DePuey E G, Aessopos A, Monroe L R, Hall R J, Thompson W L, Sonnemaker R E, Burdine J A
J Nucl Med. 1983 Aug;24(8):703-9.
In 144 patients, creatine kinase MB was measured serially at 0, 8, 16, 24, 48, and 72 hr using a two-site immunoradiometric assay (IRMA). Cardiac enzymes were also measured, including SGOT, LDH, total CPK, and CK-MB by electrophoresis. The presence of perioperative myocardial infarction (poMI) was established in 24 patients by the appearance of new electrocardiographic Q waves and/or new wall motion abnormalities detected by radionuclide ventriculography. In patients without poMI, CK-MB (IRMA) was elevated (6.4 +/- 4.9 equivalent units per liter) at 0-8 hr but decreased to 3.4 +/- 1.3 EU/l by 16 hr. In patients with poMI, peak values occurred at 16-24 hr (21.0 +/- 19.8 EU/l). Using a threshold value of 8.5 EU/l, patients with poMI could be distinguished from those without with 97% accuracy (sensitivity = 88%, specificity = 99%). The CK-MB (IRMA) was more reliable than the other enzyme assays, for which we used both empirically elevated threshold values based upon previous experience, and also threshold values retrospectively optimized for the study population. We conclude that the CK-MB (IRMA) can serve as a valuable postoperative screening test for poMI.
对144例患者，采用双位点免疫放射分析（IRMA）在0、8、16、24、48和72小时连续测定肌酸激酶MB。还测定了心脏酶，包括谷草转氨酶（SGOT）、乳酸脱氢酶（LDH）、总肌酸磷酸激酶（CPK）以及通过电泳测定的肌酸激酶同工酶MB（CK-MB）。通过出现新的心电图Q波和/或放射性核素心室造影检测到的新的室壁运动异常，确定24例患者发生了围手术期心肌梗死（poMI）。在无poMI的患者中，CK-MB（IRMA）在0 - 8小时升高（6.4±4.9等效单位/升），但到16小时降至3.4±1.3等效单位/升。在有poMI的患者中，峰值出现在16 - 24小时（21.0±19.8等效单位/升）。使用8.5等效单位/升的阈值，poMI患者与无poMI患者的区分准确率可达97%（敏感性 = 88%，特异性 = 99%）。CK-MB（IRMA）比其他酶检测更可靠，对于其他酶检测，我们既使用了基于以往经验凭经验提高的阈值，也使用了针对研究人群进行回顾性优化的阈值。我们得出结论，CK-MB（IRMA）可作为poMI有价值的术后筛查试验。
