中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
12期
723-726
,共4页
王虹%刘石%邢艳琳%陈睿%于宪一
王虹%劉石%邢豔琳%陳睿%于憲一
왕홍%류석%형염림%진예%우헌일
肌酸激酶同工酶质量%心肌炎%肌病%肌钙蛋白I%肌红蛋白
肌痠激酶同工酶質量%心肌炎%肌病%肌鈣蛋白I%肌紅蛋白
기산격매동공매질량%심기염%기병%기개단백I%기홍단백
MB isoenzyme of creatine kinase%Myocarditis%Muscular disease%Troponin I%Myoglobulin
目的 通过对比小儿心肌炎、肌病时血清中肌酸激酶同工酶(CK-MB)质量与肌钙蛋白I(cTnI)和肌红蛋白(Mb)的动态变化,观察CK-MB质量在判定心肌损伤中的意义.方法 测定40例心肌炎患儿(其中有20例为暴发性心肌炎)和38例肌病患儿的肌酸激酶(CK)、CK-MB活性、CK-MB质量、cTnI、Mb、心电图以及脉冲多普勒超声心动图；肌病组同时进行肌电图、遗传代谢病筛查以及基因检测.以同期本院发育儿科门诊除外甲状腺功能减低症的10例身矮待查儿童为对照.结果 ①健康对照组儿童CK(U/L)为95.0±27.0,CK-MB活性(U/L)为22.6±1.3,CK-MB质量(μg/L)为2.4±0.3,cTnI(μg/L)为0.012±0.001.②心肌炎组患儿治疗前CK(1 033.0±408.0)、CK-MB活性(101.2±31.5)、CK-MB质量(38.2±13.2)、cTnI(5.544±1.554)均较健康对照组明显升高(均P＜0.01)；随着治疗时间延长,各项指标逐渐下降；治疗2周后CK(59.3±25.1)、CK-MB活性(24.6±13.2)、CK-MB质量(3.3±2.9)、cTnI(0.125±0.128)均恢复至正常水平(均P＞0.05).治疗1周后CK、CK-MB质量增高率即较治疗前明显下降[CK:5.9％(1/17)比56.4％(22/39);CK-MB质量:8.3％(1/12)比61.1％(22/36),均P＜0.01],CK-MB质量恢复先于cTnI,增高率出现明显差异[8.3％(1/12)比73.7％(14/19),P＜0.05].③肌病组治疗前CK(10 193.0±1 447.0)、CK-MB活性(311.7±44.4)以及CK-MB质量(229.2±47.9)均较健康对照组明显升高(均P＜0.01),但cTnI不高(0.021±0.002)；治疗2周后CK(5 735.6±6 187.8)、CK-MB活性(170.7±143.0)、CK-MB质量(207.4±136.6)仍维持在高水平,cTnI(0.230±0.150)则维持在正常水平；各项指标的增高率与治疗前均无显著差异[CK:85.7％(6/7)比97.4％(37/38); CK-MB活性:85.7％(6/7)比97.4％(37/38);CK-MB质量:100.0％(2/2)比94.1％(32/34)；cTnI:0(0/1)比6.4％(2/31),均P＞0.05].结论 ①在心肌炎时,CK-MB质量与cTnI一致,急性期升高,恢复期降至正常,但CK-MB质量观察窗短于cTnI.②在肌病时,CK-MB质量与cTnI 分离,前者治疗前后均升高,后者正常,故用测定CK-MB质量来判定肌病患儿是否有心肌损害意义有限.
