急性心肌梗死患者血清肌红蛋白水平在早期冠脉再灌流中的意义

目的　探讨急性心肌梗死患者尿激酶溶栓治疗过程中血清肌红蛋白 (Mb)的变化 ,判断其是否可以作为早期、非侵入性判断冠脉再灌流的指标。方法　对 2 2例尿激酶溶栓治疗和2 2例保守治疗的AMI患者治疗前后的 1h、2h、4h、8h、12h、14h、15h、18h和 2 4h的血清Mb进行测定 ,同时测定血清磷酸肌酸激酶同工酶 (CK MB) ,比较再灌流组和未再灌流组血清Mb的峰浓度和达峰时间 ,并同CK MB进行比较。结果　再灌流组血清Mb和CK MB的峰浓度分别为 6 19 5 9±198 5 5ng/ml和 15 7 10± 36 19u/L ,均显著高于未再灌流组 (487 31± 6 0 87ng/ml和 141 80± 2 2 18u/L) ;再灌流组较未再灌流组血清Mb达峰时间明显提前 (192min对 480min ,P <0 0 1) ,再灌流组血清Mb达峰时间显著早于血清CK MB达峰时间 (192min对 72 0min ,P <0 0 1) ,而且Mb的 2h出现率 (Mb2 /Mb0 )较未再灌流组也显著增高 (4 2 4对 2 12 ,P <0 0 1)。结论　血清Mb值早期上升、快速达峰是一种可靠、简便的非侵入性判断AMI再灌流治疗成功与否的指标。     

Determination of myoglobin: comparative evaluation of the new automated VIDAS assay with two other immunoassays

OBJECTIVES: Myoglobin provides the earliest indication of acute myocardial infarction. In this study, the new myoglobin assay for the VIDAS system (bioMérieux) was evaluated. DESIGN AND METHODS: This assay, using an enzyme-linked fluorescent immunoassay (ELFIA) method, was compared with the Olympus immunoturbidimetric method and with another immunometric method (Immulite turbo) using an enzyme-linked chemiluminescent immunoassay (CLIA). RESULTS: The CVs for within-and between-run reproducibility are very similar for the tested methods and acceptable linearity ranges were obtained. No significant interference of hemolysis, turbidity and icteria was observed. In the whole cohort, we obtained decreased values over the entire range of the assay with VIDAS and Immulite turbo methods compared to the Olympus assay; this is probably mainly linked to differences in standards used due to the absence of international standardization of the myoglobin determination. CONCLUSIONS: The new VIDAS myoglobin automated assay provides biologists with a rapid, accurate and reliable determination of myoglobin in plasma samples collected during cardiac workup.     

利培酮治疗首发精神分裂症疗效分析及对血清心肌标志物的影响

目的:探讨利培酮对首发精神分裂症的疗效及对心肌标志物的影响,从而为临床合理用药提供给依据.方法:84例患者随机分为两组,分别接受利培酮高剂量和低剂量治疗,每例患者均于治疗前及治疗2、4、8周末进行阳性和阴性症状量表(PANSS)评分及肌酸磷酸激酶(CK)、肌酸激酶同功酶(CK-MB)、肌红蛋白(MYO)和肌钙蛋白(cTnI)的测定,比较疗效及血清心肌标志物随时间的变化趋势.结果:随着治疗时间的延长,两组PANSS均呈现下降趋势,且在治疗2周起,两组PANSS与治疗前差异有统计学意义(P＜0.05),但直至治疗8周,两组间差异才具有统计学意义(P＜0.05);阳性得分:高剂量组治疗2周即与治疗前差异有统计学意义(P＜0.05),对照组治疗4周出现统计学差异(P＜0.05),但两组间差异始终无统计学意义(P＞0.05);阴性得分:高剂量组治疗8周与治疗前差异有统计学意义(P＜0.05),对照组治疗4周出现统计学差异(P＜0.05),两组间差异始终无统计学意义(P＞0.05);高剂量组总有效率92.86％,对照组90.48％,两组比较差异无统计学意义(P＞0.05);CK:治疗2周后两组均明显上升,与治疗前差异有统计学意义(P＜0.05),治疗4周时对照组恢复治疗前水平(P＞0.05),而高剂量组治疗8周时才恢复正常(P＞0.05);MYO和CK-MB:均治疗2周后升高(P＜0.05),随着治疗的进行,MYO和CK-MB水平逐渐恢复,并在治疗8周时基本恢复治疗前水平(P＞0.05);cTnI..两组治疗前及治疗过程中均未出现明显变化(P＞0.05).结论:精神分裂症利培酮治疗早期出现MYO和CK-MB变化,但随着治疗进行,该影响逐渐减弱,且此变化可能具有剂量依赖性.     

