慢性病毒感染性疾病CK-MB检测方法学探讨

目的 探讨慢性病毒感染性疾病CK-MB检测方法的选择应用.方法 选取2021年2月至4月未合并心脏疾病的慢性病毒感染性疾病患者547例、健康对照40例、心血管疾病患者35例;其中慢性病毒感染性疾病患者中艾滋病患者215例、慢性乙型肝炎病毒患者332例;用免疫抑制法和质量法检测其CK-MB.结果 同健康对照相比,入组慢性病毒感染性疾病患者使用免疫抑制法检测CK-MB活性异常升高比例较高,而使用质量法检测CK-MB均在正常参考范围,两者之间没有相关性;心血管疾病患者CK-MB活性和质量均明显升高且相关性高.结论 免疫抑制法在检测慢性病毒感染性疾病患者CK-MB时,受用药等因素影响CK-MB活性假阳性率较高,质量法在慢性病毒感染性疾病CK-MB检测时是更理想的检测方法.     

新生儿缺氧缺血性脑病儿cTn-I和CK-MB的检测

目的了解脐血心肌肌钙蛋白(cTn-I )与肌酸激酶同功酶(CK-MB)的变化.方法测定40例新生儿缺氧缺血性脑病(HIE)病儿脐血cTn-I与CK-MB水平,并与20例正常人检测结果进行比较.结果新生儿HIE组脐血cTn-I与CK-MB均较对照组升高,差异有显著性(P<0.01);且中、重度HIE组脐血cTn-I与CK-MB均高于轻度HIE组,差异有显著性(P<0.05).结论脐血cTn-I与CK-MB测定对早期发现HIE心肌损伤及判断其程度有重要价值.     

冠心病患者心肌复极异常心电图表现与cTnI及CK-MB的关系

目的 探讨冠心病心肌复极异常心电图表现与肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnI)及磷酸肌酸激酶心型同工酶(creatine kinase,CK-MB)的关系.方法 选择2018年2月至2020年2月于我院就诊的冠心病患者120例,并根据临床表现,将患者分为3组:稳定型心绞痛组(stable angina pectoris,SAP)、不稳定型心绞痛组(unstable angina pectoris,UAP)、急性心肌梗死组(acute myocardial infarction,AMI),每组40例.此外选择40例健康的体检者作为对照组.收集患者临床资料,检测心肌酶谱和生化指标,分析心电图特征与cTnI及CK-MB的关系.结果 SAP、UAP、AMI组总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL-C)明显大于对照组,高密度脂蛋白(high density lipoprotein,HDL-C)明显小于对照组(P＜0.05),AMI组TC、TG、LDL-C明显大于UAP、SAP组,HDL-C明显小于对照组(P＜0.05).4组受试者V2导联Tp-Te间期差异具有统计学意义(P＜0.05),SAP、UAP、AMI组患者T波异常、ST段异常的发生率明显大于对照组(P＜0.05).AMI、UAP组cTnI、CK-MB、CK、谷草转氨酶(glutamic oxaloacetic transaminase,AST)明显高于对照组与SAP组(P＜0.05),AMI组cTnI、CK-MB、CK、AST水平均明显高于UAP组(P＜0.05).ST段异常、T波异常组患者cTnI、CK-MB明显高于ST段正常、T波正常组患者(P＜0.05).结论 冠心病患者血清cTnI及CK-MB表达增加,且cTnI及CK-MB与心电图复极异常存在一定的关系,可为临床治疗提供一定的参考.     

