Wu A H, Laios I, Green S, Gornet T G, Wong S S, Parmley L, Tonnesen A S, Plaisier B, Orlando R
Clinical Chemistry Laboratory, Hartford Hospital, CT 06102.
Clin Chem. 1994 May;40(5):796-802.
We compared four immunoassays for serum and urine myoglobin. Within-run CVs were 5-13%, with biases seen between assays. Myoglobin was stable for 1 month in serum and 12 days in urine when the pH was adjusted to between 8.0 and 9.5. Hemoglobin caused no interference. We assayed 91 pairs of serum and timed urine specimens from 41 patients admitted for acute trauma or rhabdomyolysis. Most were treated with mannitol and alkalinization. Upon initial presentations, 21 patients with either low serum myoglobin concentrations (< 400 micrograms/L) or high myoglobin clearances (> or = 4 mL/min) had normal creatinine clearances and no clinical evidence of renal disease. The remaining 20 had low myoglobin clearances. Seven were in rhabdomyolysis-induced acute renal failure, or subsequently developed this complication. We suggest that low myoglobin clearance may indicate a high risk for developing renal failure or may be an early marker for kidney dysfunction. Low myoglobin clearance may prove useful in indicating failure of prophylactic treatment to clear myoglobin.
我们比较了四种用于检测血清和尿液中肌红蛋白的免疫测定法。批内变异系数为5%-13%，各测定法之间存在偏差。当pH值调至8.0至9.5之间时，肌红蛋白在血清中可稳定1个月，在尿液中可稳定12天。血红蛋白未造成干扰。我们检测了41例因急性创伤或横纹肌溶解症入院患者的91对血清和定时尿液标本。大多数患者接受了甘露醇和碱化治疗。初次就诊时，21例血清肌红蛋白浓度低（<400微克/升）或肌红蛋白清除率高（≥4毫升/分钟）的患者肌酐清除率正常，且无肾脏疾病的临床证据。其余20例肌红蛋白清除率低。其中7例处于横纹肌溶解症诱发的急性肾衰竭状态，或随后出现了该并发症。我们认为，低肌红蛋白清除率可能表明发生肾衰竭的风险较高，或者可能是肾功能障碍的早期标志物。低肌红蛋白清除率可能有助于指示清除肌红蛋白的预防性治疗失败。
