巨分子酶在常规检验中的“干扰”及其鉴别方法

目的：建立巨分子酶的鉴别方法，排除巨分子酶在常规检验中的干扰。方法：应用琼胆糖凝胶电泳、酶的活化能测定，免疫学方法和电泳法结合，热失活试验，单克隆抗体直接检测等鉴别方法。结果：在琼脂糖凝胶电泳中巨肌酶激酶（CK）1迁移于CK－MM与CK－MB之间，巨CK2则位于CK－MM的阴极侧，正常CK和巨CK1酶活化能范围为45－65kJ/mol，巨CK2的酶活化能范围为80－140kJ/mol。45℃水浴20min,测定CT残余活力，CK－BB和CK－MB几乎完全失活，而巨CK则不受影响。当乳酸脱氢酶（LD）的其中一种同工酶与其自身抗体免疫球蛋白形成巨LD时，几种同工酶就会聚合在一起，结论：对血清中含有巨分子酶的标本作出鉴定，可减少误诊，为临床提供正确报告。     

血清巨CK的检出率及临床意义

目的：探讨巨CK的检出率及与疾病的相关关系。方法：采用日立7170A全自动生化分析仪测试CK及CK－MB,检出CK－MB异常升高者,再取血清进行CK同工酶电泳,判断是否有异常条带,有异常条带再进行免疫学方法和电泳法结合进行鉴别巨CK的属性和活化能试验。结果：检测样品5260例,检出巨CK6例,检出率为0．11％,其中巨CK1型4例,巨CK2型2例。巨CK1型4病例分别是干燥综合症,进行性肌萎缩,急性药物中毒,风心伴心衰。CK1型的巨CK与抗IgG,IgA抗体温育后进行电泳,条带分别有改变,且活化能不高。巨CK2型病例分别是肺癌伴肝转移,原发性肝癌。两例巨CK与IgG、IgA无关,且电泳条带位于阴极端,活化能较高。两病例均呈临终前开始出现多脏器衰竭后,出现巨CK2。结论：用免疫抑制法测定CK－MB法,如果CK－MB超过总CK30％以上,要警惕有无巨CK存在。巨CK1是一种良性现象,多与肌炎,心血管疾病有关。巨CK2与恶性肿瘤密切相关。     

血清CK-MB活力的免疫抑制速率法及临床应用

本文采用德国B．M生产的CK－MB试剂盒于VITALAB－半自动生化分析仪上自编程序参数，快速测定血清CK－MB活力，收到满意效果。该法具有灵敏、简便、快速、微量等优点，特别适合医院常规和急诊开展CK－MB活力的检测。1材料与方法1．1试剂①CK－MB（NAC－act）试剂盒（德国B．M产品）。②CK总活力测定试剂盒（TRACE产品）。1．2仗器VITALABMICRO半自动生化分析仪（荷兰）。1．3测定方法于半自动生化分析仪上预置参数。波长340urn，温度30C，延迟时间300s，测定时间60s。试剂量500UI．样本量20UI．混合进作量450UI．因数…     

C－反应蛋白和肌钙蛋白检测在冠心病诊断中的作用

目的 通过比较冠心病（CAD）患C－反尖蛋白（CRP）、肌钙蛋白（TnI）、肌酸磷酸激酶（CK）及其同工酶（CK－MB）的阳性率，以了解它们与CAD之间的关系及其临床意义。方法 测定60例CAD患及20例健康（CP）的CRP、TnI、CK及CK－MB的阳性率。结果 发现CAD组患的CRP、TnI、CK－MB和CK阳性率均明显高于CP组（P＜0．05）。AMI组患的CRP、TnI、CK－MB和CK阳性率明显高于SAP组（P＜0．01）；而UAP的CRP和TnI阳性率明显高于SAP组（P＜0．01），但两组间CK－MB和CK的阳性率相比无明显差异（P＞0．05）。结论 CRP和TnI的增高与冠心病事件的发生密切相关。     

血清单项CK-MB增高的临床分析

对我院2006-03～2006-12住院患者检测CK正常、CK－MB异常增高、CK－MB／CK〉30%的127例分析如下。     

BPC216全自动生化分析仪速率法检测血清CK-MB酶活力

肌酸激酶（CreatineKinase．CK）是由B和M两ha基组成的二聚体，有三种同工酶。存在于脑和前列腺等非肌组织者为CK－BBj存在于骨骼肌及心肌中为CK－MAI，心肌除以CK－MM型为主外，尚有CK－MB型。正常血清中绝大部分为CK－MM型，偶可见有CK－MB型。急性心肌梗塞后三小时，即可出现CK－MB型显著增高，对心肌梗塞的早期诊断具有特异性的意义。当前，检测CK—MB较为理想的方法是免疫抑制原理法．该法具有快速、简便的特点，可应用于大批量常规检查。本文就我科应用BPC216全自动生化分析仪速率法检测血清CK－MB酶活力的情况简…     

