CK-MB/CK比值鉴别儿童CK-MB活性法检测假性升高  

CK-MB/CK ratio in differentiating false positive results of CK-MB activity method in children

作　　者：黄一后 张磊 叶志成 成方颖 HUANG Yihou;ZHANG Lei;YE Zhicheng;CHENG Fangying(Department of Clinical Laboratory,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心复旦大学附属儿科医院临床检验中心,上海201102

出　　处：《检验医学》2023年第6期538-542,共5页Laboratory Medicine

摘　　要：目的分析肌酸激酶MB同工酶(CK-MB)/肌酸激酶(CK)比值判断儿童血清CK-MB活性法检测假性升高的效能。方法收集2021年4月—2022年7月复旦大学附属儿科医院304例CK-MB活性法检测阳性样本(高于参考区间),以1∶1比例随机分为训练集和验证集。采用质量法复测CK-MB,以质量法阳性为活性法检测真阳性的标准;了解CK-MB活性法检测假性升高患儿的临床疾病谱。采用受试者工作特征(ROC)曲线评价CK-MB/CK比值判断活性法CK-MB检测结果假性升高的效能。结果304例样本中,CK-MB活性法检测假阳性141例。居前3位的患儿疾病谱为胃肠炎(28例,19.9%)、心血管疾病(27例,19.1%)、肿瘤(25例,17.7%)。训练集ROC曲线分析结果显示,CK-MB/CK比值判断CK-MB活性法检测真阳性的曲线下面积(AUC)为0.921[95%可信区间(CI)为0.866~0.958,P<0.001];以0.30为临界值,CK-MB/CK比值判断CK-MB活性法检测真阳性的敏感性为97.56%(95%CI为91.50%~99.70%)。验证集ROC曲线分析结果显示,CK-MB/CK比值判断CK-MB活性法检测真阳性的AUC为0.919(95%CI为0.862~0.956,P<0.001);以0.30为临界值,CK-MB/CK比值判断CK-MB活性法检测真阳性的敏感性为97.53%(95%CI为91.40%~99.70%)。结论CK-MB/CK比值可用于判断CK-MB活性法检测假性升高。胃肠炎、心血管疾病、肿瘤患儿CK-MB活性法检测易出现假阳性,临床对此类疾病患儿CK-MB活性法阳性结果应结合临床实际客观判断。Objective To evaluate the ratio of creatine kinase MB isoenzyme(CK-MB)to creatine kinase(CK)for differentiating false increased results of CK-MB activity method in children.Methods Totally,304 samples with positive results of CK-MB activity method(higher than reference interval)were collected and randomized into a training set and a validation set by 1∶1.All the samples were determined by CK-MB mass assay.Positivity by mass assay was the standard of true positivity by active method.The clinical disease spectrum of children with false increased results of CK-MB activity method was analyzed.Receiver operating characteristic(ROC)curve analysis was used to evaluate the efficiency of CK-MB/CK in differentiating false increased results of CK-MB activity method.Results Among the 304 samples,141 cases of false positivity were determined by CK-MB activity method.The top 3 diseases were gastroenteritis(28 cases,19.9%),cardiovascular disease(27 cases,19.1%)and tumor(25 cases,17.7%).In training set,the area under curve(AUC)of CK-MB/CK in differentiating true positive results of CK-MB activity method was 0.921[95%confidence interval(CI)0.866-0.958,P<0.001].Using 0.30 as CK-MB/CK cut-off value,the sensitivity of CK-MB/CK in differentiating true positive results of CKMB activity method was 97.56%(95%CI 91.50%-99.70%).In validation set,the AUC was 0.919(95%CI 0.862-0.956,P<0.001),and using 0.30 as CK-MB/CK cut-off value,the sensitivity was 97.53%(95%CI 91.40%-99.70%).Conclusions CK-MB/CK can be used to determine the false increased results of CK-MB activity method.Gastroenteritis,cardiovascular disease and tumor children are prone to false positive results of CK-MB activity method.The positive results of CK-MB activity method in children with such diseases should be objectively judged according to clinical practice.

关 键 词：肌酸激酶MB同工酶 质量法 活性法 假阳性 

分 类 号：R446.1[医药卫生—诊断学]