血清髓过氧化物酶、肌酸磷酸激酶、肌酸激酶同工酶和肌钙蛋白I检测在ERCP期间心肌缺血早期诊断中的作用

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP.

作者信息

Yıldız Kemal, Ince Ali Tüzün, Sarbay Kemik Ahu, Sert Selin, Isen Hayati Can, Tozlu Mukaddes, Baysal Birol, Akyüz Umit, Kocaman Orhan, Danalıoğlu Ahmet

机构信息

Department of Gastroenterology, Bezmialem Vakif University Medical School, İstanbul, Turkey.

出版信息

Turk J Gastroenterol. 2014 Jun;25(3):291-7. doi: 10.5152/tjg.2014.4716.

DOI:10.5152/tjg.2014.4716

PMID:25141318

Abstract

BACKGROUND/AIMS: Some patients may experience retrosternal pain during ERCP, which may be a pioneer of a serious myocardial problem, and early diagnosis is very important for the prognosis and management. In the study, we aimed to investigate the role of serum cardiac biomarkers, such as myeloperoxidase (MPO), creatine phospokinase (CPK), creatine kinase- myocardial band (CK-MB), and cTnI, on early diagnosis of myocardial ischemia during endoscopic retrograde cholangio pancreaticograpy (ERCP) procedures.

MATERIALS AND METHODS

In this prospective observational study, ERCP patients were separated into ischemic cardiac (n:48) and non-ischemic (n:76) groups. Serious cardiac, kidney, and liver disease patients were excluded from the study. Changes in electrocardigrapy (ECG), blood pressure, pulse rate, oxygen saturation, and serum MPO, CPK, CK-MB, and cTnI levels were investigated before and after the ERCP. Results were evaluated statistically (p<0.05).

RESULTS

Mean age was 59.76±16.62 (55♀, 69♂). Only one patient had clinically unimportant retrosternal pain (0.8%). ST-elevation was detected in 10.4% (n:5), ST-depression in 12.5% (n:6), and negative-T in 31.3% (n:15) of ischemic patients during ERCP. Systolic and diastolic blood pressure and pulse rates in both groups and oxygen saturations in the ischemic group were reduced after ERCP. Significance was not detected with MPO and CPK tests. CK-MB levels showed an increase after the ERCP in the non-ischemic group (p<0.001). cTnI means were higher among the ischemics when pre- and post-ERCP periods (p:0.001) were compared.

CONCLUSION

Clinically unimportant retrosternal pain, T negativity, and ST segment changes as well as reduced systolic, diastolic blood pressure, and heart rates can be seen during ERCP. MPO and CPK levels remain insignificant if myocardial injury does not develop. Increased CK-MB levels in non-ischemic patients and increased cTnI levels in ischemics may be seen.

摘要

背景/目的：部分患者在逆行胰胆管造影术（ERCP）期间可能会出现胸骨后疼痛，这可能是严重心肌问题的先兆，早期诊断对预后和治疗非常重要。在本研究中，我们旨在探讨血清心肌生物标志物，如髓过氧化物酶（MPO）、肌酸磷酸激酶（CPK）、肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白I（cTnI），在内镜逆行胰胆管造影术（ERCP）过程中对心肌缺血早期诊断的作用。

材料与方法

在这项前瞻性观察研究中，ERCP患者被分为心肌缺血组（n = 48）和非缺血组（n = 76）。严重心脏、肾脏和肝脏疾病患者被排除在研究之外。在ERCP前后，对心电图（ECG）、血压、脉搏率、血氧饱和度以及血清MPO、CPK、CK-MB和cTnI水平的变化进行了研究。结果进行统计学评估（p < 0.05）。

结果

平均年龄为59.76±16.62（女性55例，男性69例）。仅有1例患者出现临床上无重要意义的胸骨后疼痛（0.8%）。在ERCP期间，10.4%（n = 5）的缺血患者检测到ST段抬高，12.5%（n = 6）检测到ST段压低，31.3%（n = 15）检测到T波倒置。ERCP后，两组的收缩压和舒张压以及脉搏率均降低，缺血组的血氧饱和度也降低。MPO和CPK检测未发现显著差异。非缺血组ERCP后CK-MB水平升高（p < 0.001）。比较ERCP前后，缺血组的cTnI平均值更高（p = 0.001）。