Roe C R, Wagner G S, Young W G, Curtis S E, Cobb F R, Irvin R G
Clin Chem. 1979 Jan;25(1):93-8.
We compared (a) the frequency of detection of isoenzyme MB of creatine kinase (CK; EC 2.7.3.2) in serum of patients undergoing coronary-artery bypass surgery, (b) the interval during uhich its activity was supranormal in serum, and (c) an index of the amount of CK released into blood ("CK-MB area") with postoperative electrocardiographic changes in 80 patients. The frequency of detection of CK-MB is a function of frequency of sampling during the early postoperative period. Because the duration of appearance and the calculated CK-MB area increased as the electrocardiogram became more specific for infarction (p less than 0.01), a twice-daily sampling schedule proved clinically relevant. Only 5.4% of patients had electrocardiographic evidence of infarction when CK-MB was absent by the second postoperative morning. When CK-MB was still detected at that time, 69.6% of patients had persistent new Q waves, consistent with infarction. In three patients who died postoperatively, significant myocardial necrosis was demonstrated. All three had had persistently increased values for CK-MB, related to electrocardiographic changes of infarction in one patient and ischemic changes in two. Evidently CK-MB is a more sensitive indicator of myocardial necrosis than the electrocardiogram and CK-MB area should be a useful criterion in evaluating methods of intra-operative myocardial protection.
(a) 接受冠状动脉搭桥手术患者血清中肌酸激酶（CK；EC 2.7.3.2）同工酶MB的检测频率；(b) 其在血清中活性高于正常水平的持续时间；以及(c) 80例患者术后心电图变化与释放到血液中的CK量指标（“CK-MB面积”）之间的关系。CK-MB的检测频率是术后早期采样频率的函数。由于随着心电图对梗死的特异性增加，其出现持续时间和计算出的CK-MB面积增大（p<0.01），因此每天采样两次的方案被证明具有临床相关性。术后第二天早晨若未检测到CK-MB，只有5.4%的患者有梗死的心电图证据。若此时仍检测到CK-MB，69.6%的患者有持续的新Q波，符合梗死表现。在3例术后死亡的患者中，证实有明显的心肌坏死。3例患者的CK-MB值均持续升高，其中1例与梗死的心电图变化有关，2例与缺血变化有关。显然，CK-MB是比心电图更敏感的心肌坏死指标，CK-MB面积应是评估术中心肌保护方法的有用标准。
