Gerbershagen M U, Wappler F, Fiege M, Weisshorn R, Kolodzie K, Schulte am Esch J
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2004 Feb;39(2):81-6. doi: 10.1055/s-2004-817676.
The diagnosis of malignant hyperthermia is currently performed with the in-vitro contracture test (IVCT) with halothane and caffeine. This test has a sensitivity of 99.0 % but only a specificity of 93.6 %. A cumulative IVCT with 4-chloro-3-ethyl-phenole (CEP) has recently been shown to differentiate between MH susceptible (MHS) and MH normal (MHN) swine. The pur-pose of this study was to investigate the ability of bolus CEP-applications to distinguish between porcine MHS- and MHN-muscle specimens using the IVCT.
After approval by the local animal care committee 8 MHS- and 8 MHN-swine were anaesthetized and muscle biopsies taken. For IVCT, muscle specimens were exposed to bolus administration of CEP in concentrations of 75 resp. 100 micro mol l (-1). Predefined parameters were: (1) onset time of the contracture development, (2) time to the achievement of the 2, 5 and 10 mN contracture level and (3) maximum contracture level. Data are expressed as medians and ranges.
After 75 micro mol l (-1) CEP administration all MHS-muscles showed contractures after 0.5 min (0.2 min/0.9 min). The 2 mN contracture level was reached by all MHS-, the 5 mN level by four MHS- and the 10 mN level by one MHS-specimen. The maximum contracture was 5.3 mN (2.4 mN/12.9 mN). The onset time after 100 micro mol l (-1) CEP was registered as 0.3 min (0.1 min/0.7 min) in the MHS-preparations. Again, the 2 mN level was achieved by all MHS-specimens, the 5 mN level by 5 and the 10 mN level by one MHS-bundle. The maximum contracture was measured as 5.9 mN (2.8 mN/13.9 mN). In 7 MHN-specimens no contracture development was measured. After 75 micro mol l (-1) CEP one MHN-muscle showed a maximum contracture of 1.0 mN, after 100 micro mol l (-1) CEP one MHN-bundle demonstrated a maximum contracture of 1.1 mN. Hence, a significant difference between MHS and MHN without overlap was revealed with both CEP-concentrations in the onset time of contracture, in the 2 mN contracture level and the maximum contracture.
Since a clear differentiation between MHS and MHN porcine specimens was achieved after bolus application of 75 and 100 micro mol l (-1) CEP, MH-diagnosis might be possible with a CEP-IVCT. It seems worthwhile to examine this hypothesis in men.
目前恶性高热的诊断是通过使用氟烷和咖啡因的体外挛缩试验（IVCT）进行的。该试验的敏感性为99.0%，但特异性仅为93.6%。最近有研究表明，使用4-氯-3-乙基苯酚（CEP）进行累积IVCT可区分恶性高热易感（MHS）和恶性高热正常（MHN）猪。本研究的目的是探讨使用IVCT通过大剂量应用CEP区分猪MHS和MHN肌肉标本的能力。
经当地动物护理委员会批准，对8头MHS猪和8头MHN猪进行麻醉并采集肌肉活检样本。对于IVCT，将肌肉标本暴露于浓度为75 μmol/L和100 μmol/L的大剂量CEP中。预定义参数为：（1）挛缩发展的起始时间，（2）达到2 mN、5 mN和10 mN挛缩水平的时间，以及（3）最大挛缩水平。数据以中位数和范围表示。
给予75 μmol/L CEP后，所有MHS肌肉在0.5分钟（0.2分钟/0.9分钟）后出现挛缩。所有MHS标本均达到2 mN挛缩水平，4个MHS标本达到5 mN水平，1个MHS标本达到10 mN水平。最大挛缩为5.3 mN（2.4 mN/12.9 mN）。在MHS制剂中，给予100 μmol/L CEP后的起始时间记录为0.3分钟（0.1分钟/0.7分钟）。同样，所有MHS标本均达到2 mN水平，5个达到5 mN水平，1个MHS束达到10 mN水平。最大挛缩测量为5.9 mN（2.8 mN/13.9 mN）。在7个MHN标本中未检测到挛缩发展。给予75 μmol/L CEP后，1个MHN肌肉的最大挛缩为1.0 mN，给予100 μmol/L CEP后，1个MHN束的最大挛缩为1.1 mN。因此，在挛缩起始时间、达到2 mN挛缩水平和最大挛缩方面，两种CEP浓度均显示MHS和MHN之间存在显著差异且无重叠。
由于在大剂量应用75 μmol/L和100 μmol/L CEP后能明确区分猪MHS和MHN标本，因此使用CEP-IVCT进行恶性高热诊断可能是可行的。在人体中检验这一假设似乎是值得的。
