危重症患者血清心肌酶及心肌肌钙蛋白T升高的临床意义

目的探讨心肌酶及心肌肌钙蛋白T对于除急性心肌梗死以外危重症患者预后判断的价值。方法检测多例评分APACHE-Ⅱ≥9分的患者血清肌酸磷酸激酶(CK)及其同功酶(CK-MB)和心肌肌钙蛋白T(cTNT)与正常对照组进行比较研究。结果在危重症患者中发病6h内、24h、48h、72h,CK、CK-MB及cTNT值明显高于正常对照组,其中评分越高的患者检测结果越高。死亡组的CK、CK-MB及cTNT水平均显著高于存活组。结论危重症患者检测血清CK、CK-MB及cTNT有助于对患者预后的判断,具有重要临床意义。     

甲状腺功能减退症患者血清肌酸磷酸激酶升高的临床研究及相关性分析

目的观察甲状腺功能减退症（简称甲减）患者血清肌酸磷酸激酶（CK）升高情况。方法入院后分别进行甲状腺功能（FT3、FT4及TSH）、血清肌酶（CK、CKMB、LDH、HBDH、Asr）、心电图的动态监测，治疗用药为“优甲乐”，重点观察患者血清肌酸激酶值CK的变化与临床症状、体征及甲状腺功能等变化的关系。结果甲减患者可伴血清肌酶升高，尤以肌酸磷酸激酶明显升高为主，随着甲状腺功能恢复，肌酶值可迅速下降，恢复正常。结论血清肌酶的变化可作为甲状腺功能减退症疗效判断指标。     

甲型H1N1流感患者血清心肌酶学的临床研究

目的 探讨甲型H1N1流感患者血清心肌酶学水平与其疾病严重程度的关系.方法 对2009年9月至12月承德市集中收治的206例甲型H1N1流感患者的心肌酶水平进行对比分析.结果 危、重症组血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)高于轻症组(P＜0.05或P＜0.01),甲型H1N1流感的严重程度与血清CK、CK-MB、AST、LDH均呈正相关(r=0.160、0.396、0.181、0.392,P=0.021、0.001、0.009、0.001).结论 监测血清CK、CK-MB、AST、LDH等酶学水平,对判断甲型H1N1流感患者病情的危重程度及预后具有实际意义.     

恶性阻塞性黄疸患者的心肌损伤及丹参注射液的疗效

目的探讨恶性阻塞性黄疸患者黄疸对心肌组织的损伤及丹参注射液的保护作用。方法动态监测2010年2月至2011年3月重庆医科大学附属第二医院和海口市医院的57例恶性阻塞性黄疸患者血清胆红素及心肌酶天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白-1(troponin-1)及乳酸盐(lactate)的变化,超声评估心脏功能的改变并对比分析丹参注射液治疗前后患者检测结果。结果心肌酶、troponin-1在阻塞性黄疸患者有明显升高,心肌酶及troponin-1的升高与黄疸程度呈正相关,术前troponin-1的改变更明显(P<0.05),但超声心动图无明显变化(P>0.05)。丹参注射液治疗组与同时相恶性阻塞性黄疸患者相比心肌酶、troponin-1明显降低,术后恢复明显,疗效与血乳酸含量改变明显相关(P<0.05)。结论恶性阻塞性黄疸可引起心肌的损伤、心肌酶升高,但心功能无明显改变;troponin-1反应心肌损害较敏感。丹参注射液对恶性阻塞性黄疸患者黄疸的心肌组织有明显保护作用。     

硫氮酮对心肌缺血再灌注损伤内皮功能的保护作用

目的研究硫氮酮对心肌缺血再灌注(MIR)损伤内皮功能的保护作用.方法将48只大鼠制成心肌MIR模型,并随机分成假手术组、MIR组、硫氮酮组.各组分别于缺血前、缺血30 min、再灌注90 min、180 min检测乳酸脱氢酶(LDH),肌酸磷酸激酶同工酶(CK-MB),一氧化氮(NO),丙二醛(MDA)含量.结果①MIR组与假手术组相比,LDH、CK-MB升高,NO下降,MDA上升.②硫氮酮组与MIR组相比,LDH、CK-MB降低(P＜0.05和P＜0.01),NO活性增加(P＜0.05),MDA产生减少(P＜0.05).结论硫氮酮能减轻脂质过氧化程度,改善内皮功能,保护心肌MIR损伤.     

