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Objective:To investigate the effects of Danhong injection combined with intravenous recombinant tissue plasminogen activator (rt-PA) on cardiac function, myocardial zymogram and lipoprotein associated phospholipase A2 (Lp-PLA2) level in older adult patients with acute myocardial infarction (AMI). Methods:Eighty older adult patients with acute myocardial infarction who received treatment in Community-based General Hospital of Shaoxing Central Hospital, China between January 2017 and December 2019 were included in this study. They were randomly assigned to receive either intravenous thrombolysis with rt-PA (control group, n = 40) or Danhong injection combined with intravenous thrombolysis with rt-PA (observation group, n = 40). The changes in traditional Chinese medicine syndrome score, left ventricular ejection fraction, left ventricular end diastolic diameter, creatine kinase, creatine kinase-MB and lipoprotein associated phospholipase A2 level as well as adverse cardiovascular events were compared between the control and observation groups. Results:After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the two groups were decreased. After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the observation group was (2.13 ± 0.31) points, (1.98 ± 0.41) points, (1.77 ± 0.29) points, respectively, which was significantly lower than that in the control group [(2.98 ± 0.37) points, (2.52 ± 0.56) points, (2.13 ± 0.32) points, t = 11.137, 4.920, 5.272, all P < 0.001]. After treatment, left ventricular end diastolic diameter in each group was decreased compared with before treatment. After treatment, left ventricular end diastolic diameter in the observation group was significantly lower than that in the control group [(46.12 ± 4.11) mm vs. (49.74 ± 4.32) mm], and left ventricular ejection fraction in the observation group was significantly higher than that in the control group [(47.02 ± 3.55) % vs. (43.25 ± 4.10) %, t = 3.839, 4.396, both P < 0.001). After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in each group were decreased compared with before treatment. After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in the observation group were (171.02 ± 12.52) μg /L, (10.52 ± 2.11) U/L, (24.12 ± 3.52) U/L), respectively, which were significantly lower than those in the control group [(189.63 ± 11.98) μg/L, (14.71 ± 2.62) U/L, (32.79 ± 4.79) U/L), t = 6.792, 7.877, 9.224, all P < 0.001]. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group (5.00% vs. 22.50%, χ2 = 5.165, P < 0.05). Conclusion:Danhong injection combined with intravenous rt-PA for the treatment of acute myocardial infarction in older adult patients can greatly decrease traditional Chinese medicine syndrome score, improve cardiac function, regulate myocardial zymogram and Lp-PLA2 levels, and decrease the incidence of adverse cardiovascular events.
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Objective:To correlate creatine kinase (CK) and creatine kinase- isoenzyme MB (CK-MB) with different states of bipolar disorder in patients.Methods:A total of 206 patients with bipolar disorder who received treatment in The 7 th People's Hospital of Wenzhou, China between January 2018 and June 2019 were included in the patient group. A total of 369 healthy controls who concurrently received physical examination were included in the control group. CK and CK-MB levels were detected in all participants. The Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD)-7 scale, the Bech-Rafaelsen Melancholy Scale (BRMS), and modified version of the Overt Aggression Scale (MOAS) were used to evaluate the mental symptoms, depression, mania and aggression of patients. The CK and CK-MB levels were compared between patients with different states of bipolar disorder. Results:In the control group, CK and CK-MB levels in males were 112.5 (94.5, 156.5) U/L and 17.0 (15.0, 20.0) U/L, respectively, which were significantly higher than those in females [73.0 (61.0, 86.3) U/L, 15.0 (13.0, 18.0) U/L, Z = -9.732, -3.535, both P < 0.001). In the patient group, CK and CK-MB levels in males were 129.0 (80.0, 233.5) U/L, 12.0 (10.0, 17.0) U/L, respectively, which were significantly higher than those in females [73.0 (55.0, 94.0) U/L, 13.5 (11.0, 17.0) U/L, Z = -9.510, -4.746, both P < 0.001]. There was no significant difference in CK level in males between the control and patient groups ( Z = -1.003, P = 0.316), but significant difference in CK-MB level in males was observed between the two groups ( Z = -6.570, P < 0.001). There were significant differences in CK and CK-MB levels in females between the control and patient groups ( Z = -2.535, -9.707, P = 0.011, P < 0.001). In the patient group, CK level in the manic, depressive, and symptom-alleviated states was 132.0 (78.0, 297.0) U/L, 85.0 (56.0, 145.0) U/L, 128.0 (110.0, 165.0) U/L respectively in males, and it was 73.0 (49.0, 122.3) U/L, 51.0 (45.0, 67.0) U/L and 84.5 (61.0, 193.0) U/L, respectively in females. There was significant difference in CK level in males and females between different states of bipolar disorder ( χ2 = 9.019, 16.720, P = 0.011, P < 0.001). In males, CK level was correlated with the BPRS total score, BRMS total score, and MOAS total score in the manic state, as well as the BPRS total score in the symptom-alleviated state ( r = 0.282, 0.286, 0.236, 0.574). In females, CK level was correlated with the MOAS total score in the manic state ( r = 0.260). In males, CK-MB level was correlated with the BRMS total score in the manic and depressive states ( r = 0.186 and 0.496). In females, CK-MB level was correlated with the MOAS total score and the BRMS total score in the manic state ( r = 0.155, 0.572). Conclusion:CK and CK-MB levels are correlated with bipolar disorder in different states and they are of certain clinical significance and provide innovative insights into the diagnosis of bipolar disorder.