血清AFP-L3、GPC3、DCP及TSGF四者联合检测对原发性肝癌的早期诊断价值研究

目的 探讨血清甲胎蛋白异质体(AFP-L3)、磷脂酰肌醇蛋白聚糖-3(GPC3)、异常凝血酶原(DCP)及肿瘤特异性生长因子(TSGF)四者联合检测在原发性肝癌(PHC)早期诊断中的应用价值.方法 选取2016年4月至2017年4月间我院收治的PHC患者96例作为观察组,并选取同期收治的肝炎肝硬化患者50例作为疾病对照组,及健康志愿者50例作为健康对照组.对比三组血清AFP-L3、GPC3、DCP、TSG水平及阳性检出率,并观察上述指标单独检测及联合检测对原发性肝癌的诊断效率.结果 观察组患者血清AFP-L3、GPC3、DCP及TSGF水平均明显高于两对照组,差异有统计学意义(P<0.05);观察组患者上述四种指标检测的阳性率均明显高于两对照组,差异有统计学意义(P<0.05).四者联合检测的灵敏度均明显高于各指标单独检测,差异有统计学意义(P<0.05);而联合检测的特异性均低于单独检测;且相比与AFP-L3及TSGF差异有统计学意义(P<0.05);两种联合检测的准确度相比于单独检测均有所上升,但差异无统计学意义(P>0.05).结论 血清AFP-L3、GPC3、DCP及TSGF联合检测增强了检测的灵敏度,提升了检测的准确度,提高了PHC的检出率,联合检测具有重要的临床应用价值.     

肺炎支原体抗体联合白细胞计数、超敏C反应蛋白检测在小儿支原体肺炎感染诊断中的临床价值

目的研究肺炎支原体抗体(MP-Ab)、超敏C反应蛋白(hs-CRP)联合检测对诊断小儿支原体肺炎感染的临床价值。方法选择肺炎支原体肺炎确诊患儿110例,正常对照儿童120例,分别进行MP-Ab、hs-CRP检测,并对结果进行统计学分析。结果肺炎支原体肺炎患儿组MP-Ab滴度≥1：160比率显著高于正常对照组;肺炎支原体肺炎组hs-CRP显著高于正常对照组;MP-Ab检测法诊断肺炎支原体肺炎的灵敏度为78.2%,特异度为94.2%,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的灵敏度为89.1%,特异度为89.2%。 MP-Ab联合hs-CRP检测肺炎支原体肺炎的灵敏度显著高于MP-Ab检测法,差异有统计学意义((P<0.05)),但其特异性低于MP-Ab检测法,差异无统计学意义(P>0.05)。结论 MP-Ab联合hs-CRP联合检测法能提高小儿支原体肺炎感染的诊断率,但同时应注意结合其他临床表现,防止假阳性。     

尿液胱抑素C联合血清β2微球蛋白水平诊断狼疮性肾炎患者的临床价值

目的 分析尿液胱抑素C联合血清β2微球蛋白诊断狼疮性肾炎的临床价值.方法 将我院2019年8月至2021年2月间收治的120例狼疮性肾炎患者作为观察组,100例健康体检者作为对照组;检测受试者尿液胱抑素C和血清β2微球蛋白水平,采用Logistic回归模型分析尿液胱抑素C、血清β2微球蛋白对狼疮肾炎的预测价值,绘制ROC曲线分析各指标单独应用和联合应用诊断狼疮性肾炎的价值.结果 观察组患者尿液胱抑素C联合血清β2微球蛋白水平均明显高于对照组,且差异具有统计学意义(P<0.05);胱抑素C、β2微球蛋白是狼疮性肾炎的危险因素,且差异具有统计学意义(P<0.05);尿液胱抑素C联合血清β2微球蛋白联合应用预测狼疮性肾炎的灵敏度、特异性和AUC均明显高于各指标单独应用,且差异具有统计学意义(P<0.05).结论 联合检测尿液胱抑素C和血清β2微球蛋白水平可有效提高狼疮性肾炎鉴别诊断的价值.     