cTnT、cTnI在急性病毒性心肌炎诊断中的价值

目的 探讨心肌损伤指标肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)对急性病毒性心肌炎的临床诊断价值。方法116例首次诊断为急性病毒性心肌炎患者,在其发病的一至二周内,同时定量检测血清cTnT、cTnI和心肌酶谱系列肌酸磷酸激酶(CK)及其同功酶(CK-MB)、血清谷草转氨酶(sGOT)、乳酸脱氢酶(LDH)并作比较。结果 116例急性病毒性心肌炎患者中,共有53例cTnT异常升高,阳性率为45.7%;共有75例cTnI异常升高,阳性率为64.7%;而CK、CK-MB、sGOT、LDH检测阳性率分别为10.3%、7.8%、6.9%、12.9%。上述结果分别与cTnT及cTnI结果作卡方检验均有显著差异(P<0.01)。结论 病毒性心肌炎患者在急性期心肌损伤指标检测中,cTnT、cTnI比传统的CK、CK-MB、sGOT、LDH有更好的敏感度,是及时反映心肌损伤的良好的观察指标。     

高龄老年脑梗死患者心肌酶水平与脑梗死严重程度的关系研究

目的探讨高龄老年脑梗死患者发病时心肌酶水平与脑梗死严重程度的关系。方法对315例高龄老年急性脑梗死患者根据入院时改良Rankin评分将患者分为轻症组和重症组,并于入院24h内测量血清心肌酶水平,比较心肌酶水平差异,并分析其与神经功能缺损程度的相关关系。结果患者年龄、合并高血压、糖尿病比例无统计学差异(P>0.05)。两组患者血清天冬氨酸氨基转移酶、肌酸磷酸激酶及肌酸磷酸激酶同工酶比较差异有统计学意义(均P<0.01)。患者入院时神经功能缺损水平与血清心肌酶水平呈正相关。结论急性脑梗死发生时,血清心肌酶变化程度对病情的严重程度有一定的提示作用。     

急性脑血管病并发心肌损害时心肌酶及心电图变化

目的观察急性脑血管病患者并发心肌损害时血清心肌酶、心电图的变化,分析其临床意义。方法用酶速率法测定急性脑血管病88例患者的血清心肌酶谱,包括肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH),同时进行心电图检查,并根据神经功能缺损程度分轻、中、重型组,多组间进行对比分析。结果急性脑血管病(脑梗死与脑出血组)患者血清心肌酶除CK-MB外,AST、CK、LDH、α-HBDH与正常对照组比较具有统计学意义(P0.05或P0.01);脑梗死与脑出血组血清心肌酶比较无统计学意义(P0.05);重型组血清心肌酶明显高于轻型组(P0.01);心电图阳性组与心电图阴性组血清心肌酶比较无统计学意义(P0.05)。结论急性脑血管病患者并发心肌损害,血清心肌酶有明显的改变,其变化与病情轻重有关。检测血清心肌酶有助于判断病情的轻重及预后。     

酒精依赖综合征QTc间期与心肌酶的对比分析

目的探讨酒精依赖综合征(Alcohol dependence syndrome,ADS)男性患者校正QT间期(QTc)与心肌酶改变及临床意义。方法对76例ADS男性患者及42例健康体检人群的QTc间期及心肌酶进行对照分析。结果 ADS患者心电图的异常率显著高于正常组(p0.05);ADS患者的QTc间期和乳酸脱氢酶(LDH)、天门冬氨基转移酶(AST)、肌酸磷酸激酶(CK)、肌酸激酶同工酶(CK-MB)均显著高于正常组(p0.05)。结论ADS患者心电图异常率增高,QTc间期延长,心肌酶增高,心电图和心肌酶作为临床早期的检测手段对降低由ADS介导的心血管疾病的发生率和死亡率有重要意义。     

