| 杨茜,范贤峰,何志超,等.假肥大型肌营养不良症病人血清学指标检测的临床意义[J].安徽医药,2020,24(6):1155-1158. |
| 假肥大型肌营养不良症病人血清学指标检测的临床意义 |
| Diagnostic value of serological related indicators in patients with pseudohypertrophy muscular dystrophy |
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| DOI：10.3969/j.issn.1009?6469.2020.06.023 |
| 中文关键词: 肌营养不良，杜氏 丙氨酸转氨酶 肌酸激酶 肌钙蛋白 I 丙酮酸 肌酶谱 肌红蛋白 |
| 英文关键词: Muscular dystrophy,duchenne Alanine transaminase Creatine kinase Troponin I Pyruvic acid Serum muscle enzyme Myoglobin |
| 基金项目: |
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| 中文摘要: |
| 目的探讨假肥大型肌营养不良症病人血清学指标检测的意义。方法按选取标准收集 2015年 1月至 2019年 7月在安徽中医药大学神经病学研究所附属医院首次住院治疗的 49例假肥大型肌营养不良症病人为病例组，同期在该院门诊健康体检正常者 49例为健康对照组，比较两组的血清学指标水平，包括血清肌酶谱［丙氨酸氨基转移酶( ALT)、天冬氨酸氨基转移酶(AST)、肌酸激酶( CK)、肌酸激酶同工酶( CK?MB)、乳酸脱氢酶( LDH)、 α?羟丁酸脱氢酶( α?HBDH)］、其他血清学指标［肌钙蛋白 I(cTnI)、肌红蛋白( Mb)、乳酸( LAC)、丙酮酸( PA)］及相关计算项目( AST/ALT、CK?MB/CK、LAC/PA、α?HBDH/LDH)；分析病例组血清学指标的异常率、指标升高倍数(病人该项指标的检测结果 /该项指标的医学参考值范围的上限)、受试者工作特征曲线( ROC)曲线下面积( AUC)；对病例组血清学指标与年龄做 Spearman相关性分析。结果假肥大型肌营养不良症病人血清 ALT［186.0(109.5，291.0)U/L比 19.0(12.3，26.5)U/L，Z＝-8.594，P＜0.001］、 AST［146.0(104.5，192.5)U/L比 18.0(14.3，21.8)U/L， Z＝-8.659，P＜0.001］、 CK［9 493(6 592，13 315)U/L比 72(53，93)U/L，Z＝-8.657，P＜0.001］、 CK?MB［150.0(101.5，303.0)U/L比 10.5(8.0，14.8)U/L，Z＝-8.663，P＜0.001］、 LDH［740.0(537.0，1250.0)U/L比 147.0(126.0，172.8)U/L，Z＝-8.470，P＜0.001］、 α?HBDH［588.0(430.5，940.0)U/L比 100.5(89.3，126.8)U/L，Z＝-8.416，P＜0.001］、 α?HBDH/LDH［0.78(0.70，0.88)比 0.70(0.66，0.76)，Z＝-3.447，P＜0.001］、 Mb［1 097(440，1 649)ng/mL比 60(48，71)ng/mL，Z＝-8.589，P＜0.001］、 LAC［2 301(2 029， 2 843)μmol/L比 1 829(1 545，2 173)μmol/L，Z＝-4.464，P＜0.001］及 LAC/PA［62.0(40.4，111.5)比 26.2(20.0，45.5)，Z＝ -5.273，P＜0.001］高于健康对照组， AST/ALT［0.79(0.60，1.04)比 0.93(0.78，1.15)Z＝-2.433，P＜0.05］、 PA［32.8(22.0，58.9) μmol/L比 71.0(36.0，94.8)μmol/L，Z＝-3.968，P＜0.001］及 CK?MB/CK［0.02(0.01.03)比 0.15(0.11，0.19)，Z＝-8.687，P＜0.001］低于健康对照组； CTnI两组间差异无统计学意义( P＞0.05)。假肥大型肌营养不良症病人血清肌酶谱中各项指标升高倍数的中位数水平从高到低依次为 CK＞Mb＞CK?MB＞ALT＞AST＞α?HBDH＞LDH；根据 AUC，AST、CK、CK?MB、CK?MB/CK、 ALT、Mb、LDH、α?HBDH对辅助诊断假肥大型肌营养不良症均具有较高的准确性。假肥大型肌营养不良症病人 α?HBDH、 LDH、ALT、AST、CK、CK?MB及 LAC/PA与年龄呈负相关，相关系数分别为 -0.769、-0.767、-0.685、-0.579、-0.467、-0.437及 -0.369(P＜0.05)； AST/ALT、PA与年龄呈正相关，相关系数分别为 0.426和 0.400(P＜0.05)。结论在假肥大型肌营养不良症的实验室诊断中，除血清肌酶谱外， Mb和 CK?MB/CK也具有较高的价值； LAC、PA、LAC/PA可以判断骨骼肌缺氧状况。 |
| 英文摘要: |
| Objective To explore the value of serological markers in the diagnosis of pseudohypertrophy muscular dystrophy.Meth? ods We collected cases based on certain criteria.The case group consisted of 49 patients with pseudohypertrophic muscular dystro?phy who were hospitalized for the first time in The Affiliated Hospital of Neurological Research Institute of Anhui University of Chi?nese Medicine from January 2015 to July 2019，and 49 healthy outpatients having physical exams in the same period were includedin the control group.The