Bastecký J, Vávrová J, Palicka V, Ettlerová E, Wasyliwová V, Rehácek V
I. interní klinika FN, Hradec Králové.
Vnitr Lek. 1997 Nov;43(11):715-21.
In a group of 26 patients with AIM the CKMB value was raised above the discrimination level already on admission--on average 2.7 +/- 1.4 hours after development of ischaemic pain--in 46% patients. The maximal value of CKMB mass was achieved in the group with probable reperfusion 12.1 +/- 3.8 hours after the development of ischaemic pain and this value was elevated in relation to the discrimination value 41.5 +/- 17x and in relation to the so-called basal value 145 +/- 117x. In the group without probable reperfusion the maximal value was achieved significantly later, after 19.8 +/- hours and was elevated in relation to the discrimination value 31 +/- 17x and in relation to the final value 84 +/- 42 times. The value of CKMB mass increased above the discrimination limit from the onset of ischaemic pain after 4.0 +/- 1.5 and after 5.7 +/- 3 hours in the group with probable and without probable reperfusion and declined below the discrimination limit after 00 +/- 60 and 119 +/- 98.0 hours in the same groups. On comparison of CK, CKBM, CKBM mass and troponin T on admission the CKMB mass value was elevated in 46% patients, the value of CK in 23%, of CKMB in 27% and the troponin T value in 96% patients. With regard to the assembled experience that haemolytic serum raises false troponin T values, the percentage of elevated troponin T values on admission declines from the original 96% to 81% when all haemolytic samples are eliminated. The time of reaching maximal values of CKMB mass in patients with AIM and probable reperfusion was significantly shorter than in CK values and is similar as in CKMB values. The time taken to raise the CKBMB mass value above the discrimination value is significantly shorter than the time taken by CK levels, but significantly longer than the time before troponin T levels are raised. The time of total elevation of CKMB mass levels above the discrimination limit does not differ from the time taken to raise CK values, it is however shorter than the increase of troponin T values, although the exact time of persistence of raised levels of troponin T was not assessed in our work. The time of increase above and decrease below the discrimination limit was not assessed in CKMB values. Based on mutual comparison of the impact of indicators for assessment of the diagnosis of ischaemic heart attacks the authors consider it best regardless of financial costs--to assess troponin T, possibly along with levels of CKMB mass.
在一组26例急性心肌梗死（AIM）患者中，46%的患者在入院时肌酸激酶同工酶（CKMB）值就已高于鉴别水平，平均在缺血性疼痛发作后2.7±1.4小时。在可能发生再灌注的组中，CKMB质量的最大值在缺血性疼痛发作后12.1±3.8小时达到，该值相对于鉴别值升高了41.5±17倍，相对于所谓的基础值升高了145±117倍。在无可能再灌注的组中，最大值显著延迟出现，在19.8±[此处原文缺失数字]小时后达到，相对于鉴别值升高了31±17倍，相对于最终值升高了84±42倍。在可能发生再灌注和无可能再灌注的组中，CKMB质量值从缺血性疼痛发作后4.0±1.5小时和5.7±3小时开始高于鉴别限度，并在00±60小时和119±98.0小时后降至鉴别限度以下。入院时比较肌酸激酶（CK）、CKMB、CKMB质量和肌钙蛋白T，46%的患者CKMB质量值升高，23%的患者CK值升高，27%的患者CKMB升高，96%的患者肌钙蛋白T值升高。鉴于有溶血血清会提高肌钙蛋白T假值的经验，当排除所有溶血样本后，入院时肌钙蛋白T值升高的百分比从原来的96%降至81%。AIM且可能发生再灌注的患者中达到CKMB质量最大值的时间明显短于CK值，与CKMB值相似。使CKBMB质量值高于鉴别值所需的时间明显短于CK水平所需的时间，但明显长于肌钙蛋白T水平升高前的时间。CKMB质量水平高于鉴别限度的总升高时间与CK值升高所需时间无差异，然而短于肌钙蛋白T值的升高时间，尽管在我们的研究中未评估肌钙蛋白T水平升高的确切持续时间。未评估CKMB值高于和低于鉴别限度的升高时间。基于对评估缺血性心脏病发作诊断指标相互影响的比较，作者认为无论成本如何，最好评估肌钙蛋白T，可能还要结合CKMB质量水平。