目的 通過對比小兒心肌炎、肌病時血清中肌痠激酶同工酶(CK-MB)質量與肌鈣蛋白I(cTnI)和肌紅蛋白(Mb)的動態變化,觀察CK-MB質量在判定心肌損傷中的意義.方法 測定40例心肌炎患兒(其中有20例為暴髮性心肌炎)和38例肌病患兒的肌痠激酶(CK)、CK-MB活性、CK-MB質量、cTnI、Mb、心電圖以及脈遲多普勒超聲心動圖；肌病組同時進行肌電圖、遺傳代謝病篩查以及基因檢測.以同期本院髮育兒科門診除外甲狀腺功能減低癥的10例身矮待查兒童為對照.結果 ①健康對照組兒童CK(U/L)為95.0±27.0,CK-MB活性(U/L)為22.6±1.3,CK-MB質量(μg/L)為2.4±0.3,cTnI(μg/L)為0.012±0.001.②心肌炎組患兒治療前CK(1 033.0±408.0)、CK-MB活性(101.2±31.5)、CK-MB質量(38.2±13.2)、cTnI(5.544±1.554)均較健康對照組明顯升高(均P＜0.01)；隨著治療時間延長,各項指標逐漸下降；治療2週後CK(59.3±25.1)、CK-MB活性(24.6±13.2)、CK-MB質量(3.3±2.9)、cTnI(0.125±0.128)均恢複至正常水平(均P＞0.05).治療1週後CK、CK-MB質量增高率即較治療前明顯下降[CK:5.9％(1/17)比56.4％(22/39);CK-MB質量:8.3％(1/12)比61.1％(22/36),均P＜0.01],CK-MB質量恢複先于cTnI,增高率齣現明顯差異[8.3％(1/12)比73.7％(14/19),P＜0.05].③肌病組治療前CK(10 193.0±1 447.0)、CK-MB活性(311.7±44.4)以及CK-MB質量(229.2±47.9)均較健康對照組明顯升高(均P＜0.01),但cTnI不高(0.021±0.002)；治療2週後CK(5 735.6±6 187.8)、CK-MB活性(170.7±143.0)、CK-MB質量(207.4±136.6)仍維持在高水平,cTnI(0.230±0.150)則維持在正常水平；各項指標的增高率與治療前均無顯著差異[CK:85.7％(6/7)比97.4％(37/38); CK-MB活性:85.7％(6/7)比97.4％(37/38);CK-MB質量:100.0％(2/2)比94.1％(32/34)；cTnI:0(0/1)比6.4％(2/31),均P＞0.05].結論 ①在心肌炎時,CK-MB質量與cTnI一緻,急性期升高,恢複期降至正常,但CK-MB質量觀察窗短于cTnI.②在肌病時,CK-MB質量與cTnI 分離,前者治療前後均升高,後者正常,故用測定CK-MB質量來判定肌病患兒是否有心肌損害意義有限.
목적 통과대비소인심기염、기병시혈청중기산격매동공매(CK-MB)질량여기개단백I(cTnI)화기홍단백(Mb)적동태변화,관찰CK-MB질량재판정심기손상중적의의.방법 측정40례심기염환인(기중유20례위폭발성심기염)화38례기병환인적기산격매(CK)、CK-MB활성、CK-MB질량、cTnI、Mb、심전도이급맥충다보륵초성심동도；기병조동시진행기전도、유전대사병사사이급기인검측.이동기본원발육인과문진제외갑상선공능감저증적10례신왜대사인동위대조.결과 ①건강대조조인동CK(U/L)위95.0±27.0,CK-MB활성(U/L)위22.6±1.3,CK-MB질량(μg/L)위2.4±0.3,cTnI(μg/L)위0.012±0.001.②심기염조환인치료전CK(1 033.0±408.0)、CK-MB활성(101.2±31.5)、CK-MB질량(38.2±13.2)、cTnI(5.544±1.554)균교건강대조조명현승고(균P＜0.01)；수착치료시간연장,각항지표축점하강；치료2주후CK(59.3±25.1)、CK-MB활성(24.6±13.2)、CK-MB질량(3.3±2.9)、cTnI(0.125±0.128)균회복지정상수평(균P＞0.05).치료1주후CK、CK-MB질량증고솔즉교치료전명현하강[CK:5.9％(1/17)비56.4％(22/39);CK-MB질량:8.3％(1/12)비61.1％(22/36),균P＜0.01],CK-MB질량회복선우cTnI,증고솔출현명현차이[8.3％(1/12)비73.7％(14/19),P＜0.05].③기병조치료전CK(10 193.0±1 447.0)、CK-MB활성(311.7±44.4)이급CK-MB질량(229.2±47.9)균교건강대조조명현승고(균P＜0.01),단cTnI불고(0.021±0.002)；치료2주후CK(5 735.6±6 187.8)、CK-MB활성(170.7±143.0)、CK-MB질량(207.4±136.6)잉유지재고수평,cTnI(0.230±0.150)칙유지재정상수평；각항지표적증고솔여치료전균무현저차이[CK:85.7％(6/7)비97.4％(37/38); CK-MB활성:85.7％(6/7)비97.4％(37/38);CK-MB질량:100.0％(2/2)비94.1％(32/34)；cTnI:0(0/1)비6.4％(2/31),균P＞0.05].결론 ①재심기염시,CK-MB질량여cTnI일치,급성기승고,회복기강지정상,단CK-MB질량관찰창단우cTnI.②재기병시,CK-MB질량여cTnI 분리,전자치료전후균승고,후자정상,고용측정CK-MB질량래판정기병환인시부유심기손해의의유한.