肌红蛋白/碳酸酐酶Ⅲ比值:急性心肌梗塞时心肌损伤的高度特异而敏感的早期标志物

本研究旨在对血清肌红蛋白（Mb）／碳酸酐酶Ⅲ（CAⅢ）比值作为早期诊断急性心肌梗塞（AMT）的生化指标进行评价。对象为267例有AMI特征性症状并于3个月内连续收住院的患者。其中37例诊断为AMI（只包括胸痛开始的时间确定无疑且本次胸痛发作距入院时间＜24h的患者），余230例为不稳定型。心绞痛（20例）、稳定型。心绞痛（102例）或非心源性胸痛患者（108例）。入院时采血测定CK、CK－MB活性和CK－MBmass含量，男性CK参考上限为270U／L，女性为170U／L，CK－MB参考上限为15U／L，，CK－MBmass参考范围为＜5．0g／1，。Mb／C…     

AMI患者血清CK—MB蛋白浓度定量测定

由于肌酸激酶(CK),特别是其同工酶MB(CK－MB)对心肌具有较高的特异性.文献报道,在胸痛发作的48小时内,CK－MB是心肌损害的一个敏感和特异的标志物1、2.目前主要应用同工酶酶谱电泳分析以及酶动力学方法测定酶活力进行CK－MB的测定.由于自动生化分析仪的广泛应用以及免疫抑制法测定CK－MB酶活力的技术发展,故我国大多数中小实验室仍然应用测定CK－MB的酶活性来进行急性心肌梗塞的早期临床辅助诊断.由于其测定并非CK－MB含量的直接测定,并且测定结果往往受到很多因素的影响和制约.而蛋白电泳测定结果为相对含量,均不能真实反…     

用心肌钙蛋白T判断急性心肌梗塞溶栓疗效的观察

目的动态观察急性心肌梗塞（AMI）患者溶栓治疗后肌酸激酶（CK）,肌酸激酶MB同功酶（CK－MB）活性及心肌肌钙蛋白T（cTnT）浓度变化规律,探讨cTnT对判断冠脉再通的临床价值。方法选择AMI并接受溶栓治疗患者37例,将其分为再灌注组与未再灌注组,于溶栓前和发病后间隔一定时间分别采血。同时检测CK、CK－MB、cTnT,并绘制曲线加以分析比较。结果再灌注组CK、CK－MB、cTnT峰值出现时间提前,与未再灌注组之间有显著性差异。AMI发病12小时（h）以内再灌注组的CK、CK－MB、cTnT浓度分别大于未再灌注组,尤以发病后10h,12h为著。cTnT峰值浓度的升高明显高于CK、CK－MB者。结论动态观察cTnT浓度曲线变化显示与CK、CK－MB浓度曲线变化相似,且更特异、更灵敏,可作为判断溶栓再灌注的又一重要参考指标。     

巨CK对免疫抑制法测定CK—MB的干扰及鉴别

CK- MB测定作为诊断急性心肌梗塞的特异性指标 ,已广为临床和检验界所关注。常规测定 CK- MB多用免疫抑制法或电泳法 ,免疫制法测定 CK- MB由于检验快捷 ,既可在半自动分析仪上也可在全自动分析仪上测定 ,很适合于急诊筛查有无心肌梗塞。但随着免疫抑制法 CK- MB测定的日益广泛 ,我们在常规检验中连续遇到多例 CK- MB>总 CK5 0 % ,而总 CK活性正常或轻度升高 ,甚至出现了 CK- MB高于总 CK的反常现象 ,而这些患者均无心肌梗塞的临床表现。实验证明 ,这是由于巨 CK的干扰导致了 CK- MB的升高 ,同时我们发现 ,巨 CK在随机人群…     

巨肌酸激酶引起肌酸激酶-MB活性大于总肌酸激酶1例报告

目的：探讨CK和巨CK的临床意义,提高临床医生对CK的认识。 方法： 对1例巨CK引起CK-MB大于总CK活性病例的临床资料报道,对CK-MB活性大于总CK的可能原因进行分析。结果： 出现CK-BB或巨CK的干扰时,免疫抑制法测定CK-MB总活性假性升高。巨CK1不具有病理意义,而巨CK2往往提示预后不佳。 结论：CK-MB超过总CK活性浓度的30%以上,一定要警惕有无巨CK存在。     