Can Myoglobin Expression in Pancreatic Beta Cells Improve Insulin Secretion Under Hypoxia? An Exploratory Study With Transgenic Porcine Islets

The feasibility of myoglobin (Mb)-facilitated oxygen transport in improving porcine islet survival under hypoxia was investigated. Discrete groups of islets were transfected with replication-defective adenoviral vector Ad5 respiratory syncitial virus (RSV) to induce expression of Mb or green fluorescent protein (GFP). Native islets served as the controls. In vitro studies at 37 degrees C assessed islet insulin secretion efficacy: (i) to a glucose challenge from 30 to 300 mg/dL at fixed pO2; and (ii) at variable oxygen tensions ranging from 5 to 40 mm Hg over 12 h. The transfection was effective in initiating islet expression of Mb or GFP. Low Mb-expression levels equivalent to 2% the Mb concentration in a muscle cell (0.25 ng of Mb per islet) were documented, with no statistical improvement in insulin secretion. A surprising side note is that insulin secretion was impaired in islets expressing GFP. Improved Mb expression is essential to determine the feasibility of enhancing islet survival under hypoxia.     

肺支原体肺炎患儿肌红蛋白、肌钙蛋白Ⅰ和肌酸激酶同工酶的检测

目的 检测并比较肺支原体肺炎(MPP)患儿治疗前后血清中肌红蛋白(Mb)、肌钙蛋白Ⅰ(CTn-1)和肌酸激酶同工酶(CK-MB)的含量,以探讨其在MPP合并心肌损害诊治中的意义.方法 抽取MPP合并心肌损伤组(55例)患儿急性期和恢复期的静脉血,测定其血清中Mb、cTn-Ⅰ和CK-MB的含量并比较其变化,以55例健康儿童做为对照组.结果 MPP合并心肌损伤组患儿急性期血清中Mb、cTn-Ⅰ和CK-MB的含量显著高于健康对照组(P<0.01). MPP合并心肌损伤组患儿恢复期血清Mb、cTn-Ⅰ和CK-MB的含量与急性期相比明显下降(P<0.01),但仍高于对照组(P<0.05).结论 MPP患儿有部分患者急性期有不同程度的心肌损害.     

肌红蛋白检测心肌梗死型冠心病的研究

目的:探讨肌红蛋白对心肌梗死型冠心病早期诊断的价值。方法:用ELISA法测定156例冠心病患者的肌红蛋白浓度,对其中66例心肌梗死型冠心病急性期入院患者,42例在冠脉再灌注前与再通治疗后进行比较;另观察40例不稳定型心绞痛患者,疼痛发作期和间歇期肌红蛋白含量及50例运动试验受试对象的结果。结果:心肌梗死型冠心病在起病后1.5 h肌红蛋白升高,42例在冠脉再通后(46.7±17.3)min出现升高峰值,平均为(889.9±47.3)μg/L,比再灌注前升高65.5%,肌红蛋白异常升高持续(37.3±6.8)h,另40例不稳定型心绞痛患者,疼痛发作期和间歇期肌红蛋白分别为(56.3±21.6)μg/L和(41.6±12.3)μg/L,自身对比差异无统计学意义(P>0.05);50例运动试验受试对象:运动前后分别为(33.7±12.4)μg/L和(46.3±21.3)μg/L。该两组与心肌梗死型冠心病组入院肌红蛋白相比,差异均有统计学意义(P<0.05)。心肌梗死型冠心病肌红蛋白诊断的敏感度为100%,特异度为84%,阳性预测值为89.2%,阴性预测值为100%。结论:肌红蛋白是心肌梗死型冠心病急性期诊断很敏感且较特异的生化指标,有助于与不稳定型心绞痛相鉴别。     