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Objective@#To investigate the clinical significance of cellular immune function, inflammatory factors and myocardial enzyme detection in evaluation of prognosis of septic shock, so as to provide a reference for clinical diagnosis and treatment of septic shock.@*Methods@#From June 2015 to June 2018, 73 patients with septic shock treated in the First People's Hospital of Yongkang were selected as the research subjects.According to the 28d prognosis after the patients entered the ICU, the patients were divided into the death group and the survival group.Another 67 cases of health examination from June 2015 to June 2018 were selected as control group.The changes of T lymphocyte subsets includingCD3, CD4 and CD8 were measured by BD FACSCanto I I flow cytometry, the content of procalcitonin(PCT) was determined by immunoluminescence assay, the content of C-reactive protein(CRP) was determined by immunoturbidimetry, and the content of creatine kinase MB(CK-MB), cardiac troponin I(cTnI) and lactate dehydrogenase(LDH) was determined by enzymatic kinetics.@*Results@#The APACHE Ⅱ score and MODS score of the survival group and the death group were higher than those of the control group [(2.20±0.61)points and (4.86±1.29)points]. The APACHE Ⅱ score and MODS score of death group [(16.45±4.28)points and (27.63±4.97)points] were higher than those of survival group [(9.84±2.45)points and (19.84±3.28)points](all P<0.05). The CD3+, CD4+ and CD4+/CD8+ in the survival group and the death group were significantly lower than those in the control group[(71.32±6.96)%, (42.63±4.26)%, (1.67±0.31)%](all P<0.05). The contents of PCT and CRP in the survival group and the death group were higher than those in the control group [(0.19±0.03)ng/mL and (2.19±0.76)mg/L], and the contents of PCT [(15.93±3.26)ng/mL] and CRP [(184.32±29.80)mg/L] in the death group were higher than those in the survival group [(6.87±1.94)ng/mL and (69.49±17.42)mg/L] (all P<0.05). The CK-MB content in the survival group and the death group of septic shock was lower than that in the control group [(1.97±0.21)μg/L], and the cTnI and LDH contents were higher than that in the control group [(0.03±0.01)μg/L and (168.93±16.52)U/L], the content of CK-MB [(0.68±0.10)μg/L] in the death group was lower than that in the survival group [(1.27±0.13)μg/L], while the contents of cTnI [(0.39±0.06)μg/L] and LDH [(384.52±39.89)U/L] in the death group were lower than those in the survival group [(0.17±0.04)μg/L and (257.18±25.47)U/L] (P<0.05).@*Conclusion@#The immune function of the patients with septic shock is obviously reduced, there are obvious inflammatory reactions and abnormal myocardial enzymes, and the detection of cellular immune function, inflammatory factors and myocardial enzymes can be used as an effective index to judge the shock of septic shock.