老年百草枯中毒患者血清酶学水平的动态变化

目的探讨老年百草枯中毒患者血清酶学水平的动态变化。方法选取56例老年百草枯中毒患者作为研究组,同期体检的健康人群70例作为健康对照组。检测老年百草枯中毒患者血清肌酸激酶(CK)、CK同工酶(CK-MB)、乳酸脱氢酶(LDH)、碱性磷酸酶(AST)等指标。结果与健康对照组比较,中毒第1天轻度组血清CK、CK-MB、LDH、AST水平差异无统计学意义(P0.05);但中度组和重度组患者血清CK、CK-MB、LDH、AST水平均高于健康对照组(P0.05);且三组间两两比较均有统计学差异(P0.05)。轻度组血清CK、CK-MB、LDH、AST水平在第3天达峰值,但在第7天开始下降。中度组和重度组血清CK、CK-MB、LDH、AST水平不断升高,在第7天达到峰值。第3、7天时,三组间血清CK、CK-MB、LDH、AST水平两两比较均有统计学差异(P0.05)。结论百草枯中毒可造成老年患者心肌损害持续性加重,且心肌损害程度与百草枯中毒程度相关。     

原发性甲状腺功能减退与肌酶谱的相关性研究

目的 探讨不同程度原发性甲状腺功能减退(甲减)对肌酶谱的影响,观察甲减患者激素替代治疗后肌酶谱的动态变化.方法 收集原发性甲减患者68例,其中亚临床甲减组21例,中度甲减组15例,重度甲减组32例,另选取39例健康体检者作为对照组.分别在初诊和激素替代治疗后1个月、2个月检测各组血清游离T3(FT3)、游离T4(FT4...     

静脉输液反应诱发老年患者心电图、心肌酶及cTnI改变初探

目的 观察老年患者输液反应时心电图、心肌酶及肌钙蛋白Ⅰ（cTnI）变化情况.方法 对我院2010年6月至2012年6月出现输液反应的62例老年患者（输液反应组）进行心电图、血清心肌酶和cTnI检测,并以60例无输液反应老年患者作为对照组进行比较.结果 输液反应组患者心电图异常率高于对照组（P＜0.05或P＜0.01）;血清天冬氨酸转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和cTnI水平及阳性例数亦明显高于对照组（P＜0.01）;输液反应组患者cTnI异常率高于其他心肌酶指标.结论 静脉输液反应可诱发老年患者潜在性心肌损伤,导致心电图、心肌酶及cTnI发生改变,应加强检测,尽早发现及时治疗.     

老年急性心肌梗死患者B型利钠肽和超敏C反应蛋白检测分析

目的 探讨B型利钠肽(BNP)和超敏C反应蛋白(hs-CRP)在急性心肌梗死(AMI)检测中的价值.方法 回顾性分析60例AMI患者和50例健康者的资料,观察BNP和hs-CRP在AMI和Killip分级中的表达特征,并探讨其与预后的关系.结果 治疗前AMI组的BNP、hs-CRP和肌酸激酶同工酶(CK-MB)与对照组比较差异均有统计学意义(P＜0.05),AMI组治疗前后比较差异有统计学意义(P＜0.05).治疗前后BNP、hs-CRP与CK-MB呈正相关(r=0.892,r=0.683,均P＜0.05).BNP、hs-CRP和CK-MB水平随Killip分级的严重程度而升高,呈正相关.BNP、hs-CRP和CK-MB各级别比较差异有统计学意义(P＜0.01).60例中,8例(13.3%)死亡,单因素分析结果显示BNP(≥56.1 pmol/L)、hs-CRP(≥9.0 mg/L)、CK-MB(≥75.1 U/L)和Killip分级Ⅲ、Ⅳ级为AMI患者预后的不良因素(均P＜0.05).结论 BNP和hs-CRP为AMI较为敏感的生化指标,其检测对于AMI的诊断、病情评估及预后具有重要价值.

Abstract：

Objective To explore the clinical significance of determination of the serum levels of brain (B-type) natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) in patients with acute myocardial infarction (AMI).Methods The clinical data of 60 cases with AMI and 50healthy controls were analyzed retrospectively.The BNP and hs-CRP levels were analyzed in AMI and Killip class,and their relationship with prognosis was investigated.Results The serum levels of BNP,hs-CRP and creatine kinase (CK)-MB) were higher in AMI group than in control group (all P＜0.05),and the levels were lowered after treatment (P＜0.05).The correlation analysis indicated that BNP and hs-CRP had positive correlations with CK-MB (r=0.892 and 0.683,all P＜0.05),and increased along with the severity of Killip classification.The 8 cases (13.3 % ) died,and single factor analysis revealed that BNP (≥56.1 pmol/L),hs-CRP (≥9.0 mg/L),CK-MB (≥75.1 U/L) and Killip classification (grade Ⅲ and Ⅳ) were the poor prognostic factors (P＜0.05).Conclusions The elevation of BNP and hs-CRP level is correlated with the severity of AMI,and could be used to evaluate the AMI patients' diagnosis and prognosis.     