七种恶性肿瘤患者血清CK和CK-MB含量分析

目的比较肌酸激酶(CK)及其同工酶(CK-MB)在正常人群和恶性肿瘤患者的含量及其异常率。方法检测前列腺癌组患者108例,胃癌组患者139例,乳腺癌组患者101例,胰腺癌组患者160例,结肠癌组患者101例,肺腺癌组患者71例,宫颈癌组患者72例,和健康对照组200名人群血清CK和CK-MB含量。结果前列腺癌组CK含量与正常对照组相比较,有显著升高,差异有统计学意义(P<0.05);而六种恶性肿瘤组与正常对照组之间差异无统计学意义(P>0.05)。七组恶性肿瘤患者CK-MB含量与正常对照组相比较,差异均无统计学意义(P>0.05)。七组恶性肿瘤患者CK-MB异常率与正常对照组相比,均显著升高,差异有统计学意义(P<0.05),胃癌组的异常率最高,乳腺癌组次之。结论前列腺患者CK含量会异常升高,胃癌与乳腺癌患者CK-MB异常率较高。     

不同尿沉渣检测方法在检测尿红细胞形态及参数中的价值分析

目的 探究全自动尿沉渣分析仪联合尿干化学分析法在尿沉渣检测中的价值.方法 随机选取118份从住院患者处收集的血尿样本,根据临床诊断结果将其分为肾小球疾病组(肾小球性血尿组,n =72)及非肾小球疾病组(非肾小球性血尿组,n=46).比较两组血尿样本尿平均红细胞体积(MCV)、尿平均红细胞血红蛋白(MCH)水平差异.每份尿样均分为2管(15mL/管),分别予以显微镜人工镜检法及全自动尿沉渣分析仪+尿干化学检测法检测(尿液收集后2h内完成).记录两种检测方法的尿红细胞(RBC)阳性检出率;以临床诊断结果为依据评估其尿RBC形态参数测定结果差异.结果 肾小球性血尿组患者尿MCV、尿MCH水平均明显低于非肾小球性血尿组患者,差异有统计学意义(P＜0.05).118份血尿样本经全自动尿沉渣分析仪+尿干化学检测法测得尿RBC阳性率为76.3％ (90/118),显微镜人工镜检法测得尿RBC阳性率75.4％ (89/118);两组尿RBC阳性检出率比较,差异无统计学意义(P＞0.05).显微镜人工镜检法鉴别灵敏度为97.2％(70/72)、特异性为84.8％ (39/46);全自动尿沉渣分析仪+尿干化学检测法鉴别灵敏度为94.4％ (68/72)、特异性为80.4％(37/46),两种方法灵敏度及特异性比较,差异无统计学意义(P均＞0.05).结论 全自动尿沉渣分析仪+尿干化学检测法对血尿来源的定位诊断准确性较高且操作性强,临床可将其作为一种可行性途径,为后续治疗工作的顺利开展提供依据.     

恶性血液肿瘤患者化疗后粒缺期合并感染患者超敏C反应蛋白、降钙素原水平研究

目的 探讨恶性血液肿瘤患者化疗后粒细胞缺乏期合并感染患者降钙素原(PCT)、血清超敏C-反应蛋白(hs-CRP)水平变化,为恶性血液肿瘤合并感染患者临床治疗提供理论参考.方法 选取144例恶性血液病患者作为研究对象,根据是否合并感染分为感染组和非感染组,各72例,比较两组患者在化疗前后,抗感染治疗前后hs-CRP、PCT水平变化.结果 感染组患者hs-CRP、PCT水平高于非感染组(P<0.05),化疗后粒缺期发热组患者经抗感染治疗后血清hs-CRP、PCT均明显下降,治疗前后hs-CRP、PCT差异具有统计学意义(P<0.05);T2粒缺期合并发热患者血清hs-CRP、PCT水平高于T1,T3经抗感染治疗后血清hs-CRP、PCT水平低于T2,差异具有统计学意义(P<0.05);联合检测hs-CRP、PCT水平的灵敏度、特异性、阳性预测值均高于单一的hs-CRP、PCT检测,差异具有统计学意义(P<0.05).结论 恶性血液肿瘤患者化疗后粒缺期合并感染患者超敏C反应蛋白、降钙素原水平显著上升,经抗感染治疗后下降;采用hs-CRP、PCT联合检测对于化疗后粒缺期感染的诊断具有临床价值.     

