Bonnefoy E, Grollier G, Fradin S, Ovize M, Potier J C
Service de chirurgie cardiaque, Hôpital cardiologique, Lyon.
Arch Mal Coeur Vaiss. 1993 Sep;86(9):1367-71.
The biological diagnosis is usually late with respect to clinical and electrocardiographic signs of acute myocardial infarction. Recent laboratory methods have stimulated renewed interest in very early marker of infarction: myoglobin and CPK isoforms. The authors undertook a prospective study of the diagnostic sensitivity of myoglobin (MG), CPK and CPK-MM isoforms in 30 consecutive patients undergoing intravenous thrombolytic therapy in the acute phase of myocardial infarction. Blood samples were obtained on admission and every 30 minutes for 1 h 30. The Mb contributed to diagnosis of infarction on admission in 89% of patients. This percentage fell to 44% for the ratio MM3/MM1 > 0.5 to 27% for the CPK and to 24% for the ratio MM3/MM1 > 1. The sensitivity of all tests increased in the later blood samples but it remained low in the CPK and MM3/MM1 > 1 criteria. The diagnostic sensitivity of the first sample was also better in patients admitted after the 3rd hour (Mb = 100%; MM3/MM1 > 0.5: 58%; CPK: 41%) compared with those admitted before the 3rd hour (Mb = 82%; MM3/MM1 > 0.5: 35%; CPK: 17%). These results show that the diagnostic sensitivity of biological markers of myocardial infarction is very different. The serum myoglobin is an earlier and more sensitive marker than the CPK or CPK-MM isoforms.
相对于急性心肌梗死的临床和心电图表现，生物学诊断通常较晚。最近的实验室方法激发了人们对梗死极早期标志物：肌红蛋白和肌酸磷酸激酶同工酶的新兴趣。作者对30例在心肌梗死急性期接受静脉溶栓治疗的连续患者进行了肌红蛋白（MG）、肌酸磷酸激酶（CPK）和CPK-MM同工酶诊断敏感性的前瞻性研究。入院时及之后每30分钟采集血样，共采集1小时30分钟。肌红蛋白在89%的患者入院时有助于梗死诊断。当MM3/MM1>0.5时，这一比例降至44%；CPK为27%；MM3/MM1>1时为24%。所有检测在后续血样中的敏感性均有所提高，但CPK和MM3/MM1>1标准的敏感性仍然较低。与第3小时之前入院的患者（肌红蛋白=82%；MM3/MM1>0.5：35%；CPK：17%）相比，第3小时之后入院的患者第一个样本的诊断敏感性也更高（肌红蛋白=100%；MM3/MM1>0.5：58%；CPK：41%）。这些结果表明，心肌梗死生物学标志物的诊断敏感性差异很大。血清肌红蛋白是比CPK或CPK-MM同工酶更早、更敏感的标志物。
