Penttilä Karri, Koukkunen Heli, Halinen Matti, Rantanen Tapio, Pyörälä Kalevi, Punnonen Kari, Penttilä Ilkka
Department of Clinical Chemistry, Kuopio University Hospital, Kuopio, Finland.
Clin Biochem. 2002 Nov;35(8):647-53. doi: 10.1016/s0009-9120(02)00385-5.
Measurements of myoglobin and creatine kinase (CK)-MB isoforms have been suggested to be sensitive tests for the early diagnosis of myocardial infarction (MI). We have investigated the utility of myoglobin, creatine kinase (CK)-MB isoforms and creatine kinase MB mass (CK-MBm) in early diagnosis of MI using cardiac troponin T (cTnT) positivity as a reference.
The study population comprised 440 patients who had had chest pain for less than 12 h. Patients were divided into cTnT negative (cTnT-) or cTnT positive (cTnT+) patients (concentration of cTnT >0.1 microg/L at two different time points during 72 h).
At the time of admission to the emergency department receiver operating characteristics (ROC) curves of CK-MB isoforms and CK-MBm were not better than that of myoglobin. Six hours after admission CK-MB isoforms and CK-MBm provided statistically significantly larger areas under the curve (AUC) than myoglobin (p < 0.01). When ROC curves were related to the onset of chest pain (< 3 h, 3-6 h, and > 6 h) there were no significant differences between the cardiac markers studied.
According to the present findings, CK-MB isoforms or myoglobin offer no advantage over CK-MBm as early markers of myocardial infarction.
有人提出测定肌红蛋白和肌酸激酶（CK）-MB同工酶是早期诊断心肌梗死（MI）的敏感试验。我们以心肌肌钙蛋白T（cTnT）阳性为参照，研究了肌红蛋白、肌酸激酶（CK）-MB同工酶和肌酸激酶MB质量（CK-MBm）在MI早期诊断中的效用。
研究人群包括440例胸痛时间少于12小时的患者。患者被分为cTnT阴性（cTnT-）或cTnT阳性（cTnT+）患者（72小时内两个不同时间点cTnT浓度>0.1μg/L）。
在急诊科入院时，CK-MB同工酶和CK-MBm的受试者工作特征（ROC）曲线并不优于肌红蛋白。入院6小时后，CK-MB同工酶和CK-MBm的曲线下面积（AUC）在统计学上显著大于肌红蛋白（p<0.01）。当ROC曲线与胸痛发作时间（<3小时、3-6小时和>6小时）相关时，所研究的心脏标志物之间无显著差异。
根据目前的研究结果，作为心肌梗死的早期标志物，CK-MB同工酶或肌红蛋白并不比CK-MBm更具优势。