Gene deletional strategies reveal novel physiological roles for myoglobin in striated muscle

Myoglobin is an abundant hemoprotein that is expressed in cardiomyocytes and oxidative skeletal myofibers of vertebrates. Elegant studies using physiological, biochemical and spectroscopic analyses support a role for myoglobin in facilitated oxygen transport and as a reservoir for oxygen in muscle of diving and hypoxia-adapted animals. In contrast, the functional role of myoglobin in terrestrial animals that function at ambient oxygen levels is a subject of debate. This debate was further fueled by the observation that genetically engineered mice that lack myoglobin are viable and capable of withstanding the hemodynamic stress associated with reproduction. Analysis of the myoglobin mutant striated muscle reveals a spectrum of adaptive mechanisms that partially compensate for the absence of myoglobin and further supports an important function for this hemoprotein in the maintenance of contractile function during exercise under ambient and hypoxic conditions. Future studies utilizing transgenic and gene deletional strategies will further enhance our understanding of myoglobin function under normoxic and hypoxic conditions and will impact our understanding of exercise physiology.     

心脏型脂肪酸结合蛋白在诊断早期急性非ST段抬高心肌梗死中的临床应用

目的探讨心脏型脂肪酸结合蛋白（H—FABP）在临床诊断早期急性非sT段抬高心肌梗死（NSTEMI）中的优势及应用价值。方法疑似NSTEMI患者118例,按发病后就诊时间分为两组,分别在发病后0-3h、3-6h内检测H—FABP,同时检测肌钙蛋白I（cTnI）、肌酸激酶同功酶（CK—MB）及肌红蛋白（MYO）进行对比,计算各项指标的灵敏度、特异性、准确性、阳性预测值及阴性预测值并进行比较分析。结果H—FABP在发病0-3h内诊断NSTEMI的灵敏度为66．7％,高于cTnI及CK—MB,差异有统计学意义（P〈0．05）;特异性为88．9％;准确性为78．4％。在发病3-6h内诊断NSTEMI的灵敏度为94．4％,高于cTnI及cK—MB,差异有统计学意3L（P〈0．05）,特异性87．1％,准确性为91．0％。结论H—FABP是诊断早期（发病6h以内）NSTEMI的敏感指标,在急性冠脉综合征早期的危险分层中有重要的临床应用价值。     

Novel Controlling Mechanism of the Oxygen Affinity in Myoglobin With Isomeric Porphyrins

The biological function of the core modified porphyrin isomers such as porphycene, corrphycene, and hemiporphycene was examined. The iron complexes stoichiometrically coupled with apomyoglobin to afford stable holoproteins. The oxygen affinity of the reconstituted myoglobins (Mbs) changed over a 60 000-fold range depending on the molecular structure of the prosthetic groups. For instance, a corrphycene with electronegative substituents to the bipyrrole part reduced the oxygen affinity of Mb to P ₅₀ = 300 mm Hg while the porphycene-substituted Mb exhibited a P ₅₀ = 0.005 mm Hg. A notable increase in the oxygen delivery capacity of the corrphycene-substituted Mb was explained on the basis of the trapezoidal corrphycene shape that stabilizes the iron displacement from the macrocycle plane toward the proximal histidine. The above observations demonstrate that the core modified heme isomers serve as novel molecular tools to regulate the oxygen affinity of Mb.