肺炎支原体抗体联合超敏C反应蛋白检测在小儿支原体肺炎感染诊断中的临床价值

目的 调查研究小儿支原体肺炎感染患者肺炎支原体抗体(MP-Ab)及超敏C反应蛋白(hs-CRP)水平的变化,探讨肺炎支原体抗体与超敏C反应蛋白联合检测对小儿支原体肺炎感染的临床诊断价值.方法 肺炎支原体肺炎患儿110例,对照儿童120例,均按照《诸福棠实用儿科学》中支原体肺炎诊断标准确诊,两组分别进行MP-Ab、hs-CRP检测,肺炎支原体抗体判定以MP-Ab滴度≥1:160为阳性,超敏C反应蛋白判定以hs-CRP＞ 5mg/L为阳性.通过分析MP-Ab检测法与MP-Ab联合hs-CRP检测法敏感性、特异性差异,探讨MP-Ab联合hs-CRP检测法诊断小儿支原体肺炎感染的临床意义.结果 肺炎支原体肺炎患儿组MP-Ab滴度≥1∶160比率高于正常对照组,肺炎支原体肺炎患儿组hs-CRP高于正常对照组,差异均有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的灵敏度为78.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的灵敏度为89.1％,MP-Ab联合hs-CRP检测肺炎支原体肺炎的灵敏度高于MP-Ab检测法,差异有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的特异度为94.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的特异度为89.2％,差异无统计学意义(P＞0.05).结论 MP-Ab与hs-CRP联合检测能提高小儿支原体肺炎感染的诊断率,具有较高临床价值.     

The determination of CK-MB protein mass]

It has been well known that the determination of CK-MB is a useful parameter for the diagnosis of acute myocardial infarction (AMI). Currently, several methods such as Electrophoresis, Ion-exchange chromatography, Immunoinhibition method and Protein mass determination are available. From a point of the diagnosis of AMI, the method should be satisfied with the requirements of high speed, ease to perform, high analytical specificity and high analytical sensitivity. However, there are no appropriate methods which can satisfy all of the requirement. In this paper, we have introduced the present situation concerning the determination of CK-MB in our hospital and discussed the results of study on the IMx method based on the determination of protein mass of CK-MB. We obtained good results in the fundamental study and found some advantages of protein mass determination. The first advantage was its high analytical specificity by use of monoclonal antibody. The second advantage was its high analytical sensitivity because of its low detection limit. The third advantage was the stability of sample because the antigenicity of CK-MB to the antibody of reagent is stable comparing with that of enzyme activity. From those advantages, the mass determination of CK-MB will be a useful method for the diagnosis of AMI in the near future.     

Analysis of CK-MB using immunoinhibition method]

The significance of creatine kinase (CK) in the diagnosis of acute myocardial infarction was evaluated. The serum level of CK-MB, a CK isozyme was determined by the immunoinhibition method. The CK-MB activity could be determined by the immunoinhibition method in a short time with an autoanalyzer, suggesting that the immunoinhibition technique is adequate as a method of emergency examination. The immunoinhibition method has the disadvantage of error induction because of contamination with CK-BB, CKm and macro-CK by this method. Thus, CK-MB activity should be determined in parallel with total CK activity. When a significant contribution from CK-BB is suspected, its presence should be confirmed by other methods. The present results suggest that the efficiency of coronary artery reperfusion therapy can be evaluated earlier by determination of CK-MB activity than by that of total CK activity.     

Circulating CK-MB and CK-BB isoenzyme after gastrointestinal surgery.

The effect of gastrointestinal surgery on serum creatine kinase activity was studied in 30 patients. The MB isoenzyme was demonstrated in sera of 30% of the patients and BB isoenzyme in 23%. MB content varied from 0.8 to 10.3% of the total creatine kinase activity, and the BB content from 0.6 to 18.4%. The CK-BB was probably of gastrointestinal origin, since gastrointestinal tract contains high CK activity with BB isoenzyme predominating. A cardiac origin for the observed serum CK-MB isoenzyme increase would seem the most likely, although no patients showed evidence of electrocardiographic changes. Increased CK-MB activity has been observed in myocardial ischaemia without infarction.     