急性心肌梗死溶栓疗效判断中血清酶测定时间的合理选择

目的　适时合理选择急性心肌梗死 (AMI)溶栓疗效判断中血清酶学指标。方法　回顾性分析 145例AMI溶栓患者血清酶学及心肌肌钙蛋白T(TnT)资料 ,其中男 10 7例 ,女 38例 ,平均年龄 (6 1 9± 9 3)岁。以无创指标判断溶栓成功者 110例 ,未成功者 35例。 6 5例行冠脉造影 ,梗死相关血管 (IRA)开通者 44例 ,未开通者2 1例。 5 9例同时测定TnT。结果　 (1)TnT首次异常检出率 84 7% ,高于肌酸磷酸激酶 (CK)同功酶 (CK -MB)(4 9 2 % ) (P <0 0 5 )。 (2 )溶栓成功、IRA开通者与溶栓未成功、IRA未开通者间CK/CK -MB峰值无显著性差异 (P >0 0 5 )。结论　 (1)TnT用于AMI心肌损伤早期诊断优于CK -MB。 (2 )CK/CK -MB峰值前移与溶栓成功与否、IRA开通与否有关 ,而CK/CK -MB峰绝对值与此无直接关系。对早期溶栓的AMI患者不必过早取血测定CK/CK -MB ,而在发病后 16～ 2 0h间取血测定即可满足判断酶峰是否前移的需要 ,从而减轻病人痛苦和经济负担。     

血清心肌标记物与心电图在室间隔缺损介入治疗中的变化

目的探讨经导管室间隔缺损（VSD）封堵术治疗前后心脏血清标记物及心电图的变化及关系。方法检测VSD患者介入治疗前后血清肌钙蛋白I（cTnI）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、天门冬氨酸氨基转移酶（AST）、超敏C反应蛋白（hs-CRP）的含量变化,并分别记录手术前后心电图（ECG）,对治疗前后资料进行对比分析。结果介入治疗后6hVSD患者较治疗前血清cTnI明显升高（t=12.796,P〈0.01）,24h已下降,但仍有统计学意义（t=44.444,P〈0.01）,术后48h已恢复至术前水平,hs-CRP术后6h、24h、48h逐渐升高,且升高明显（t6h=55.463,t24h=111.558,t48h=109.831,P值均〈0.05）,血清CK、CK-MB、LDH、AST水平无明显变化。部分ECG术后较术前出现新发传导阻滞,多见于膜周部室间隔缺损病例,但与心肌酶、C反应蛋白变化无明显关系。结论经导管VSD封堵术对患者cTnI、hs-CRP及ECG有一定影响,但cTnI、hs-CRP的变化与ECG的变化关联度不大。     

经皮腔内冠状动脉成形术前后冠心病患者血清肌酸激酶-同工酶和镁的变化

目的 :了解冠心病患者行经皮腔内冠状动脉成形术 (PTCA)前后血清肌酸激酶 -同工酶 (CK- MB)、镁 (Mg2 +)的变化。方法 :以 1 6例冠状动脉造影 (CAG)阴性者为阴性对照组 ,以 1 0例 CAG阳性但不宜行 PTCA者为阳性对照组 ,观察 2 4例行 PTCA冠心病患者 (PTCA组 )手术前后血清 CK- MB、Mg2 +的动态变化。结果 :PTCA组术后 5、30、1 2 0 min血清 CK- MB较术前及同时点两对照组均有显著增加 (P <0 .0 1 ) ,Mg2 +在术后 5、30、1 2 0、360 min较术前及同时点阴性对照组显著减少 (P <0 .0 5) ;阳性对照组 Mg2 +值在术后 5min比术前及同时点阴性对照组显著减少 (P <0 .0 5及 P <0 .0 1 )。另外 ,PTCA组术后 30 min血清 CK- MB与 Mg2 +呈负相关 (P <0 .0 0 1 )。结论 :PTCA可引起一定程度的心肌损伤 ,但尚未造成心肌明显坏死 ;该研究可部分揭示PTCA后心肌缺血再灌注损伤的发生机制     

