Vrouenraets B C, Kroon B B, Klaase J M, Bonfrer J M, Nieweg O E, van Slooten G W, van Dongen J A
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam, The Netherlands.
Ann Surg Oncol. 1997 Jan;4(1):88-94. doi: 10.1007/BF02316815.
Severe limb toxicity following isolated limb perfusion (ILP) can lead to compartmental compression syndrome and severe rhabdomyolysis, occasionally necessitating amputation of the affected limb. We determined whether laboratory tests for muscle damage and inflammation could predict impending limb toxicity.
All 184 consecutive ILPs performed in our institute from 1988 to 1994 were included in this study. Creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT) and white blood cell (WBC) counts were determined on post-ILP days 1-4, 6, 8, and 15.
"Late peak" CK patterns, characterised by a peak on or after the 5th post-perfusion day, were strongly associated with severe limb toxicity (p < 0.001). Severe toxicity did develop in 40% of the limbs when CK values exceeded 1000 IU/L on the 2nd to 5th post-ILP day (p < 0.001). There was a correlation between the peak CK and the individual grades of toxicity (r = 0.6, p < 0.001). Serum LDH and ASAT values peaked 2.9 and 3.4 days after the CK peak respectively. Severe limb toxicity was statistically significantly associated with higher WBC counts from the 2nd post-ILP day onwards.
CK values exceeding 1000 IU/L after the 1st and WBC counts increasing after the 2nd post-ILP day could be predictors of impending limb toxicity. These patients should be observed closely for signs of compartmental compression syndrome and severe rhabdomyolysis.
孤立肢体灌注（ILP）后严重的肢体毒性可导致骨筋膜室综合征和严重的横纹肌溶解，偶尔需要截肢受影响的肢体。我们确定肌肉损伤和炎症的实验室检查是否可以预测即将发生的肢体毒性。
本研究纳入了1988年至1994年在我们研究所进行的所有184例连续ILP。在ILP后第1 - 4天、6天、8天和15天测定肌酸激酶（CK）、乳酸脱氢酶（LDH）、天冬氨酸转氨酶（ASAT）和白细胞（WBC）计数。
“晚期峰值”CK模式，其特征是在灌注后第5天或之后出现峰值，与严重的肢体毒性密切相关（p < 0.001）。当ILP后第2至5天CK值超过1000 IU/L时，40%的肢体确实发生了严重毒性（p < 0.001）。CK峰值与个体毒性等级之间存在相关性（r = 0.6，p < 0.001）。血清LDH和ASAT值分别在CK峰值后2.9天和3.4天达到峰值。从ILP后第2天起，严重的肢体毒性与较高的WBC计数在统计学上显著相关。
ILP后第1天CK值超过1000 IU/L以及第2天起WBC计数增加可能是即将发生肢体毒性的预测指标。这些患者应密切观察是否有骨筋膜室综合征和严重横纹肌溶解的迹象。
