肌酸激酶、肌酸激酶同工酶、肌钙蛋白指标在新兵身体状况评估中的意义

 目的 探讨肌酸激酶(creatine kinase, CK)及其同工酶(creatine kinase-MB, CK-MB) 和肌钙蛋白Ⅰ(cardiac troponin Ⅰ, CTnⅠ)指标在新兵身体状况评估中的意义。方法 选择2019秋季武警某部新入伍战士1660名为研究对象,入伍14 d检测CK值,其中CK值高于90%分位数人员归入高CK组,低于10%分位数纳入对照组;比较两组人员既往运动史、入伍14~90 d临床症状情况,以及入伍90 d后CK、CK-MB、CTnⅠ、CK较入伍14 d的改变量。结果 (1)1660名士兵入伍14 d CK中位数(四分位数)为321(201,592)U/L,整体分布呈左偏态分布,95%医学参考值范围为33.59~1906.53 U/L。(2)入伍14~90 d,高CK组166例样本中38例(22.89%)出现临床症状,对照组166例样本中8例(4.82%)出现临床症状,两组比较差异有统计学意义(χ²=22.71,P＜0.01,OR=5.86,95%CI:2.64~13.01);高CK组中16例(9.64%)有既往训练史,对照组中有35例(21.08%), 两组比较差异有统计学意义(χ²=8.36,P=0.004,OR=0.40, 95%CI:0.21~0.75)。(3)入伍90 d,两组样本CK-MB值、CTnⅠ值均在正常范围内,高CK组较对照组CK值低、CK改变量大、CK-MB值低、CTnⅠ值高。结论 新兵体格复查时,CK医学参考值范围推荐为33.59~1906.53 U/L,同时无明显临床症状时血清CK值升高无需过多关注。新兵集训的运动量及持续时间可能无法导致CK-MB、CTnⅠ升高,其他阳性指征时查血清CK-MB、CTnⅠ亦可能无临床意义。

Significance of creatine kinase,creatine kinase isoenzyme and troponin in physical condition assessment of recruits

Objective To explore the significance of creatine kinase, creatine kinase isoenzyme and troponin in physical condition assessment of recruits.Methods A total of 1660 recruits from a unit of the People's Armed Police in 2019 were selected as subjects. CK values were measured 14 days after enlistment. Those whose CK values were above 90% quantile were assigned to the high CK group, while those whose CK values were lower than 10% quantile were assigned to the control group. CK, CK-MB, CTnⅠ, previous amounts of physical activity and clinical symptoms were compared between the two groups 14 days and 90 days after enlistment.Results (1) The median CK of the 1660 soldiers 14 days after enlistment was 321 (201, 592) U/L, and the overall distribution was left-skewed. The 95% medical reference value ranged from 33.59 to 1906.53 U/L. (2) Between 14 to 90 days after enlistment, 38 (22.89%) of the 166 samples in the high CK group showed clinical symptoms, compared with 8 (4.82%) in the control group. The difference between the two groups was statistically significant (χ²=22.71,P＜0.01,OR=5.86,95%CI:2.64-13.01). 16 patients (9.64%) in the high CK group had received training before, compared with 35 (21.08%) in the control group. The difference between the two groups was statistically significant (χ²=8.36,P=0.004,OR=0.40, 95%CI:0.21-0.75). (3) 90 days after enlistment, the values of CK-MB and CTnⅠ in both groups were within the normal range. The high CK group had a lower value of CK, greater changes in CK, a lower value of CK-MB and a higher value of CTnⅠ than in the control group.Conclusions It is recommended that the CK medical reference value range from 33.59 to 1906.53 U/L during physical examination of recruits. An increase of serum CK values can be negligible unless there are obvious clinical symptoms. The amount and duration of training may not lead to the increase of CK-MB or CTnⅠ. Detection of serum CK-MB and CTnⅠ is of no clinical significance in case of other positive indications.