而参与心血管疾病的发生发展。目前研究表明microRNA参与了心肌缺血、缺血后心脏重塑、心肌梗死后继发性心律失常等相关的病理过程,人工干预microRNA的表达可以加剧或预防心肌缺血缺氧损伤的进展。microRNA可能成为治疗心血管疾病的靶向分子。     

microRNA与心肌缺血损伤研究新进展

背景：研究发现多种microRNA在心肌缺血缺氧时表达明显异常,它们对心血管疾病的发生和发展起着重要作用.目的：介绍近5年来microRNA对心肌缺血损伤的影响、作用机制及可能的治疗方案.方法：分别以＂microRNA、心肌、缺血、缺氧＂为检索词,应用计算机检索PubMed 数据库和ISI Web of Knowledge平台检索近5年有关文章,排除与研究目的无关和内容重复者,保留42篇文献做进一步分析.结果与结论：microRNA是一类具有转录后调节活性的内源性小分子RNA,通过与靶mRNA的3端非编码区结合负性调控基因的表达而参与心血管疾病的发生发展.目前研究表明microRNA参与了心肌缺血、缺血后心脏重塑、心肌梗死后继发性心律失常等相关的病理过程,人工干预microRNA的表达可以加剧或预防心肌缺血缺氧损伤的进展.microRNA可能成为治疗心血管疾病的靶向分子.     

Soluble serum Klotho levels in healthy subjects. Comparison of two different immunoassays

Objective

Soluble serum Klotho is a new biomarker linked to chronic kidney disease, cardiovascular disease and diabetes. This study describes the evaluation and comparison of two different immunoassays and establishment of assay specific reference intervals in adults.

Design and methods

Serum Klotho concentrations were determined in 120 healthy adults aged 19–66 years. Blood samples were collected, and stored sera were assayed for Klotho according to age and gender. In addition several other clinical and laboratory characteristics were determined in the cohort and compared to the levels of serum Klotho.

Results

Serum Klotho levels were significantly higher in time-resolved fluorescence immunoassay (TRF) compared to an ELISA (IBL) and no correlation was found between the assays. No signal was obtained in either assay when the standard curve was switched between the two different immunoassays. The median serum Klotho concentration using TRF was 61 ng/mL (2.5–97.5% reference limits; 11–181 ng/mL) for males and 99 ng/mL (2.5–97.5% reference limits; 19–316 ng/mL) for females while the ELISA gave a mean value of 472 pg/mL (2.5–97.5% reference limits; 204–741 pg/mL) with no difference between genders. Concentrations of serum Klotho were independently associated with estimated glomerular filtration rate (eGFR) and body weight using TRF whereas serum Klotho concentrations were associated with age using the ELISA.

Conclusion

Comparison of two different immunoassays for serum Klotho indicate, that the protein exists in human beings in different forms which may function as independent factors and whose role and potential value as biomarkers needs to be evaluated separately. Reference intervals specific for the different forms recognized by the different assays were calculated in this study.     

Stability of cardiac troponins and CK-MB mass isoenzyme.

The stability of an analyte can have an important influence on its diagnostic performance and therefore should be documented before an analyte is introduced into routine practice. The stability of creatine kinase MB isoenzyme (CK-MB), troponin I and troponin T was studied by incubating samples at temperatures between 26 degrees C and 39 degrees C for periods up to 5400 min. Arrhenius plots were made which showed that all three proteins demonstrated a rapid decrease in stability between 15 degrees C and 20 degrees C. The activation energies for CK-MB, troponin I and troponin T were 7.7, 6.34 and 6.34 cal/mol, respectively.     

S-troponin T in suspected ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzyme MB

In a multicenter study we compared three tests for ischemic myocardial injury (IMI): a new, automated enzyme immunoassay for S-troponin T (S-TNT; Boehringer Mannheim) and two S-creatine kinase (CK) isoenzyme MB assays (mass and catalytic concentrations). For critical evaluation of clinical sensitivity, we studied 243 cases with an IMI prevalence of 43% and an 18% prevalence of cases with unstable angina. Relative peak values of S-TNT and S-CK-MB (mass) after onset of pain were four- to fivefold higher than S-CK-MB (catalytic) results. Increases of S-TNT and S-CK-MB (mass), even though still within their reference ranges, indicated minor myocardial damage in about one-third of the cases primarily classified as unstable angina. The diagnostic window for S-TNT ranged from hours to weeks after the acute episode. The time courses were frequently biphasic, with the initial S-TNT peak closely paralleling that of the mass concentrations of S-CK-MB. With a biological half-life for S-TNT of 2 h, the prolonged increases in S-TNT indicate a continuous release of S-TNT from necrotizing cells. Clinical specificities of S-TNT and S-CK-MB (mass) were greater than that of S-CK-MB (catalytic), even in the presence of 30% to 40% severe skeletal muscle injuries. The combination of S-TNT and S-CK-MB (mass) is excellent for detection of acute IMI, including minor myocardial damage.     

