Mall T, Scholer A, Burckhardt D
Schweiz Med Wochenschr. 1982 Jul 17;112(29):1039-45.
Elevations of creatine kinase (CK) are not specific for myocardial disease. However, enzyme release due to extracardial factors is not necessarily comparable in healthy and diseased persons. It is therefore questionable whether normal values obtained in a group of healthy or mildly ill subjects are also valid for severely ill patients. The activity pattern of CK and its isoenzyme MB was therefore examined in the serum of 100 consecutive patients attending the medical outpatient clinic and of 170 patients at the time of admission to the medical emergency ward. The clinical and laboratory findings and diagnoses for all patients are recorded. Acute coronary disease was excluded. Determination of CK was performed according to the method described by Oliver [21] and Preston [27], but the results were calculated for a reaction temperature of 30 degrees C and determination of CK-MB was in cue with the method described by Prellwitz [25]. 4% of the outpatients and 14% of the emergency patients had CK values of over 100 U/1. In the majority of the patients (19 of 28) with CK values of over 100 U/1, the history revealed that the elevated values could be attributed to skeletal muscle trauma. After these values had been excluded, the 95% percentile was 20-85 U/1 (outpatients) and 20-110 U/1 (emergency ward) for men and 15-90 U/1 (outpatients) and 20-75 U/1 (emergency ward) for women. Without this selection, the newly admitted male patients in particular would have presented considerably elevated values. Since an explanation was found for most of the elevating values, the adjusted figures show no major differences between outpatients and hospital patients. The limit for CK-MB activity indicative of cardiac origin is presumed to be between 4-10% of the total CK activity. However, individual variations are observed, since CK-MB activity in skeletal muscle in variable and atypical isoenzymes may interfere with CK-MB determination. In this study 14% of the patients admitted to the emergency ward with CK values of under 100 U/1 presented false positive CK-MB values of over 10% of the total CK activity. It is concluded that CK-MB determination using the antibody method does not afford reliable results when there is no elevation of total CK.
肌酸激酶（CK）升高并非心肌病所特有。然而，心外因素导致的酶释放情况在健康人和患病者中不一定具有可比性。因此，在一组健康或轻症受试者中获得的正常数值对于重症患者是否同样有效值得怀疑。因此，对100例连续就诊于内科门诊的患者以及170例入住内科急诊病房的患者血清中的CK及其同工酶MB的活性模式进行了检测。记录了所有患者的临床和实验室检查结果及诊断情况。排除了急性冠状动脉疾病。CK的测定按照Oliver[21]和Preston[27]描述的方法进行，但结果是按照30摄氏度的反应温度计算的，CK-MB的测定采用Prellwitz[25]描述的方法。4%的门诊患者和14%的急诊患者CK值超过100 U/1。在大多数CK值超过100 U/1的患者（28例中的19例）中，病史显示升高的值可归因于骨骼肌创伤。排除这些值后，男性的95%百分位数为20 - 85 U/1（门诊患者）和20 - 110 U/1（急诊病房），女性为15 - 90 U/1（门诊患者）和20 - 75 U/1（急诊病房）。若不进行此项筛选，尤其是新入院的男性患者会呈现出明显升高的值。由于大多数升高的值都能找到原因，调整后的数字显示门诊患者和住院患者之间没有重大差异。提示心脏来源的CK-MB活性界限推测在总CK活性的4% - 10%之间。然而，观察到存在个体差异，因为骨骼肌中可变且非典型同工酶的CK-MB活性可能会干扰CK-MB的测定。在本研究中，14%入住急诊病房且CK值低于100 U/1的患者出现了CK-MB假阳性值，超过总CK活性的10%。结论是，当总CK没有升高时，使用抗体法测定CK-MB不能提供可靠结果。
