急性毒鼠强中毒患者心肌酶活力的动态观察

Change of myocardial enzymes in patients with acute tetramine poisoning

目的探讨急性毒鼠强(TEM)中毒时心肌酶变化的规律及其临床意义。方法动态观察67例急性TEM中毒患者及67例对照人群的心肌酶活力及心电图(ECG)变化。结果急性TEM中毒患者天冬氨酸转氨酶(AST)、肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶同工酶(CK-MB)活力,在中毒1 d内均有不同程度升高,中毒组患者5种心肌酶活力与对照组的差异有统计学意义(P＜0．01)；轻、中、重度中毒患者各时点心肌酶活力对应比较,差异均有统计学意义(P＜0．01)；病情越重,酶活力越高,ECG异常率也越高。CPK活力升高最早,升降幅度最大,升高持续时间最长；心肌酶活力改变早于ECG的改变。在中毒第3天,中毒组患者的AST、CPK、CK-MB、LDH、α-HBDH活力异常率分别为86．6%、98．5%、94．0%、89．6%、79．1%,ECG异常率为49．3%。结论急性TEM中毒可致心肌损害；CPK表现典型,可考虑作为临床上重要监测指标之一；TEM对心肌的损害是可逆的。

Objective To investigate the clinical significance of myocardial enzymes in patients with acute tetramine（TEM） poisoning. Methods The dynamic changes of the activity of myocardial enzymes and ECG were observed in 67 patients with acute TEM poisoning as well as in 67 healthy people for medical checkup at outpatient department as the control group. Results Myocardial enzymes of the patients with acute TEM poisoning were increased to different extents on the first day. There was significant difference in the activity of aspartate aminotransferase （AST）, creatine phospokinase（CPK）, lactic delrydrogenase （ LDH ）, α--hydroxybutyrate dehydrogenase （ α--HB- DH） and CPK isoenzyme MB（CK-MB） between the patients and the healthy people in the control group（ P 〈 0.01） There was significant difference in the myocardial enzymes at different time points among the patients with mild,middle and severe poisoning（ P 〈 0.01）. The severer the TEM poisoning was, the higher the activity of myocardial enzymes and the abnormal rate of ECG were. The activity of CPK was the earliest to rise with the highest aptitude of fluctuation and the longest time of elevation. The change of the myocardial enzymes was earlier than that of ECG.The abnormal rate of AST, CPK, CK-MB,LDH,a-HBDH was 86.57% ,98.51% ,94.03% ,89.55% and 79.10% respectively.The abnormal rate of ECG was 49.3% on the third day of poisoning. Measurement of myocardial enzymes was better than ECG in sensitivity. Conclusion Acute tetramine poisoning can damage myocarditum, which is reversible. CPK is a typical marker for the damage and can serve as one of the important clinical monitoring indices.