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Objective To investigate the clinical significance of cellular immune function, inflammatory factors and myocardial enzyme detection in evaluation of prognosis of septic shock,so as to provide a reference for clinical diagnosis and treatment of septic shock.Methods From June 2015 to June 2018,73 patients with septic shock treated in the First People＇s Hospital of Yongkang were selected as the research subjects.According to the 28d prognosis after the patients entered the ICU,the patients were divided into the death group and the survival group. Another 67 cases of health examination from June 2015 to June 2018 were selected as control group.The changes of T lymphocyte subsets includingCD3,CD4 and CD8 were measured by BD FACSCanto I I flow cytometry,the content of procalcitonin(PCT) was determined by immunoluminescence assay,the content of C -reactive protein(CRP) was determined by immunoturbidimetry,and the content of creatine kinase MB(CK-MB),cardiac troponin I(cTnI) and lactate dehydrogenase(LDH) was determined by enzymatic kinetics. Results The APACHE Ⅱ score and MODS score of the survival group and the death group were higher than those of the control group [(2.20 ± 0.61)points and (4.86 ± 1. 29 ) points]. The APACHE Ⅱ score and MODS score of death group [(16. 45 ± 4. 28) points and (27.63 ± 4.97)points] were higher than those of survival group [(9.84 ± 2.45)points and (19.84 ± 3.28)points] (all P＜0.05).The CD+3 ,CD+4 and CD+4 /CD+8 in the survival group and the death group were significantly lower than those in the control group[(71.32 ± 6.96)%,(42.63 ± 4.26)%,(1.67 ± 0.31)%] ( all P＜0.05).The contents of PCT and CRP in the survival group and the death group were higher than those in the control group [(0.19 ± 0.03) ng/mL and (2.19 ± 0.76)mg/L],and the contents of PCT [(15.93 ± 3.26) ng/mL] and CRP [(184.32 ± 29.80)mg/L] in the death group were higher than those in the survival group [(6.87 ± 1.94)ng/mL and (69.49 ± 17.42)mg/L] (all P＜0.05).The CK-MB content in the survival group and the death group of septic shock was lower than that in the control group [(1.97 ± 0.21)μg/L],and the cTnI and LDH contents were higher than that in the control group [(0.03 ± 0.01)μg/L and (168.93 ± 16.52) U/L],the content of CK-MB [(0.68 ± 0.10)μg/L] in the death group was lower than that in the survival group [(1.27 ± 0.13)μg/L],while the contents of cTnI [(0.39 ± 0.06)μg/L] and LDH [(384.52 ± 39.89)U/L] in the death group were lower than those in the survival group [(0.17 ± 0.04) μg/L and (257.18 ± 25.47) U/L] ( P ＜0.05). Conclusion The immune function of the patients with septic shock is obviously reduced,there are obvious inflammatory reactions and abnormal myocardial enzymes, and the detection of cellular immune function, inflammatory factors and myocardial enzymes can be used as an effective index to judge the shock of septic shock.
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As miosites inflamatórias idiopáticas são um grupo heterogêneo de doenças de repercussão sistêmicas. A polimiosite é a manifestação fenotípica mais comum entre as miosites inflamatórias idiopáticas. A apresentação típica é dor e fraqueza progressiva simétrica da musculatura proximal e flexora do pescoço, com evolução de semanas a meses, associada à elevação dos marcadores de lesão muscular. O presente relato demonstra um quadro de polimiosite que se manifestou como dor torácica, acompanhado de aumento de creatinofosfoquinase e creatinofosfoquinase fração MB (CKT-MB), fazendo diagnóstico diferencial com síndrome coronariana aguda. O caso motivou a realização do levantamento bibliográfico, na busca de casos semelhantes e detalhamento dos critérios diagnósticos. Fizemos uma revisão comparando os aspectos clínicos importantes para diagnóstico diferencial das miopatias inflamatórias com os da síndrome coronariana aguda, além de discutir critérios diagnósticos da miopatias inflamatórias e seu tratamento.(AU)
Idiopathic inflammatory myositis is a heterogeneous group of diseases with systemic repercussions. Polymyositis is the most common phenotypic manifestation among idiopathic inflammatory myositis. The typical presentation is pain and progressive symmetrical weakness of the proximal and flexor musculature of the neck, with progression from weeks to months, associated with elevation of the markers of muscle injury. The present report demonstrates a picture of polymyositis that manifested as chest pain, with increased creatine kinase and creatine phosphokinase MB, making a differential diagnosis with acute coronary syndrome, which motivated the bibliographic survey in search for similar cases, and detailing of the diagnostic criteria. Thus, we performed a review comparing the clinical aspects that are important for a differential diagnosis of inflammatory myopathies with those of the acute coronary syndrome, and discussed the diagnostic criteria for inflammatory myopathies and their treatment.(AU)