Detection of macro-creatine kinase and macroamylase by polyethylene glycol precipitation and ultrafiltration methods

BackgroundMacroenzymes may cause elevations in serum enzyme activity. Macroenzymes are not common; however their detection is important because they cause diagnostic confusion and therapeutic errors.MethodsWe analyzed 2 of the most prevalent macroenzymes in the literature, macro-creatine kinase (macro-CK) and macroamylase, using 2 methods for detection, polyethylene glycol (PEG) precipitation and ultrafiltration (UF). Enzyme measurements were made using a Roche Modular Analytics P analyzer. Imprecision was assessed using quality control material. We evaluated 125 samples from apparently healthy subjects to establish reference intervals. For macro-CK comparison, 94 samples with activities > 200 U/l were analyzed with both PEG precipitation and UF and compared to electrophoresis. PEG precipitation and UF were compared for macroamylase detection using 130 samples with amylase activities > 110 U/l.ResultsUF was more precise and demonstrated narrower reference intervals for both analytes. PEG precipitation and UF were able to detect true cases of macro-CK with overall agreement with electrophoresis of 79.8% and 80.9%, respectively. Both methods detected the same number of ‘positive’ macroamylase samples; however PEG precipitation resulted in a greater number of ‘indeterminate’ cases.ConclusionThis is the first report where UF has been shown useful for the detection of both macro-CK and macroamylase.     

Macro creatine kinase in a case of carnitine palmitoyltransferase deficiency

A stout man was admitted to the hospital with acute rhabdomyolysis associated with macro creatine kinase (macro-CK, EC 2.7.3.2). This anomaly of CK was detected by gel electrophoresis as an atypical band between CK-MB and CK-MM, classified according to Stein's criteria (Clin Chem 1982; 28:19-24) as type 1, and identified by immunofixation electrophoresis as containing CK isoenzymes MM and MB and immunoglobulin A. Muscle biopsy showed that the etiology of rhabdomyolysis in this case was deficiency of carnitine palmitoyltransferase (CPT, EC 2.3.1.21) in the muscle. We report the first observation of macro-CK in a case of CPT deficiency; its presence may result from recurrent rhabdomyolytic attacks owing to CPT deficiency, and may suggest underlying enzymic abnormality in muscle.     

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.     

CK-MB mass test in ischemic myocardial injury. Comparison of two tests: BioMerieux Vidas and sanofi access immunoassays

The analytical and clinical performances of the new fluorescent immunoassay (CK-MB mass Vidas-BioMerieux) were examined and compared to the chemiluminescent test (CK-MB mass Access-Sanofi-Pasteur). Assay precisions of the CK-MB Vidas test within-assay or between-assay were less than 5.4 and 5.3%, respectively. Linearity was tested up to 214 microg/L. The CK-MB Vidas test was free of interference with CK-BB, CK-MM, and macro-CK. One hundred nineteen blood samples from patients with ischemic myocardial injury (IMI): acute myocardial infarction (AMI), suspected myocardial contusion (SMC), and unstable angina pectoris (UA), were tested using both immunoassays. In AMI, a good correlation was found (Y [CK-MB Access] = 1.1372 x [CK-MB Vidas] - 6.3902; r(2) = 0.96). In UA and SMC, low values were observed and both methods were well correlated (Y [CK-MB Access] = 1.3662 x [CK-MB Vidas] + 0.0671; r(2) = 0.97). Clinical data were in good agreement with both immunoassays. ROC analysis performed in AMI demonstrated that the clinical performances of the two assays were similar.     

Clinical and analytical evaluation of two immunoassays for direct measurement of creatine kinase MB with monoclonal anti-CK-MB antibodies

We examined the clinical and analytical performance of two immunoassays (Becton Dickinson CK-MB; Ciba-Corning Magic Lite CK-MB) in which monoclonal anti-CK-MB antibodies are used for directly measuring creatine kinase (EC 2.7.3.2) isoenzyme MB (CK-MB) in serum, and also one electrophoretic method (Ciba-Corning). Within- and between-assay precision for both immunoassays was good at the upper reference limits (less than 10% CV). Analytical recoveries ranged from 102 to 114%. Both immunoassays were free from interference by CK-BB, mitochondrial-CK, macro-CK, adenylate kinase, and CK-MM. Retrospectively, we evaluated four categories of patients, using both immunoassays and electrophoresis: normal controls, acute myocardial infarction (AMI) patients, severe skeletal muscle trauma patients, and acutely ill patients known not to have AMI. In general, there were excellent correlations among all three methods. CK-MB activity (U/L) measured by the Becton Dickinson immunoassay was approximately 50% of the mass concentration (microgram/L) of the Magic Lite immunoassay and 50% of the activity concentration (U/L) determined by electrophoresis. Both immunoassays were easy to perform and sensitive to the low CK-MB concentrations often found with low total-CK activities.     