Effect of statin therapy prior to elective percutaneous coronary intervention on frequency of periprocedural myocardial injury

This study evaluated whether pretreatment with statins was associated with a decreased incidence of periprocedural myocardial injury. Periprocedural myocardial injury occurs after percutaneous coronary intervention (PCI) and is associated with adverse outcomes. The pleiotropic properties of statins stabilize plaque and decrease the inflammatory milieu of atherosclerotic lesions. Accordingly, we hypothesized that preprocedural statin therapy would decrease periprocedural myocardial injury. We enrolled 425 patients who underwent successful PCI. The control arm (n = 150) included patients not on statin therapy at the time of PCI, and the statin arm (n = 275) included patients who were taking statin medication before PCI. All patients had serial enzymes measured, including creatine kinase (CK), CK-MB, and troponin I. The incidence of increased levels of CK and CK-MB >3 times normal and the absolute increase in CK and troponin I were compared between groups. The control arm had significantly higher periprocedural levels of CK. In the control group, 6% of patients had CK increases >3 times the upper limit of normal compared with 1.8% in the statin group (p = 0.02). The control arm had a higher frequency of CK-MB increases >3 times the upper limit of normal (7.3% vs 2.2%, p = 0.01). There was a trend toward higher levels of troponin I in the control group (3.21 vs 1.85 ng/ml, p = 0.06). Thus, statin therapy before elective PCI was associated with lower levels of periprocedural CK.     

Troponin is more useful than creatine kinase in predicting one-year mortality among acute coronary syndrome patients.

AIMS: To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes (ACS). METHODS AND RESULTS: In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2% and 59.0% of patients had abnormal Tn and CK (or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients (6% lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio [OR] 2.06; 95% CI 1.37-3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality (OR 1.83; 95% CI 1.14-2.93; P=0.01). In contrast, abnormal CK (or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95% CI 1.30-2.44; P<0.001) but not CK/CK-MB was independently associated with increased one-year mortality. CONCLUSIONS: Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.     

Creatine kinase isoenzymes. Predictive value in the early diagnosis of acute myocardial infarction.

This is a prospective study of the value of the creatine kinase (CK) isoenzyme determination in the early diagnosis of acute myocardial infarction. The presence or absence of the MB isoenzyme was correlated with electrocardiogram and standard enzymes. The frequency of falsely positive and falsely negative results for CK-MB, electrocardiogram and each standard enzyme was calculated and, using the elements of conditional probability theory, their predictive values for the diagnosis of acute myocardial infarction were determined. Results indicate that CK-MB combines the best attributes of the electrocardiogram and standard enzyme tests: detectable MB isoenzyme activity by acrylamide slab electrophoresis has a predictive value for the diagnosis if acute myocardial infarction comparable to that of a positive electrocardiogram; absence of MB isoenzyme activity, in the 24 hour period following the onset of symptoms, excludes the diagnosis of acute myocardial infarction with a probability equivalent to that provided by normal standard enzyme results.     

Clinical applicability of creatine kinase MB mass and the electrocardiogram versus conventional cardiac enzymes in the diagnosis of acute myocardial infarction

We compared creatine kinase MB (CK-MB) mass and total creatine kinase (CK) sampled three times daily with conventional cardiac enzymes. The influence of the electrocardiogram (ECG) on admission, frequency of blood sampling, thrombolytic therapy, different upper reference limits of the biochemical markers and duration of symptoms were assessed in 100 consecutive patients with suspected AMI of whom 63 were confirmed according to WHO criteria. Early sensitivity but not specificity of CK-MB mass, with and without ECG, for cut points <8 μg/l was significantly better than total CK sampled frequently. The sensitivity of ECG on admission (52%) was significantly improved by CK-MB analysis (79%) but not by total CK. Duration of symptoms (range of means 3.5–9 h) or thrombolytic treatment had no influence on the sensitivity and specificity of CK-MB mass. In AMI with inconclusive ECG, CK-MB mass performed best of the markers with a sensitivity of 70% versus 17% of total CK (P<0.001) on admission. CK-MB mass was also elevated in 8 patients classified conventionally as unstable angina. We conclude that CK-MB mass is a more useful marker of AMI during the first 16 h of chest pain than frequently sampled total CK, ECG and conventional cardiac enzymes.