长春市不同年龄段健康成人血清心肌酶谱水平观察

Observation of serum myocardial enzymes levels in healthy adults of different ages in Changchun

目的参照实验室信息管理系统中健康成人数据,观察长春市不同年龄健康成人心肌酶谱水平,建立长春市成人肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和α-羟丁酸脱氢酶(α-HBDH)的参考区间。方法选取2019年1月至2020年12月该院实验室信息管理系统中健康成人数据。采用K-S检验判断数据的正态性,对数转换呈偏态分布的数据,箱图法剔除离群值,LMS法拟合连续百分位数曲线,Z检验比较性别及年龄的差异;采用非参数法计算参考区间的上、下限,Bootstrap计算90%CI。对已建立的参考区间进行适用性验证。结果共纳入6831例20~79岁健康人群数据。除CK外,CK-MB、LDH、α-HBDH数据均服从正态分布,箱图法剔除数据277例。男性和女性CK、CK-MB水平比较,差异均有统计学意义(P<0.05)。各年龄组男性LDH、α-HBDH水平及女性CK、CK-MB、LDH、α-HBDH水平比较,差异均有统计学意义(P<0.05)。非参数法得出的参考区间为CK男性53.0~273.0 U/L(20~79岁),女性41.0~162.7 U/L(20~49岁)、女性42.0~187.8 U/L(50~79岁);CK-MB男性8.5~24.1 U/L(20~79岁),女性7.3~22.5 U/L(20~69岁)、女性7.5~24.9 U/L(70~79岁);LDH男、女性133.0~244.0 U/L(20~59岁)、144.0~264.0 U/L(60~79岁);α-HBDH男、女性74.0~167.0 U/L(20~49岁)、79.0~183.0 U/L(50~79岁)。LDH参考区间与少数研究参考区间的相对偏差均高于参考变化值。心肌酶谱各项目均通过适用性验证。结论长春市健康成人CK、CK-MB有性别差异,男性LDH、α-HBDH及女性CK、CK-MB、LDH、α-HBDH有年龄差异,健康女性CK,以及男、女性CK-MB、LDH、α-HBDH水平均随年龄增长呈逐渐上升趋势。

Objective To establish the reference intervals of creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)andα-hydroxybutyrate dehydrogenase(α-HBDH)in Changchun adults by observing the levels of myocardial enzymes in healthy adults of different age groups based on the data of laboratory information management system.Methods The data of healthy adults in the laboratory information management system of the hospital from January 2019 to December 2020 were selected.K-S test was used to determine the normality of the data,log transformation was used to data with skewed distribution,box plot method was used to remove outliers,LMS method was used to fit continuous percentile curve,and Z test was used to compare the differences in gender and age.The upper and lower limits of the reference intervals were calculated by nonparametric method,and the 90%confidence intervals were calculated by Bootstrap method.The applicability of the established reference intervals was verified.Results A total of 6831 healthy people aged 20-79 years were included.Except CK,CK-MB,LDH,α-HBDH data followed normal distribution,and 277 cases of data were excluded by box plot method.There were significant differences in CK and CK-MB levels between males and females(P<0.05)in all age groups.There were significant differences in the levels of LDH andα-HBDH in males and CK,CK-MB/LDH andα-HBDH in females(P<0.05).The reference intervals of CK obtained by nonparametric method were 53.0-273.0 U/L(20-79 years old)for men,41.0-162.7 U/L(20-49 years old)for women,and 42.0-187.8 U/L(50-79 years old)for women.CK-MB reference intervals were 8.5-24.1 U/L(20-79 years old)for men,7.3-22.5 U/L(20-69 years old)for women,and 7.5-24.9 U/L(70-79 years old)for women.The reference intervals of LDH in men and women were 133.0-244.0 U/L(20-59 years old)and 144.0-264.0 U/L(60-79 years old).The reference interval ofα-HBDH was 74.0-167.0 U/L(20-49 years old)in men and 79.0-183.0 U/L(50-79 years old)in women.The relative deviation between the LDH reference interval and the reference interval of a few studies was higher than the reference change value.All items of myocardial enzymes were verified by applicability.Conclusion There are gender difference in CK and CK-MB of healthy adults in Changchun,and there are age differences in CK,CK-MB,LDH andα-HBDH of male and female.The levels of CK in healthy women,CK-MB,LDH,α-HBDH in male and female are gradually increased with age.