血清肌酸激酶同工酶CK-MB活性高于肌酸激酶的病例分析及消除巨肌酸激酶干扰的初步探索  

Analysis of cases with serum CK-MB activity higher than total-CK and preliminary exploration of eliminating interference of macro-creatine kinase

作　　者：王晶晶[1] 于建英 李理想[2] 郝明巨[1] 李焱[1] 李月 王玉娇 WANG Jingjing;YU Jianying;LI Lixiang(Department of Clinical Laboratory Medicine,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Medicine and Health Key Laboratory o£Laboratory Medicine,Shandong Jinan,250014)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)检验医学,山东省医药卫生临床检验诊断学重点实验室,山东济南250014 [2]山东大学齐鲁医院胃肠疾病转化医学实验室,山东济南250012

出　　处：《医学检验与临床》2022年第12期13-18,共6页Medical Laboratory Science and Clinics

基　　金：济南市临床医学科技创新计划,项目编号:202019129;2020年度山东省千佛山医院国家自然科学基金培育基金,项目编号:QYPY2020NSFC0808。

摘　　要：目的:为探讨血清心肌型肌酸激酶同工酶(creatine kinase-ME,CK-MB)活性高于总肌酸激酶(creatine kinase,CK)活性现象产生的原因及其与疾病的关联,并对如何消除血清巨肌酸激酶(macro-CK)干扰进行初步探讨。方法:筛选2021牟9月-2022年9月期间本院住院患者血清CK-MB活性高于总CK活性的319例标本进行回顾性研究;以热失活法结合葡萄球菌SpA蛋白血清吸附实验对巨CK血清进行鉴定。结果:血清CK-MB活性高于血清总CK的患者主要集中在60~79岁的老年患者中,而20~39岁的青年患者占比最小;其中,有54.86%的患者被诊齢为恶性肿瘤,血液系统恶性肿瘤、肝癌、肺癌、胃癌和结肠癌是後常见的5种恶性肿瘤;此外,恶性肿瘤患者的CK-MB/CK比值显著高于非恶性肿瘤患者;发现3例患者血清中存在巨CK,其中2例非肿瘤患者血清中存玉IgG结合的I型巨CK,1例结肠癌患者血清中可能存在II型巨CK。结论:CK-ME/CK比值作为一种有效易得的实验室指标,在辅助筛查恶性肿瘤中可能具有重要的诊断价值,需要引起实验室及临床重视;此外,利用SpA对疑似巨CK血清进行吸附沉淀,可以成为消除巨酶对血清检测带来的干扰的一种简单可行的方法。Objective:To investigate the cause of serum CK-MB activity higher than total CK activity(CK-MB/CK>1)and its correlation with diseases.How to eliminate the interference of serum macro-creatine kinase(macro-CIK) was also discussed.Methods:A total of 319 samples with serum CK-MB activity higher than total CK activity were screened from the inpatient department of Shandong Provincial Qianfoshan Hospital from September 2021 to September 2022 for a retrospective study.Sera with macro-CK were identified by the heat inactivation assay and staphylococcal protein A serum,adsorption assay.Results:The patients with CK-MB/CK>1 were mainly concentrated in elderly patients aged 60~79 years,while rarely in young patients aged 2079 years.Among the enrolled patients,54.86% of them were diagnosed with malignancies.The five most common malignancies were hematological malignancies,liver cancer,lung cancer,gastric cancer and colon cancer.In addition,the level of CK-MB/CK ratio in patients with malignancies was significandy higher than that in patients without malignancies.Macro-CK was identified in the serum of three patients.The typeⅠ macro-CK aggregated with IgG was found in the serum of two non-malignancy patients,and the type Ⅱ macro-CK was found in the serum of a colon cancer patient Conclusion:As an efective and readily available laboratory indicator,the CK-MB/CK ratio has important diagnostic value in the auxiliary screening of malignancies,which needs to be paid attention by laboratories and clinicians.In addition,the use of SpA to adsorb and precipitate the suspected serum contained with macro-CK can be a simple and feasible method to eliminate the interference caused by macro-enzymes in serum detection.

关 键 词：心肌型肌酸激酶同工酶 肌酸激酶 恶性肿瘤 巨肌酸激酶 葡萄球菌蛋白A 

分 类 号：R542.2[医药卫生—心血管疾病]