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Humans , Male , Adult , Chest Pain/complications , Polymyositis/diagnosis , Prednisone/therapeutic use , Polymyositis , Diagnosis, DifferentialABSTRACT
ABSTRACT INTRODUCTION: It is not clear whether the levels of troponin I (TI) and creatine kinase isoenzyme MB (CK-MB) are changed in premature infants (PI) without evidence of myocardial ischemia (MI). OBJECTIVES: To investigate whether TI and CK-MB change their levels in newborns without MI while on mechanical ventilation (MV). METHODS: We conducted a prospective cohort study in which 165 PI were divided into control group ([CG]; n = 68), mechanical ventilated group ([VG]; n = 21) and a surfactant therapy group ([SG]; n = 76), and had their TI, creatine kinase (CK) and CK-MB levels were determined. After the division, within the first four hours after the introduction of the mechanical ventilation (MV) and one hour after the withdrawal of it, we performed a new measurement of TI, CK and CK-MB to all PI from VG and VS. We used the chi-square test to evaluate the association among qualitative variables and the Kruskall-Wallis test to compare the serum levels of TI, and CK-MB among the groups, before, during and after MV using the statistical package SPSS 16.0 software. RESULTS: TI, CK, and CK-MB serum values before the groups were divided were considered normal. The TI concentration among the groups before and after MV (p > 0.05) did not changed; however, the CK-MB levels were higher in VG when compared to the CG (p = 0.009). CONCLUSION: The increase of CK-MB serum levels in VG and SG seems to indicate an increased work of thoracic skeletal muscle and do not represent a MI signal, which invalidate its use as a marker.
RESUMO INTRODUÇÃO: Não está claro se os níveis séricos de troponina I (TI) e de creatinoquinase fração MB (CK-MB) estão alterados em recém-nascidos prematuros (RNP) sem indícios de isquemia miocárdica (IM). OBJETIVO: Investigar se os níveis de TI e CK-MB se alteram nos RNP sem IM quando em ventilação mecânica (VM). MÉTODOS: Coorte prospectiva com 165 RNP que, antes de serem divididos em grupo-controle ([CG]; n = 68), ventilado ([VG]; n = 21) e surfactante ([SG]; n = 76), tiveram seus níveis séricos de TI, creatinoquinase (CK) e CK-MB determinados. Após a divisão, dentro das primeiras 4 horas do início da VM e 1 hora após sua retirada, realizamos nova dosagem de TI, CK e CK-MB nos RNP dos VG e VS. Foram utilizados o teste do Qui-quadrado para avaliar a associação entre as variáveis qualitativas e o teste de Kruskall-Wallis para comparar os valores séricos de TI e CK-MB entre os grupos, antes, durante e depois da VM, usando o pacote estatístico SPSS 16.0. RESULTADOS: Os valores séricos de TI, CK e CK-MB antes dos grupos serem divididos foram considerados normais. As concentrações de TI entre os grupos antes e depois da VM não se alteraram (p > 0,05), entretanto as de CK-MB foram maiores nos ventilados em relação aos do CG (p = 0,009). CONCLUSÃO: A elevação dos níveis séricos de CK-MB nos VG e SG parece indicar aumento do trabalho da musculatura torácica e não um sinal de IM, o que inviabiliza o uso desta como um marcador.
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ObjectiveTo investigate the effect of Huangqiinjection on the immune function of cardiomyocytes and myocardial enzymes of the children with viral myocarditis.MethodsA total of 86 patients who met the inclusion criteria of viral myocarditis were randomized into two groups. Fourty-onepatients in the control group took 1, 6 Fructose Diphosphate (FDP), and 86 patients of the treatment group tookHuangqi injection based on the intervention of control group. Both groups were treated for three weeks. The main outcomes were myocardial enzymes and immune function of cardiomyocytes.ResultsTotal effective rate of treatment group was significantly higher than the control group (95.56%vs. 80.49%;χ2=4.740,P<0.05). After treatment, the levels of CD3+ (64.9% ± 8.8%vs. 52.7% ± 8.2%,t=6.633), CD4+ (41.7% ± 6.5%vs.37.3% ± 7.2%,t=2.978), CD8+ ( 28.9% ± 4.2%vs.26.4% ± 4.3%,t=2.726) of treatment group were siginificantly higher than the control group (P<0.05). The CK (129.7 ± 29.8 U/Lvs. 167.7 ± 34.5 U/L,t=-5.479), CK-MB (12.7 ± 4.2 U/L vs.18.9 ± 6.2 U/L,t=-5.472), LDH (165.3± 38.4 U/Lvs.197.2 ± 46.3 U/L,t=-3.489), cTnⅠ(0.129 ± 0.012μg/Lvs. 0.204 ± 0.071μg/L,t=-6.981) of treatment group were significantly lower than the control group (P<0.05). Conclusion Huangqiinjection can significantly improve the clinical efficative rates, the immune function of cardiomyocytes and reduce the myocardial enzymes of children with viral myocarditis.
