Donald T G, Cloonan M J, Neale C, Wilcken D E
Br Heart J. 1977 Jan;39(1):29-34. doi: 10.1136/hrt.39.1.29.
We studied myoglobin excretion in 33 patients admitted to the coronary care unit with a provisional diagnosis of acute myocardial infarction. Sixteen proved to have definite and uncomplicated acute myocardial infarction and 17 possible infarction, using WHO criteria. For 5 days after admission, aliquots of every urine specimen voided by each patient were analysed for myoglobin using an immunochemical method able to detect a minimum urinary myoglobin concentration of 0-02 mg/ml. Myoglobinuria was detected in 14 of the 16 patients with definite infarction but was not found in any of the 17 patients with possible infarction. There were 3 patterns of myoglobin excretion. In 8 of the 14 patients it was excreted in one episode starting 10 to 40 hours after the onset of chest pain and lasting for 5 to 45 hours. In 3 of the remaining patients it was excreted over a much longer period (mean 83 hours) and in the final 3 patients myoglobinuria occurred in 2 or 3 intermittent episodes with periods of between 10 and 20 hours during which it was not detected. Total myoglobin excretion, which varied between 2 and 100 mg (mean 51 mg), did not correlate with peak serum enzyme levels. We concluded that in the appropriate clinical setting, the finding of myoglobinuria provides additional evidence for a diagnosis of acute myocardial infarction. The variable myoglobin excretion pattern suggests that in seemingly uncomplicated myocardial infarction there is considerable variation between patients in the pattern of evolution of the infarction process. This may be relevant to the assessment of measures directed towards limiting infarct size.
我们研究了33名入住冠心病监护病房、初步诊断为急性心肌梗死患者的肌红蛋白排泄情况。按照世界卫生组织标准，其中16例确诊为明确且无并发症的急性心肌梗死，17例为可能梗死。入院后5天，采用能检测最低尿肌红蛋白浓度为0.02mg/ml的免疫化学方法，对每位患者排出的每份尿液标本进行分析。16例确诊梗死患者中有14例检测到肌红蛋白尿，而17例可能梗死患者中均未发现。肌红蛋白排泄有3种模式。14例患者中有8例在胸痛发作后10至40小时开始单次排泄，持续5至45小时。其余3例患者排泄时间更长（平均83小时），最后3例患者肌红蛋白尿呈2至3次间歇性发作，发作间隔为10至20小时，期间未检测到。总肌红蛋白排泄量在2至100mg之间（平均51mg），与血清酶峰值水平无关。我们得出结论，在适当的临床环境中，肌红蛋白尿的发现为急性心肌梗死的诊断提供了额外证据。肌红蛋白排泄模式的差异表明，在看似无并发症的心肌梗死中，患者梗死过程演变模式存在相当大的差异。这可能与评估旨在限制梗死面积的措施有关。
