急性一氧化碳中毒患者血清酶活力的动态变化

目的探讨血清酶变化在急性一氧化碳(CO)中毒中的临床意义.方法检测62例急性CO中毒患者血清酶活力及心电图(ECG),并进行动态观察.结果急性CO中毒者5种血清心肌酶活力在中毒后24h开始增高,天冬氨酸转氨酶(AST)、肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶同工酶(CK-MB)活力分别为(20.2±12.3)、(151.6±91.8)、(146.8±50.4)、(154.8±47.7)、(13.8±8.1)U/L,对照组分别为(12.1±6.7)、(90.6±17.3)、(118.7±13.5)、(89.9±27.9)、(5.9±3.3)U/L,两组的差异均有显著性(P＜0.01);3 d后分别为(21.3±12.3)、(105.8±51.4)、(144.8±51.4)、(159.8±35.4)、(16.2±9.1)U/L;7、12 d后α-HBDH和CK-MB活力仍较对照组增高,差异均有显著性(P＜0.01).乳酸脱氢酶同工酶1(LDH1)、乳酸脱氢酶同工酶2(LDH2)活力中毒后24h内增高,并达峰值,分别为(35.3±5.8)、(43.8±5.7)U/L,3 d时LDH1、LDH2和7 d时LDH1与对照组的差异均有显著性(P＜0.01).轻、中度中毒组同期比较,7 d时LDH1与12 d时的差异有显著性(P＜0.01).LDH1血清酶检查异常率最高达78.7%,LDH2为58.3%,LDH为45.2%,CK-MB为37.1%,α-HBDH为33.6%.ECG检查异常率＜10%.结论CO中毒可引起心肌损害,血清酶活力检测可提示心肌损害,有助于此种损害的的早期诊治、疗效观察及预后判断.

Changes of myocardial enzymes in patients with acute carbon monoxide poisoning

OBJECTIVE: To study the clinical significance of changes of serum myocardial enzymes in patients with acute carbon monoxide poisoning. METHODS: To determine the dynamic changes of the activity of myocardial enzymes and ECG in 62 patients with acute CO poisoning. RESULTS: In patients with acute CO poisoning 5 kinds of myocardial enzymes begin to increase within 24 hours, the activities of aspartate aminotransferase (AST), creatine phosphokinase (CPK), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), CPK isoenzyme (CK-MB) were (20.2 +/- 12.3), (151.6 +/- 91.8), (146.8 +/- 50.4), (154.8 +/- 47.7), (13.8 +/- 8.1) U/L respectively, while those in control group were (12.1 +/- 6.7), (90.6 +/- 17.3), (118.7 +/- 13.5), (89.9 +/- 27.9), (5.9 +/- 3.3) U/L respectively. There was significant difference between two groups (P < 0.01); 3 d later, the activities of 5 enzymes were still increased (21.3 +/- 12.3), (105.8 +/- 51.4), (144.8 +/- 51.4), (159.8 +/- 35.4), (16.2 +/- 9.1) U/L respectively]. 7 and 12 d later, the activities of alpha-HBDH and CK-MB were still higher than those of control (P < 0.01). LDH(1) and LDH(2) increased to peak value in 24 h after poisoning (35.3 +/- 5.8), (43.8 +/- 5.7) U/L vs (24.8 +/- 3.9), (36.9 +/- 4.3) U/L, P < 0.01. The abnormal rate of serum LDH(1) was 78.7%, LDH(2) 58.3%, LDH 45.2%, CK-MB 37.1%, alpha-HBDH 33.6% and the abnormal rate of ECG was less than 10%. CONCLUSION: Acute carbon monoxide poisoning may cause myocardial injury. Determination of serum myocardial enzymes may contribute to showing myocardial injury, early diagnosis and treatment, results of treatment and prognosis.