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Objective To investigate the early diagnosis of myocardial injury after neonatal asphyxia based on the clinical manifestations of myocardial injury, electrocardiogram (ECG), cardiac enzymes and tissue Doppler echocardiography. Methods From January 1, 2013 to June 30, 2014, 101 cases of neonatal asphyxia in the neonatal intensive care unit of the First Hospital of Tsinghua University, with gestational age> 37 weeks and birth weight > 2 500 g, were enrolled. Apgar scores were used to diagnose neonatal asphyxia. Myocardial damage after neonatal asphyxia was diagnosed according to the hypoxia history, clinical presentation, ECG and cardiac enzymes. According to the umbilical arterial blood gas analysis, severe asphyxia was divided into two groups:the severe asphyxia with severe acidosis group and the severe asphyxia without acidosis group. The incidence of myocardial damage, clinical manifestations associated with myocardial damage, ECG and myocardial enzymes [creatine kinase isoenzyme MB (CK-MB) and cardiac troponin T (TnT); control group involved 50 cases for the same period of admission with newborn jaundice] and echocardiography (control group involved 30 cases for the same period with normal term delivery) were compared among the three groups [mild asphyxia (n=72), severe asphyxia with severe acidosis (n=18) and severe asphyxia without severe acidosis (n=11)]. One-way ANOVA, the LSD test, Kruskal-Wallis test for independent samples, Chi–square test and Fisher's exact test were used for statistical analysis. Results (1) The incidence of myocardial damage after asphyxia was 34.6%(35/101). It was higher in the severe asphyxia group than in the mild asphyxia group [62.1%(18/29) vs 23.6% (17/72), χ2=7.549, P=0.006]; and it was higher in the severe asphyxia with severe acidosis group than in the severe asphyxia without severe acidosis group (14/18 vs 4/11, Fisher's exact test, P=0.048). (2) Clinical manifestations: The proportion of bradycardia was greater in the severe asphyxia with severe acidosis group (13/14) than in the severe asphyxia without severe acidosis group (1/4) and the mild asphyxia group (7/17);the differences were statistically significant (Fisher's exact test, P=0.019 and 0.007). (3) ECG: Eighteen cases (51.4%, 18/35) showed ECG abnormalities. (4) Cardiac enzymes:CK-MB 48 h after birth in the severe asphyxia with severe acidosis group, severe asphyxia without severe acidosis group, mild asphyxia group and the control group were 78.72 (34.63-122.01), 31.71 (21.33-37.12), 23.11 (14.61-36.02) and 11.82 (8.64-18.93) μg/L, respectively. CK-MB in the severe asphyxia with severe acidosis group was higher than in the severe asphyxia without severe acidosis group, mild asphyxia group and the control group (H=48.425, 90.040 and 96.045, respectively, all P<0.01). After treatment for 5-7 days, there was no statistically significant difference in these four groups (H=7.165, P=0.416). TnT 48 h after birth in the four groups was 0.19 (0.12-0.39), 0.11 (0.06-0.34), 0.07 (0.05-0.13) and 0.06 (0.04-0.08) μg/L, respectively. TnT in the severe asphyxia with severe acidosis group was higher than in the other three groups (H=45.753, 44.665 and 61.215, respectively, all P < 0.01). Despite the reduced TnT level after treatment for 5-7 days, TnT in the severe asphyxia with severe acidosis group was higher than that in the other three groups (H=17.520, 21.122 and 43.286, respectively, all P<0.01). (5) Echocardiography:Twenty cases (57.1%, 20/35) showed abnormalities. The values of mitral systolic peak velocity and late diastolic peak velocity in the severe asphyxia with severe acidosis group were lower than those in the control group found by tissue Doppler echocardiography [(3.4±0.3) vs (4.8±0.3) cm/s, (4.1±0.2) vs (6.0±1.1) cm/s, respectively, t=3.293 and 2.542, both P < 0.05]. Conclusions Myocardial damage can occur after neonatal asphyxia. Cord blood pH value should be combined to determine the severity of asphyxia. Myocardial damage is more serious in the severe asphyxia with severe acidosis group. Clinical manifestations should be taken seriously, and laboratory examinations should be improved for early diagnosis and treatment.