serological indexes of the two groups were compared，including serum muscle enzymes［alanine transami? nase(ALT)aspartate transaminase(AST)creatine kinase(CK)creatine kinase MB(CK?MB)，lactate dehydrogenase(LDH)，al? pha?hydroxybu，tyric dehydrogenase(α?HBDH)，］，otherserologicalind，icators［cardiac troponin I(cTnI)，myoglobin(Mb)，lactic ac? id(LAC)，pyruvic acid(PA)］ and related calculation items(AST/ALT，CK?MB/CK，LAC/PA，α?HBDH/LDH).The abnormal rate of serological indicators，the increase multiple of serological indicators(the patient′s test results divided by the upper limit of the medical reference range)and the area under ROC curve(AUC)were analyzed in the case group.Spearman correlation analysis was made between serological parameters and age in the case group. Results The results showed that serum ALT［186.0(109.5， 291.0)U/L vs. 19.0(12.3，26.5)U/L，Z＝-8.594，P＜0.001］，AST［146.0(104.5，192.5)U/L vs. 18.0(14.3，21.8)U/L，Z＝-8.659， P＜0.001］，CK［9 493(6 592，13 315)U/L vs. 72(53，93)U/L，Z＝-8.657，P＜0.001］，CK?MB［150.0(101.5，303.0)U/L vs. 10.5(8.0，14.8)U/L，Z＝-8.663，P＜0.001］，LDH［740.0(537.0，1 250.0)U/L vs. 147.0(126.0，172.8)U/L，Z＝-8.470，P＜0.001］，α? HBDH［588.0(430.5，940.0)U/L vs. 100.5(89.3，126.8)U/L，Z＝-8.416，P＜0.001］，α?HBDH/LDH［0.78(0.70，0.88)vs. 0.70(0.66，0.76)，Z＝-3.447，P＜0.001］，Mb［1 097(440，1 649)ng/mL vs. 60(48，71)ng/mL，Z＝-8.589，P＜0.001］，LAC［2 301(2 029，2 843)μmol/L vs. 1 829(1 545，2 173)μmol/L，Z＝-4.464，P＜0.001］and LAC/PA［62.0(40.4，111.5)vs. 26.2(20.0， 45.5)，Z＝-5.273，P＜0.001］were higher in the case group than those in the control group，while AST/ALT［0.79(0.60，1.04)vs. 0.93(0.78，1.15)，Z＝-2.433，P＜0.05］，PA［32.8(22.0，58.9)μmol/L vs. 71.0(36.0，94.8)μmol/L，Z＝-3.968，P＜0.001］and CK? MB/CK［0.02(0.01，0.03)vs. 0.15(0.11，0.19)，Z＝-8.687，P＜0.001］were lower in the case group than those in the control group. There was no significant difference in CTnI between the two groups(P＞0.05).In pseudohypertrophy muscular dystrophy patients， the median levels of the increase multiple of serological indicators ranking from high to low were CK，Mb，CK?MB，ALT，AST，α? HBDH，and LDH.According to the size of AUC area，AST，CK，CK?MB，CK?MB/CK，ALT，Mb，LDH and α?HBDH had high accura? cy in the diagnosis of pseudohypertrophic muscular dystrophy.α?HBDH，LDH，ALT，AST，CK，CK?MB and LAC/PA were negatively correlated with age in patients with pseudohypertrophic muscular dystrophy；the correlation coefficients were -0.769，-0.767， -0.685，-0.579，-0.467，-0.437 and -0.369(P＜0.05).AST/ALT and PA were positively correlated with age；the correlation coeffi? cients were 0.426 and 0.400(P＜0.05).Conclusion In the laboratory diagnosis of pseudohypertrophic muscular dystrophy，be? sides serum muscle enzymes，Mb and CK?MB/CK also have high value.And LAC，PA，LAC/PA can judge the condition of skeletal muscle hypoxia. |
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