创伤性脾破裂患者早期外周血肌酸激酶及其同工酶的变化及临床意义

Clinical significance of creatine kinase and creatine kinase isoenzyme in patients with traumatic rupture in early stage

目的探讨创伤性脾破裂患者早期外周血肌酸激酶（CK）及其同工酶（CK．MB）的变化情况及其临床意义。方法选取2011年10月至2013年11月我院急诊科收治并行脾切除手术的创伤性脾破裂患者86例（脾破裂组），选取我院同期收治非脾破裂的腹部外伤患者40例作为腹部外伤组，另选取40名健康体检者作为健康对照组，健康对照组于体检当天抽取外周静脉血进行心肌酶谱检测，手术患者均于术前（TO）、术后2h（T1）、术后12h（T2）、术后24h（T3）、术后3d（T4）和术后7d（T5）抽取外周静脉血进行心肌酶谱检测，对3组研究对象心肌酶谱检测结果进行比较。结果脾破裂组术前CK为（573．4±168．6）U／L，CK—MB为（30．4±15．3）U／L；腹部外伤组术前CK为（59．3±37．5）U／L，CK—MB为（7．6±4．8）U／L；健康对照组CK为（30．7±16．2）U／L，CK-MB为（5．6±1．4）U／L，3组比较差异均有统计学意义（F值分别为295．696和90．109，P均〈0．001），经SNK-q检验两两比较，脾破裂组术前CK和CK—MB均高于腹部外伤组和健康对照组，差异均有统计学意义（P均〈0．05），腹部外伤组与健康对照组CK和CK—MB比较差异均无统计学意义（P均〉0．05）。脾破裂组患者T1～眄外周血CK和CK．MB分别为（668．2±215．4）、（589．3±187．6）、（551．2±202．8）、（214．9±194．5）、（134．2±118．3）U／L和（36．8±17．5）、（29．3±16．4）、（27．9±17．3）、（15．6±9．7）、（10．1±4．4）U／L，均高于腹部外伤组[CK：（67．5±41．8）、（43．5±24．7）、（34.2±17．6）、（33．4±16．5）、（32．2±17．1）U／L，CK-MB：（8．1±5．2）、（7．5±4．3）、（7．1±3．9）、（6．7±2．5）、（6．1±1．9）U／L]，差异均有统计学意义（P均〈0．05）；T0-T3时刻，脾破裂组Ⅲ、Ⅳ级患者外周血CK．MB分别为（37．9±15．2）、（42．8±16．9）、（33．2±17．2）、（29．7±16．6）U／L，均高于I、Ⅱ级患者[（26．5±17．3）、（31．2±18．2）、（25．3±15．7）、（23．2±18．4）U／L1，差异均有统计学意义（P均〈0．05）。结论创伤性脾破裂患者早期外周血CK和CK—MB升高，且CK—MB的改变与脾破裂损伤程度分级呈正相关，提示创伤性脾破裂早期可能出现了心肌损伤，应尽早关注患者心肌酶谱变化。

Objective To investigate creatine kinase （CK） and creatine kinase isoenzyme （CK-MB） changes of patients with traumatic rupture in the early stage. Methods Eighty-six patients with traumatic rupture who were treated in the Fourth Hospital Affiliated to China Medical University were enrolled to rupture group（ rupture group） and 40 cases of patients with abdominal trauma but non-rupture were admitted to abdominal trauma group. Another 40 healthy volunteers were enrolled to healthy control group. The myocardial enzymes were detected at before operation （T0） ,2 h after operation （T1）, 12 h after operation（ T2 ）, 24 h after operation （T3） ,3 d after operation（T4） and 7 d after operation（T5）. Results The contents of CK and CK-MB in rupture group, abdominal trauma group and control group were （573.4 ±168.6 ） U/L and （ 30. 4 ± 15.3 ） U/L,（59.3 ±37.5） U/L and （7.6 ±4.8） U/L, （30.7± 16.2） U/L and （5.6± 1.4） U/L respectively. There was significant difference among three group （ F = 295. 696,90. 109 ; P 〈 0. 001 ）. SNK test showed that the contents of CK and CK-MB in rupture group were higher than that in abdominal trauma group or control group （P 〈 0. 05） , and there was no significant difference between abdominal trauma group and control group（P 〉0. 05）. The contents of CK and CK-MB levels in rupture group at T1 ,T2 ,T3 ,T4 and T5 were （668.2±215.4）,（589.3± 187.6）,（551.2±202.8）,（214.9 ± 194.5）,（134.2 ± 118.3） U/L and （36.8 ±17. 5 ）, （29. 3± 16. 4 ）, （ 27. 9 ±17.3 ）, （ 15.6 ± 9.7 ）, （ 10. 1 ± 4. 4 ） U/L respectively, which were all higher than that in abdominal trauma group （ CK ： （ 67.5 ± 41.8 ）, （ 43. 5 ±24. 7 ）, （ 34. 2 ±17.6 ）, （ 33.4 ±16.5）,（32.2±17.1） U/L;CK-MB：（8.1±5.2）,（7.5±4.3）,（7.1 ±3.9）,（6.7±2.5）,（6.1 ±1.9）U/L）, and the differences were statistically significant（ P 〈 0. 05）. At TO, T1 and 33 time point, the content of CK-MB of patients with III and IV stage in rupture group were （37. 9 ± 15.2）, （42. 8± 16. 9）, （33.2 ±17. 2）, （29.7 ± 16. 6） U/L respectively, higher than that in patients with I and II stage （ （26. 5 ± 17.3 ）, （ 31.2 ± 18.2）, （25.3±15.7）, （23.2 ±18.4） U/L;P 〈0. 05）. Conclusion The CK and CK-MB levels of patients with traumatic rupture appear elevated at early stage. Meanwhile,the changes of CK-MB are positively correlated with the rupture injury classification, which indicated that myocardial injury may appear in early stage of patients with traumatic rupture. It should be concerned myocardial enzymes changes in patients as early as possible.