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Objective To explore the clinical value of myocardial enzyme on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were classified as cardiac insufficiency group (n=14) and non-cardiac insufficiency group (n=36). The serum biochemical markers, such as cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase, MB form (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were examined in two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity for cardiac insuffi-ciency using myocardial enzyme. The APACHEⅡscore was also calculated. The relationship between myocardial enzyme and APACHEⅡscore was analyzed in two groups. Results The levels of cTnI, LDH and AST were significantly increased in cardiac insufficiency group than those in non-cardiac insufficiency group (P<0.05). There were no significant differences in MYO and CK-MB between two groups of patients. The area under ROC curve for cTnI was 0.940, with a cut-off value of 0.07μg/L. The sensitivity and specificity of cTnI for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. The area under ROC curve for LDH and AST was more than 0.7, with the low sensitivity for LDH (0.571) and the specificity for AST (0.778). The area under ROC curve for MYO and CK-MB was less than 0.7. APACHEⅡscore was positively correlated with cTnI, CK-MB and LDH (r= 0.639, 0.451 and 0.552,respectively, P<0.05). Conclusion The serum cTnI level can be used as the index for the diagnosis of cardiac insufficiency in patients with SAP, and can prefer-ably reflect the severity of SAP.
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Objective To explore the protective effect of pre-operation administration of nicorandil on myocardial injury and recurrent angina in patients with unstable angina pectoris who underwent percutaneous coronary intervention (PCI). Methods A total of 91 patients with unstable angina pectoris were admitted for PCI and randomly divided into 2 groups who either received nicorandil(5 mg tid)or not for 7 days prior to the procedure and routine dose of nicorandil (5mg tid) after it. The concentrations of creatine kinase MB (CK-MB) and cardiac troponin I(cTnI) were compared between two groups before PCI and 6 hours, 18 hours and 24 hours after PCI;Recurent angina and major adverse cardiac events,includ-ing death,re-infarction and stroke at 6 months after the procedure were also chased and compared. Results In total, 75 pa-tients who were successfully undergone elective PC1 were finally enrolled,among whom 37 cases were in nicorandil group and 38 cases were in routine group. Post-procedural levels of CK-MB and cTnI significantly reduced in the nicorandil group between 6~24 h (P<0.05) compared those in routine group.At 6 months follow-up,symptoms of recurrent angina after PCI were significantly relieved in the nicorandil group compared with that in routine group (P < 0.05).Conclusion nicorandil can limit the PCI-induced myocardial injury and relieve the symptoms of recurrent angina after PCI in patients with unstable angina.
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Objective To analyze the significance of cardiac enzymes and troponin in chronic kidney failure combined with acute left heart failure patients.Methods Thirty-eight chronic kidney failure combined with acute left heart failure patients were chosen as the experimental group,and 42 chronic kidney failure without acute left heart failure patients were chosen as the control group.The changes of creatine phosphokinase isoenzyme-MB (CK-MB),aspartic transaminase (AST),cardiac troponin Ⅰ (cTnI),creatinine were tested and compared.The prognosis of two groups was recorded.Results The level of CK-MB,cTnI in experimental group were significantly higher than those in control group [(36.23 ± 14.27) U/L vs.(14.71 ±8.27) U/L,(11.26 ± 5.04) μ g/L vs.(5.24 ± 2.31) μ g/L] (P ＜ 0.05).The level of AST,creatinine in two groups were higher than normal value,but there were no significant differences between two groups (P ＞0.05).The fatality rate in experimental group was significantly higher than that in control group [47.37％(18/38)vs.16.67％(7/42)](P＜ 0.01).Multiple stepwise regression analysis showed that CK-MB,cTnI were independent factors of prognosis (r =5.03,3.27,P ＜ 0.05).Conclusion The level of cardiac enzymes and troponin are important for the prognosis of chronic kidney failure combined with acute left heart failure patients.
