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Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain levels in suspected acute myocardial infarction. Analysis of 28 months of follow-up in 196 patients.
血清肌酸激酶同功酶 MB 质量、心肌肌钙蛋白 T 和肌球蛋白轻链水平对疑似急性心肌梗死的独立预后价值。196 例患者 28 个月的随访分析。

摘要

OBJECTIVES:We sought to determine the incidence and independent prognostic value of increased serum levels of sensitive serologic markers in patients in whom a conventionally diagnosed acute myocardial infarction had been ruled out.
BACKGROUND:Increased serum levels of creatine kinase (CK) isoenzyme MB mass and cardiac troponin T in patients with unstable angina pectoris are associated with a poor prognosis.
METHODS:We analyzed data from 196 consecutive patients with suspected acute myocardial infarction, which was later ruled out in 124. Increased serum levels of CK-MB mass, troponin T and myosin light chains were compared with clinical findings, ST-T wave abnormalities and presence of arrhythmias.
RESULTS:Of the patients in the noninfarction group, 28% had serum CK-MB mass > or = 6 micrograms/liter, 20% had troponin T > or = 0.20 micrograms/liter, and 26% had myosin light chains > or = 0.4 micrograms/liter (discrimination limits). The cardiac event rate (cardiac death, nonfatal acute myocardial infarction) within 28 months was significantly higher in patients in the noninfarction group with elevated marker levels (range 22% to 24%) than in patients with values below these discriminators (range 3% to 5%) but was not significantly different from that in patients with a definite diagnosis of acute myocardial infarction (29%). Further, significant predictors of cardiac events were previous myocardial infarction; myocardial infarction or angina pectoris, or both; previous congestive heart failure; ST-T wave abnormalities on admission; a transient ST-T wave shift on serial electrocardiograms (ECGs); recurrent chest pain; and occurrence of supraventricular or ventricular tachycardia, or both, during the 1st 48 h after admission. It was found that all three biochemical markers, in the main, convey independent prognostic information with respect to clinical findings and presence of arrhythmias but not ST-T wave abnormalities on admission or a transient ST-T wave shift on serial ECGs.
CONCLUSIONS:Increased serum levels of CK-MB mass, troponin T and myosin light chains all detect a subgroup of 25% of patients without acute myocardial infarction who have as poor a prognosis as that of patients with a definite diagnosis of acute myocardial infarction. All three biochemical markers provide similar important independent prognostic information with regard to clinical findings and arrhythmias but add no additional prognostic information once ECG ST-T wave changes are considered.

译文

目的: 我们试图确定在常规诊断为急性心肌梗死的患者中,敏感血清标志物血清水平增加的发生率和独立预后价值。
背景: 不稳定型心绞痛患者血清肌酸激酶 (CK) 同功酶 MB 质量和心肌肌钙蛋白 T 水平的升高与不良预后相关。
方法: 我们分析了 196 名连续疑似急性心肌梗死患者的数据,这在后来的 124 中被排除在外。将 CK-MB 质量、肌钙蛋白 T 和肌球蛋白轻链的血清水平升高与临床表现、 ST-T 波异常和心律失常的存在进行比较。
结果: 在非梗死组患者中,28% 的患者血清 CK-MB 质量> 或 = 6 微克/升,20% 的患者肌钙蛋白 T> 或 = 0.20 微克/升, 26% 的人有肌球蛋白轻链> 或 = 0.4 微克/升 (辨别极限)。28 个月内的心脏事件率 (心脏死亡,非致命性急性心肌梗死) 在标记物水平升高的非梗死组患者中显著更高 (范围为 22% 至 24%) 比患者的值低于这些鉴别器 (范围 3% 到 5%)但与明确诊断为急性心肌梗死的患者没有显著差异 (29%)。此外,心脏事件的重要预测因素是先前的心肌梗塞; 心肌梗塞或心绞痛,或两者兼而有之; 先前的充血性心力衰竭; 入院时 ST-T 波异常; 连续心电图 (ecg) 上的短暂 ST-T 波移位; 复发性胸痛; 室上或室性心动过速的发生,或两者兼而有之,在入院后第1 48 小时内。发现所有三个生化标记,主要是, 传达与临床发现和心律失常存在相关的独立预后信息,但不传达入院时 ST-T 波异常或连续心电图上短暂的 ST-T 波移位。
结论: CK-MB 质量的血清水平增加, 肌钙蛋白 T 和肌球蛋白轻链都检测到 25% 的无急性心肌梗死患者的亚组,这些患者的预后与明确诊断为急性心肌梗死的患者一样差。所有三个生化标记物都提供了关于临床发现和心律失常的相似重要的独立预后信息,但是一旦考虑到心电图 ST-T 波动的变化,就不会增加额外的预后信息。

creatine kinase isoenzyme

心血管 CK 临床研究术语
概述  :  

肌酸激酶(CK)分子是由两个亚单位组成的二聚体,每个亚单位的分子质量约40000 Da。脑型亚单位(B)及肌型亚单位(M)是两个不同结构基因的产物,形成二聚体时有活性,可产生3种CK同工酶(creatine kinase isoenzyme),即CK-BB(CK-1)、CK-MB(CK-2)及CK-MM(CK-3)。CK同工酶亚型测定主要是指后两者的检测。刚从组织中释放的CK-MB和CK-MM分别为CK-MB2和CK-MM3,称为组织亚型或基因型同工酶。CK-MB主要存在于心肌组织

Creatine 英 ['kriːətiːn]  美 ['kriə,tɪn] 

释义   n. 肌(氨)酸,肌肉素

短语   creatine kinase 肌酸激酶

creatine phosphokinase 肌酸磷酸激酶

例句   To study the expression of mitochondrial creatine kinase in lung cancers. 

研究线粒体肌酸激酶在肺癌中的表达及意义。

 

Kinase 英 [ˈkaɪneɪz]  美 [ˈkɪnneɪz] 

释义   n. [生化] 激酶;致活酶

短语   protein kinase 蛋白激酶

thymidine kinase 胸苷激酶;胸腺嘧啶核苷漱酶

例句   More than 500 kinases have been identified, but we only have a half-dozen targeted kinase inhibitors. 

现在已经发现了500多种激酶,但是我们只研制出六个靶向激酶抑制剂。

 

Isoenzyme 英 ['aɪsəʊ,enzaɪm]  美 [,aɪso'ɛn,zaɪm] 

释义   n. [生化] 同工酶;同功酶

例句   After reperfusion, the serum levels of MB isoenzyme of creatine kinase and lactate dehydrogenase were measured with automatic biochemical analyzer. 

再灌注结束后大鼠血清肌酸激酶同工酶、乳酸脱氢酶水平采用全自动生化仪检测。


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