超声诊断急性阑尾炎的价值

目的探讨超声诊断急性阑尾炎的价值。方法268例急性阑尾炎患者均行超声检查。结果268例患者中,急性单纯性阑尾炎135例,超声诊断119例,漏诊16例;急性化脓性阑尾炎115例,超声诊断108例,漏诊7例;急性坏疽性阑尾炎12例,超声诊断12例;阑尾周围脓肿6例,超声诊断5例,漏诊1例。结论超声检查对急性阑尾炎的诊断有重要价值。     

脑室肿瘤的影像学诊断价值(附26 例分析)

目的　分析脑室肿瘤的CT和MRI特征 ,提高对各种脑室肿瘤诊断的准确率。方法　收集 2 6例经手术与病理证实的脑室多种肿瘤 :其中侧脑室 1 5例 ,三脑室 3例 ,四脑室 8例。单独作CT检查 5例 ,同时作CT和MRI检查 2 1例。根据 2 6例多种脑室肿瘤的发生部位 ,进行脑室定位分类。结果　 5例中央性神经细胞瘤和 2例胶样囊肿发生于中线室间孔区 ;6例髓母细胞瘤分别发生于小脑上蚓部和四脑室顶部近中线区 ;5例室管膜瘤发生在单侧脑室 ,年龄分别为 2 8～ 36岁 ;3例室管膜瘤发生在四脑室 ,年龄分别为 7～ 1 3岁 ;2例脉络丛乳头状瘤发生侧脑室三角区 ,年龄 1 3～ 1 5岁 ;2例脑膜瘤发生在侧脑室三角区 ,年龄为 1 5～ 71岁 ,1例巨细胞型星形细胞瘤发生在右侧脑室底部 ,年龄为 30岁。结论　CT与MRI有助于对脑室肿瘤的鉴别诊断 ,结合临床资料进行综合分析 ,可提高诊断的准确率     

鼻内镜手术治疗慢性鼻窦炎鼻息肉200例临床探讨

目的探讨鼻内镜手术治疗鼻窦炎鼻息肉的临床疗效。方法选择本院2005年5月至2009年5月慢性鼻窦炎鼻息肉患者200例,以上患者均行鼻内镜手术。治疗后根据疗效评定标准,评定本组患者的临床治疗效果。结果在本组患者中Ⅰ型36例中,治愈34例,好转2例,总有效率为100％;Ⅱ型74例患者中,治愈66例,好转8例,总有效率为100％;Ⅲ型19例患者中,治愈13例,好转4例,无效2例,总有效率为89．8％。本组200例患者中,治愈184例,好转14例,无效2例,本组患者总有效率为99．0％。结论鼻内镜手术治疗慢性鼻窦炎鼻息肉临床疗效显著,其治疗效果与慢性鼻窦炎临床分型分期有一定关系。     

42例硬化性肺细胞瘤的CT特殊征象及病理分析

目的探讨硬化性肺细胞瘤(PSP)的CT特殊征象及病理学特点,以提高临床对PSP的认识及诊断水平。方法收集经术后病理证实的42例PSP患者的临床记录、螺旋CT图像与组织病理学报告,观察病灶的大小、分布、形态、强化特征、CT特殊征象和病理学特征。结果42例患者中,男女比例为1∶13;其中行增强扫描23例,无明显强化1例,轻度强化7例,中度强化8例,高度强化7例。病灶外观呈圆形、类圆形34例,不规则形态6例,磨玻璃状2例。血管贴边征阳性16例,晕征7例,空气新月征9例,跨裂征6例,钙化20例。行免疫组化检查者23例,其中CK阳性18例,EMA阳性19例,Vimentin阳性15例,CD34阳性9例,KI-67<5%18例,TTF-1阳性22例,PR阳性2例。结论"血管贴边征""空气新月征""晕征""跨裂征"及"钙化"作为PSP的CT特殊表现,为PSP诊断提供重要依据,TTF-1是确诊PSP的特异性指标,CK、EM高阳性率支持PSP来源于原始呼吸道上皮细胞,KI-67<5%高阳性率支持PSP良性属性。