同步测定血清CK-MB/CK比值及肌钙蛋白I对急性有机磷农药中毒判断评估的意义

目的探讨同步测定血清肌酸激酶的同功酶(CK-MB)与血清肌酸激酶(CK)比值及肌钙蛋白I(cTnI)在急性有机磷农药中毒(AOPP)中的变化及其在病情判断、评估中的临床意义和实用价值。方法对868例原未有心、肺、脑、肾、骨骼各其他结缔组织疾病的AOPP患者于中毒后12h时抽取空腹静脉血4ml同步测定CK、CK-MB及cTnI,并计算出CK-MB/CK比值,另选同期测定288例健康查体者的血清CK、CK-MB、CK-MB/CK及cTnI作为对照组。结果轻、中、重中毒组的CK、CK-MB及cTnI与正常对照组比较,中度组与轻度组、重度组与中度组比较均显著升高(P<0.01)。CK-MB/CK比值:轻度、中度、重度中毒组与对照组比较显著低于对照组(P<0.01);重度中毒组显著低于中度中毒组(P<0.01);中度中毒组显著低于轻度中毒组(P<0.01);发生中间综合征(IMS)组显著低于未发生IMS组。结论①CK-MB/CK比值变化与AOPP中毒程度呈负相关,cTnI与AOPP中毒程度呈正相关,可用于协助AOPP临床分级、病情判断及指导AOPP的急诊、救治和预后评估;②在中度、重度急性AOPP患者中,发生IMS几率与CK、CK-MB/CK及cTnI存在着密切相关性。在一定范围内,CK-MB/CK比值越小、CK及cTnI值越大,则发生IMS的几率越高。对本组资料进行统计学处理所得的函数方程可作为早期IMS的有效预报指标,更有利于对AOPP患者早期实施更具个体化的救治方案,为AOPP患者并发IMS及心脏猝死提供了一个客观、灵敏的早期评估判断指标。

SIMULTANEOUS DETERMINATION OF THE RATIO OF SERUM CK-MB/CK AND TROPONIN I IN ACUTE ORGANOPHOSPHORUS ASSESSMENT TO DETERMINE THE SIGNIFICANCE OF PESTICIDE POISONING

Objective To discuss the clinical significance and practical value of synchronization determination blood serum creatine activating enzyme isozyme(CK-MB) and blood serum creatine activating enzyme(CK) ratio and myo-calcium protein I in acute organic phosphorus pesticide poisoning(AOPP) change.Methods All of 868 patients with AOPP,no disorder in the lung,brain,kidney,skeleton each other knots contract the organization disease,whose empty stomach venous blood were extracted after the poison 12h to determine CK,CK-MB and the myo-calcium protein I,and calculates the CK-MB/CK ratio.At the same time,blood serum CK,CK-MB,CK-MB/CK and the myo-calcium protein I levels were determined for 288 healthy controls.Results The level of CK,CK-MB and the myo-calcium protein I was raise evidently in the Light,moderate and heavy toxicant group vs control group,the moderate vs light toxicant group,the heavy vs moderate toxicant group(P<0.01).Inverse,the CK-MB/CK ratio was lower remarkably in the groups above comparing(P<0.01);and they were obviously lower in complicate IMS group than had no IMS group(P<0.01).Conclusion ①the CK-MB/CK ratio change and the AOPP poison degree assume the inverse correlation,the myo-calcium protein I with the AOPP poison degree present correlation,available in assists the AOPP clinical graduation,the condition to judge and instructs AOPP the emergency medical treatment,to treat and cure with the prognosis appraisal;②Moreover,in moderate,specific weight acute AOPP patient,has the IMS probability and CK,CK-MB/CK and the myo-calcium protein I has the close relevance.In certain scope,the CK-MB/CK ratio is smaller,CK and the myo-calcium protein I value is bigger,then has the IMS probability to be higher.And using statistics to this group of material obtained functional equation may the early time take IMS the effective forecast target,was more advantageous to has the individuation to the AOPP patient early time implementation to treat and cure the plan to reduce IMS and the heart sudden death occurrence has provided objectively,the keen appraisal judgment target.