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ObjectiveTo investigate the changes of serum creatine kinase isoenzyme (CK-MB) and creatine kinase (CK) ratio(CK-MB/CK) and cardiac troponin I(cTnI) simultaneously in patients with acute organophosphorus pesticide poisoning (AOPP) and the clinical value in disease condition judgment.Methods Eight hundred and sixty-eight AOPP patients without disease history of heart,lung,brain,kidney,muscle and other connective tissue were extracted 4 ml of fasting venous blood to determine CK,CK-MB and cTnI simultaneously at 2,12,24,48,96 and 120 hours after poisoning,and the CK-MB/CK was calculated.There were 279 mild poisoning cases (mild poisoning group),289 moderate poisoning cases (moderate poisoning group) and 300 severe poisoning group (severe poisoning group) ; and 208 cases with intermediate myasthenia syndrome (IMS)(IMS group) and 660 cases without IMS (non-IMS group).The result was compared with 288 healthy people (control group) in the same period.Results ( 1 ) The CK,CK-MB and cTnI of mild,moderate and severe poisoning groups between 2 to 12 h,13 to 24 h,25 to 120 h after poisoning were significandy higher than those in control group,CK-MB/CK was obviously lower (P ＜ 0.01 ).The CK,CK-MB,cTnI and CK-MB/CK had significant differences between each two of mild,moderate and severe poisoning groups (P＜ 0.01 or ＜ 0.05).The CK,CK-MB and cTnI of IMS group in 2 to120 h after poisoning were significantly higher than those in non-IMS group,and CK-MB/CK was lower (P ＜ 0.05 or ＜ 0.01 ).In IMS group,the rates of sudden cardiac death (SCD) and multiple organ dysfunction syndrome (MODS) were 23.08％(48/208),37.50％(78/208) respectively,while 4.24％(28/660),9.85％(65/660) in non-IMS group.The incidence of SCD and MODS of two groups had statistical significance (P ＜ 0.01 ).(2) According to IMS and non-IMS group,discriminant equation with independent variables of cTnI (X1), CK (X2) and CK-MB/CK (X3) was established:Y =-0.0014X1 + 0.0225X2 + 65.2376X3,F=21.4911,P ＜ 0.01.The discriminant critical value(Y0) was 2.8124.If Y ＜ 2.8124 belonged to IMS group and Y ≥2.8124 was in non-IMS group,the contribution rates of X1,X2 and X3 were 34.5％,25.4％ and 40.1％ respectively.The coincident rate of return was 91.26％.ConclusionsCK-MB/CK change has negative correlation with poisoning degree of AOPP;cTnI level is positively correlated with AOPP poisoning degree.they may be used to assist the clinical classification,disease judgement and to guide the emergency,treatment and prognosis assessment of AOPP.The function equation with cTnI,CK and CK-MB/CK can be used as effective prediction indexes of IMS,MODS and SCD in early period.
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ObjectiveTo explore the changes and significances of cardiac troponin Ⅰ (cTnⅠ),myoglobin (Mb) and creatine kinase MB (CK-MB) in old patients with acute myocardial infarction(AMI).MethodThe levels of cTnⅠ, Mb and CK-MB in 89 cases with AMI patients (AMI group) and 100 healthy controls (control group) were detected and compared. ResultsThe levels of cTnⅠ, Mb and CK-MB in AMI group were ( 8.15 + 3.26) μ g/L, (478.45 ± 96.87 ) μ g/L and ( 128.17 ± 53.26 ) U/L, while were (0.03 ±0.02) μ g/L, (21.61 + 9.38 ) μ g/L and (9.53 ± 2.94) U/L in control group, the levels of cTnⅠ, Mb and CK-MB in AMI group were significantly higher than those in control group(P ＜ 0.05 ). The sensitivity rate of cTnⅠ,Mb and CK-MB for detecting AMI was 95.5％ (85/89), 97.8％ (87/89) and 87.6％ (78/89), and the specificity rate was 98.0％(98/100), 82.0％(82/100) and 94.0％(94/100). ConclusionThe levels of cTnⅠ, Mb and CK-MB are significantly increased in AMI patients, which cTnⅠ for detecting AMI has high sensitivity and specificity.