带状疱疹后神经痛患者CK、CK-MB及LDH水平特征及其临床意义分析

目的对带状疱疹后神经痛(PHN)患者的CK、CK-MB及LDH水平特征与其相关的临床意义进行分析,为PHN患者病情监测及个性化防治方案的制定提供参考依据。方法本研究共获得符合要求的观察对象212例,其中病例组102例,对照组110例;用横断面调查的研究方法对入选人群的基本信息及相关流行病学资料进行收集,同时采用包括触觉改变、局部色素沉着情况改变、阵发性钝痛感等临床症状自评量表对病例组受试者PHN各相关临床表现的严重程度进行评分,并取受试对象的病变组织制备匀浆进行LDH、CK、CK-MB的实验室定量测定,并整合所有获得的资料进一步分析。结果 PHN病例组和对照组受试者的CK、CK-MB及LDH水平均有统计学差异,同时病例组中不同年龄组患者的LDH水平差异有统计学意义(均P<0. 05);PHN患者触觉改变、局部色素沉着、阵发性钝痛感、刀割样疼痛感、抑郁情绪、自我效能感严重程度均与LDH水平呈正相关,触觉改变、阵发性钝痛感、自我效能感严重程度均与CK、CK-MB水平呈正相关(均P<0.05)。结论 CK、CK-MB及LDH水平与PHN患者的诸多临床表现的严重程度存在正相关,且这几项指标在PHN患者中高表达,因此CK、CK-MB及LDH高水平对PHN具有一定的诊断意义。     

Cardiac troponin I and CK-MB mass after cardiac surgery with cardiopulmonary bypass

Cardiac troponin I (cTnI) assay is used in the diagnosis of myocardial infarction after cardiac surgery. Variations in the cut-off value have been reported even with the same assay method. The aim of this work is to investigate the release profile of cTnI and CK-MB mass after cardiac surgery and to determine the cut-off value of cTnI and CK-MB mass allowing the diagnosis of perioperative myocardial infarction. In patients without postoperative cardiac complication, the cTnI peak was observed 24 hours after surgery both in coronary artery bypass grafting and in valve replacement. Moreover, the amount of cTnI released within the three hours after surgery is 2.5 fold higher in valve replacement than in coronary artery bypass grafting. The CK-MB peak was observed 3 hours after surgery in the two surgical procedures. In these patients, cTnI and CK-MB concentrations increased with the cross clamp time duration. In patients with postoperative myocardial infarction, the cTnI and CK-MB peaks were observed 24 hours after surgery. Diagnosis of perioperative myocardial infarction can be performed with a sensitivity of 100% at 24 hours with cut-off values of 32 and 7 microg/L for CK-MB and cTnI, respectively, both with Stratus (Dade Behring) and Immulite (DPC) analysers.     

Discordant results of CK-MB and troponin I measurements: a review of 14 cases

In the course of a clinical comparison involving 204 parallel total creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB), and cardiac troponin I (cTnI) measurements, 12 patients were identified in whom cTnI was elevated while total CK was normal, as well as 2 patients in whom CK-MB was elevated while cTnI was normal. CK-MB relative index was elevated in 6 of the twelve cTnI-positive patients with normal total CK; only 2 of these patients had a discharge diagnosis of acute myocardial infarction (AMI). All of the 12 patients in this group had medical conditions that are associated with greater risk for acute cardiac events. Both patients with normal cTnI but elevated total CK and CK-MB index had chronic renal insufficiency; one of these patients had a positive stress test and a diagnosis of AMI. The other cTnI-negative patient died 2 days after admission, and autopsy revealed evidence of ischemic changes, but not acute infarction. Significant differences were apparent between traditional CK-MB results and cTnI measurements. Using total CK elevation as a prerequisite for subsequent CK-MB measurement may limit the clinical sensitivity of this enzyme marker for detecting subacute ischemic damage to the myocardium. Elevated total CK and CK-MB isoenzyme without corresponding elevations in cTnI, on the other hand, may reflect changes in enzyme elimination kinetics due to renal failure, or cross-reactivity of the cTnI assay with non-cardiac antigens.