cTnI、CK-MB和MB定量检测在急性心肌梗死诊断中的价值

目的探讨心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和肌红蛋白(MB)定量分析对急性心肌梗死诊断的临床价值。方法对96例急性心肌梗死(AMI)患者胸痛发作后24h内定量检测血清cTnI、CK-MB、MB浓度,比较它们对AMI诊断的敏感性和特异性。结果急性AMI患者的cTnI、CK-MB、MB的检测结果分别为(7.17±6.32)μg/L、(93±45)IU/L和(593±218)μg/L,较正常对照组均有显著性升高(P0.05)。cTnI、CK-MB、MB对AMI的敏感性分别为97.9%、78.1%和100%,特异性分别为97.5%、95.8%和87.5%。结论急性AMI患者的cTnI、CK-MB、MB值均明显升高。CK-MB、MB在AMI诊断中具有较高的灵敏度和特异性,cTnI具有很高的灵敏度和特异性。cTnI是诊断AMI最好指标,为梗死诊断提供必要的信息。     

CK-MB及cTnI对手足口病患儿心肌损伤的诊断价值研究

目的探讨血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)对手足口病(HFMD)患儿心肌损伤的诊断价值。方法选择2012年7月至2013年6月住院治疗的HFMD患儿80例(HFMD组),同期体检健康儿童50例(对照组)。比较两组血清CK-MB、cTnI水平。结果 HFMD组治疗前CK-MB、cTnI水平分别为(38.10±19.50)U/L、(0.08±0.02)μg/L,均高于对照组(P0.05)。HFMD患儿治疗前CK-MB、cTnI阳性率分别为56.3%、33.8%,阳性率比较差异有统计学意义(P0.05)。经治疗后,HFMD患儿CK-MB、cTnI水平均明显下降(P0.05)。结论联合检测血清CK-MB、cTnI对HFMD合并心肌损伤的早期诊断具有重要临床意义。     

Comparison of two Cobas Core enzyme immunoassays with other test systems for the detection of cytomegalovirus-specific IgG and IgM antibodies

The new Cobas Core CMV IGM and IgG enzyme immunoassays (Roche Diagnostic Systems, Basle, Switzerland) were evaluated for their ability to detect cytomegalovirus (CMV)-specific IgM and IgG antibodies. Therefore, both were compared with some other commercially available and already established serological tests used in the laboratory diagnosis of CMV infection. These included the Abbott IMx CMV IgM and IgG assays, the Abbott CMV-M EIA, the Gull CMV IgM and IgG immunofluorescence tests, the medac CMV-IgM-ELA, and the Enzygnost anti-cytomegalovirus assay (Behringwerke). A total of 572 serum samples of various categories were examined and the results showed high concordances between all methods, ranging from 84.5% to 94.9%. In a follow-up on renal transplant patients, the times of first detection of seroconversions were compared. Since a high overall agreement between the Cobas Core CMV IgM and IgG enzyme immunoassays and the other test systems were observed, these new assays represent useful and reliable tools for clinical CMV diagnosis. © 1994 Wiley-Liss, Inc.     

Standardization of creatine kinase-MB (CK-MB) mass assays: the use of recombinant CK-MB as a reference material.

BACKGROUND: The AACC assembled a committee to identify and validate a standard creatine kinase MB isoenzyme (CK-MB) material to improve the comparability of CK-MB mass assays. METHODS: Three protocols were used. In protocol I, various CK-MB materials prepared in different matrices were screened as candidate standards. In protocol II, participating manufacturers calibrated their systems with concentrates of human heart CK-MB and then tested 20 patient samples to evaluate calibration bias. In protocol III, participating manufacturers calibrated their immunoassay systems using recombinant CK-MB2 (rCK-MB2) diluted into their respective sample diluents and measured 50 samples. RESULTS: Candidate materials showed high recovery in stripped human serum, but bias improved only from 59% to 38%. These data led to the use of human heart CK-MB diluted in each manufacturer's sample diluent. This strategy reduced bias from 31% to 15%. Because human heart CK-MB is difficult to provide, a lyophilized source of CK-MB2 was identified. rCK-MB2 was shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, reversed-phase HPLC, intrinsic protein fluorescence, circular dichroism, agarose gel electrophoresis, immunoreactivity studies, high and low temperature stability, and reconstituted stability to be equivalent to human heart CK-MB. Calibration of immunoassay systems with rCK-MB2 added into each respective manufacturer's sample diluent showed a 13% between-manufacturer bias. CONCLUSION: Lyophilized rCK-MB2 was determined suitable for use as a reference material for CK-MB mass assays.     