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About 50-70% patients will have secondary cardiac damage after subarachnoid hemorrhage (SAH),and the cardiac damage will aggravate cerebral ischemia and hypoxia,which may also promote the occurrence of delayed hypoxic-ischemic encephalopathy. By means of the detections of electrocardiogram,echocardiography,and serum myocardial enzymes,many researchers observe the clinical features and duration of this change and its relationship with the prognosis. This article reviews the advance in research on the causes of early cardiac damage after SAH,as well as the clinical features of the changes of electrocardiogram,echocardiography,and myocardial enzymes.
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Objective To investigate the correlation of serum ereatine kinase iseenzyme-MB (CK-MB) and recent cardiac events(30 days, 180 days) and late cardiac events (360 days) in patients with acute coronary syndrome (ACS). Methods Serum creatine kinase (CK) and CK-MB in 168 patients with ACS were measured, and these patients were divided into four groups according to the levels of CK and CK-MB. The occurrence of cardiac events analysis of CK and CK-MB was followed up for 30, 180 and 360 days and the relationship between the occurrence of cardiac events and the levels of CK and CK-MB were studied. Results There was statistical correlation between increased CK-MB and abnormal ECG Q wave, ST segment change (P< 0.05), 168 patients had followed up 30, 180 and 360 days, in which cardiac events happened in 57 common patients (64 examples), 27 examples (16.1%) happened in the recent cardiac event, and 37 examples(22.0%) happened in the late cardiac event. The cardiac event and CK-MB elevation had statistical correlation (P<0.05). Conclusion ACS patients with increased CK-MB levels prompt a poor prognosis, and could be an independent indicator of recent and late cardiac events in patients with ACS.
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BACKGROUND AND OBJECTIVES: Although cardiac troponin I is widely used as a marker for myocardial infarction (MI), minor elevations of cardiac troponin I are also observed in other clinical situations. The prognostic factors for patients with these clinical features are not well established. The aim of this study was to discover the predictors of mortality for the patients who had minor troponin elevations without acute MI. SUBJECTS AND METHODS: We enrolled consecutive 154 patients from the emergency department or inpatient units who had a peak troponin I level greater than the lower limit of detectability (0.04 ng/mL), and the level was also less than the suggestive value of MI (0.6 ng/mL). They were with chest pain or nonspecific symptoms of circulatory abnormality, but they lacked the traditional features of acute MI. The endpoint was defined as death from all causes. The Cox proportional hazard model was used to test the relationship between the clinical and biochemical variables and the outcomes. RESULTS: During the follow-up period of 7.9+/-7.3 months, mortality occurred in 15 patients. Age, the creatine kinase myocardial isoform (CK-MB) level and the C-reactive protein (CRP) level as continuous variables had significant correlations with the occurrence of death. After adjusting for any possible confounders in the multivariate model, these variables remained as independent predictors of mortality: age (HR 1.07, CI 1.02-1.14, p=0.012), CK-MB level (HR 1.61, CI 1.16-2.24, p=0.005), and CRP level (HR 1.01, CI 1.00-1.01, p=0.025). CONCLUSION: Integration of the CK-MB and CRP levels, as well as age, can be used for risk-stratification in the patients showing minor troponin I elevation for reasons other than acute MI.
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Humans , C-Reactive Protein , Chest Pain , Creatine Kinase , Emergency Service, Hospital , Follow-Up Studies , Inpatients , Mortality , Myocardial Infarction , Prognosis , Proportional Hazards Models , Troponin , Troponin IABSTRACT
Objective To evaluate the safety and efficacy of distal protection device(GuardWire PlusTM) during high risk PCI in patients with acute myocardial infarction(AMI).Methods Seventy-two patients with AMI admitted from September 2004 to May 2006 who received PCI were categotized into the GuardWire PlusTM group(GW group,n=38) and the conventional guidewire group(NGW group,n=34) according to the device used.The basic clinical characteristics,angiographic results,degree ST of resolution and changes in serum CK-MB and cTnI levels were compared.LVEF was measured by echocardiography at discharge and again at 3 months after PCI.Results All the distal protection deveices were applied successfully in the GW group.A greater percentage of patients in the GW group had post procedural ST-segment resolution ≥50% compared with the NGW group(68.4% vs 41.2%,P