Objective To examine the changes in serum MB isoenzyme of creatine kinase mass (CK-MB mass),cardiac troponin I(cTnI),and myoglobulin(Mb)in children with myocarditis and muscular disease in order to evaluate the significance of index CK-MB mass for the diagnosis of myocardium injury in these diseases.Methods Blood samples were collected from 40 children with myocarditis,38 children with muscular diseases,and 10 healthy children,for the measurement of creatine kinase(CK),CK-MB activity,CK-MB mass,cTnI,and Mb.Myocarditis patients also received electrocardiogram and pulse Doppler electrocardiogram examination while muscular diseases patients were subjected to electro-myographic examination,inherit-metabolic diseases screening and related gene analysis.The data were analyzed for differences between groups,and differences between values before and after the treatment.Results In comparison with healthy controls[CK(U/L):95.0 ± 27.0,CK-MB activity(U/L):22.6 ± 1.3,CK-MB mass(μg/L):2.4±0.3,cTnI(fig/L):0.012±0.001],the patients with myocarditis had significantly(all P＜0.01)higher mean values in CK(1 033.0± 408.0),CK-MB activity(101.2± 31.5),CK-MB mass (38.2± 13.2)and cTnI(5.544±1.554)before the treatment.After 2 weeks of treatment these indexes returned to the level of controls,with cTnI responded the last(CK:59.3±25.1,CK-MB activity:24.6± 13.2,CK-MB mass:3.3±2.9,cTnI:0.125±0.128).One week after treatment,the incidences of CK and CK-MB mass elevation were significantly lower than the values before the treatment[CK:5.9 ％(1/17)vs.56.4％(22/39); CK-MBmass:8.3％(1/12)vs.61.1％(22/36),both P＜0.01],with the change in CK-MB mass appeared significantly earlier than cTnI[8.3％(1/12)vs.73.7％(14/19),P＜0.05].The patients with muscular disease also had significantly elevated mean value in CK(10 193.0± 1 447.0),CK-MB activity(311.7 ± 44.4),and CK-MB mass(229.2 ± 47.9)in comparison with healthy controls before the treatment(all P＜0.01).But their cTnI(0.021±0.002)was not significantly different from the control at this time.Two weeks after treatment,the elevated indexes were still significantly higher than the control(CK:5 735.6±6 187.8,CK-MB activity:170.7±143.0,CK-MB mass:207.4±136.6),while the level of cTnI(0.230±0.150)remained at the level of the control group.The incidence of index elevation was not significantly different from the values before the treatment for all the indexes tested[CK:85.7％(6/7)vs.97.4％(37/38); CK-MB activity:85.7％(6/7)vs.97.4％(37/38); CK-MB mass:100.0％(2/2)vs.94.1％(32/34); cTnI:0(0/1)vs.6.4％(2/31),all P＞0.05].Conclusions In patients with myocarditis,CK-MB mass and cTnI both follow a consistent pattern of change:elevated in the acute stage of the disease but return to normal after recovery.In patients with muscular diseases,these 2 indexes have different pattern of change.CK-MB mass is significantly higher than control even after the treatment,while cTnI value remain unchanged.Therefore,CK-MB mass has very limited value as an index for myocardial injury in these patients.