两种抑郁模型的行为学比较

目的：比较5-羟色胺神经元损毁致小鼠抑郁症状模型与慢性刺激抑郁模型小鼠强制游泳实验和悬尾实验中的行为学特点，评估两种模型在研究抑郁症中的适用性。方法：实验于2005-04／07在解放军第四军医大学完成。①分组：40只C57BL／6小鼠随机分为慢性刺激组、5-羟色胺损毁组、假手术组及空白对照组。②模型制备：慢性刺激组小鼠每日慢性中性刺激。共21d；5-羟色胺损毁组小鼠脑室中注射特异性5-羟色胺毒剂5，7-双羟色胺，特异性损毁小鼠中缝背核中的5-羟色胺能神经元；假手术组小鼠侧脑室给予注射等量的生理盐水。⑧观察指标：分别测试两种模型小鼠的体质量变化、蔗糖摄取实验、强制游泳实验和悬尾实验等行为学表现。结果：40只小鼠均进入结果分析。5-羟色胺损毁组和慢性刺激组的小鼠表现出多项抑郁症状：①两者模型小鼠体质量增加缓慢、增加量明显减少。②两种模型小鼠均表现糖摄取量明显减少。③两种模型小鼠强制游泳实验和悬尾实验中无动时间的总和均明显延长。结论：慢性刺激模型和5-羟色胺损毁模型均复制出人类了抑郁症的多项表现，提示环境因素的改变和5-羟色胺降低在抑郁症的发病机制中发挥一定作用。     

两种抑郁模型的行为学比较

目的:比较5-羟色胺神经元损毁致小鼠抑郁症状模型与慢性刺激抑郁模型小鼠强制游泳实验和悬尾实验中的行为学特点,评估两种模型在研究抑郁症中的适用性。方法:实验于2005-04/07在解放军第四军医大学完成。①分组:40只C57BL/6小鼠随机分为慢性刺激组、5-羟色胺损毁组、假手术组及空白对照组。②模型制备:慢性刺激组小鼠每日慢性中性刺激,共21d;5-羟色胺损毁组小鼠脑室中注射特异性5-羟色胺毒剂5,7-双羟色胺,特异性损毁小鼠中缝背核中的5-羟色胺能神经元;假手术组小鼠侧脑室给予注射等量的生理盐水。③观察指标:分别测试两种模型小鼠的体质量变化、蔗糖摄取实验、强制游泳实验和悬尾实验等行为学表现。结果:40只小鼠均进入结果分析。5-羟色胺损毁组和慢性刺激组的小鼠表现出多项抑郁症状:①两者模型小鼠体质量增加缓慢、增加量明显减少。②两种模型小鼠均表现糖摄取量明显减少。③两种模型小鼠强制游泳实验和悬尾实验中无动时间的总和均明显延长。结论:慢性刺激模型和5-羟色胺损毁模型均复制出人类了抑郁症的多项表现,提示环境因素的改变和5-羟色胺降低在抑郁症的发病机制中发挥一定作用。     

Release kinetics of serum cardiac troponin i in ischemic myocardial injury

Objectives: The study was undertaken to evaluate the release kinetics of cardiac troponin I (c-cTn-I) in ischemic myocardial injury.

Design and Methods: The reference range for cTn-I was established by determination of cTn-I in sera and plasma obtained from 622 healthy volunteers (Group 1). cTn-I was compared to: (a) Creatine kinase (CK) MB mass and myoglobin in 12 patients with severe skeletal muscle damage (Group 2); (b) CK-MB activity in 48 patients with myocardial infarction (MI) receiving intravenous thrombolysis (Group 3) (in this group, an additional 43 patients with MI were analyzed separately to characterize cTn-I patterns in thrombolyzed and nonthrombolyzed populations); and in 44 patients with unstable angina (Group 4).

Results: In Groups 1 and 2, no positive results (0.1 μg/L) were obtained. In Group 3, the time-courses of cTn-I were mostly monophasic in form. A pathologic increase occurred earlier in cTn-I than in CK-MB activity (p = 0.0002); the period with increased cTn-I was longer (p = 0.001), the overall sensitivity of cTn-I (93.9%) was higher than that of CK-MB activity (p = 0.00001). cTn-I was more sensitive at admission (p = 0.0004). In additional patients, the cTn-I peak occurred and cTn-I disappeared significantly later in nonthrombolyzed than in the thrombolyzed group. In Group 4, positive tests results were detected in 45% of patients for cTn-I, 16% for CK-MB activity, and 32% for CK-MB mass.

Conclusions: The cTn-I assay appears to be ideally suited for the detection of ischemic myocardial injury in complex clinical situations because of its high specificity; cTn-I indicates myocardial tissue damage in patients with unstable angina and is superior to CK-MB activity and mass in this respect.