动态检测CK、LDH、AST在骨筋膜室综合征早期诊断中的作用  

Dynamic detection of CK,LDH and AST in early diagnosis of compartment syndrome

作　　者：刘燚[1] 沈海琦[1] 夏永祥[2] 姚京东[1] 曾逸文[1] 

机构地区：[1]南京医科大学附属南京第一医院骨科,江苏南京210006 [2]南京医科大学附属南京第一医院检验科,江苏南京210006

出　　处：《临床骨科杂志》2009年第3期336-339,共4页Journal of Clinical Orthopaedics

基　　金：南京市重大科技项目(编号:ZKX05007)

摘　　要：目的探讨连续、动态检测血浆中磷酸肌酸激酶(CK)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)浓度在骨筋膜室综合征早期诊断中的作用。方法选择40例四肢骨筋膜室综合征患者,连续、动态检测2、24 h以及1、2、3、4周血浆中CK、LDH、AST浓度,在术中以及术后1、2、3周取患肢受累肌肉组织行病理检查。结果患者受伤2 h后,血浆中CK、LDH、AST浓度即急剧升高:CK(2 447.80±3 407.41)U/L、LDH(354.90±118.51)U/L、AST(137.03±117.38)U/L,分别为正常值的20、2、4倍。24 h后各项指标达到峰值或谷值:CK(5 184.60±4 695.65)U/L、LDH(729.75±237.65)U/L、AST(241.13±172.23)U/L,分别达正常值的42、4、10倍。1周后,LDH、AST与正常值比较差异有显著性(P<0.05)。病理检验显示术中所取肌肉标本明显坏死呈不可逆性变化。结论CK、LDH、AST指标的变化能客观反映病情严重程度。当这些指标急剧升高时要高度警惕骨筋膜室综合征的发生。动态、连续监测这些指标能为早期诊断及评估骨筋膜室综合征病情提供帮助。Objective To determine the efficacy of several biochemical indicators in the early diagnosis of compartment syndrome. Methods 40 cases of compartment syndrome were recruited. Phosphocreatine kinase （ CK）, lactate dehydrogenase （ LDH ） and aspartate aminotransferase （AST） were continuously and dynamically monitored after injury in 2, 24 hours, 1,2,3 and 4 weeks later. The concentration of CK, LDH and AST were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremities were taken after operation and 1,2,3 weeks later for biopsy. Results Two hours later after injury, the contents of CK, LDH and AST increased sharply. The contents of CK （2 447.80 ± 3 407.41 ） U/L, LDH （354. 90 ± 118.51 ） U/L, AST （ 137.03 ± 117.38） U/L were about 20, 2 and 6 times more than the normal. 24 hours later, the contents of CK（5 184. 60 ± 4 695. 65） U/L, LDH（729. 75 ± 237.65 ） U/L, AST（241.13 ± 172.23 ）U/L reached the maximum, which were about 42, 4 and 10 times more than the normal. After 1 week, the differences of LDH, AST remained significant（ P 〈 0. 05 ）. Pathological changes of muscle were irreversible. Conclusions The change of the contents of CK, LDH and AST can reflect the progress of disease objectively. If these increase sharply, the chance of compartment syndrome is high. Dynamic monitor CK, LDH and AST can provide assistant for early diagnosis of compartment syndrome and evaluating pathology condition.

关 键 词：早期诊断 筋膜间隔综合征 磷酸肌酸激酶 乳酸脱氢酶 谷草转氨酶 

分 类 号：R685[医药卫生—骨科学] R686[医药卫生—外科学]