The Research Of Clinical Value And Choice Of Testing Projection Of Markers In Myocardial Injuries

Cardiopathy threatens people's health gravely, it is a principal disease and a main cause of death in developed countries. In our country, the coronary artery disease is also becoming one of the main principal diseases and a main cause of death for our city dweller. Myocardial damage is a series of heart function's pathology changes after myocardial cells'edema because of inflammation, ischemia, hypoxia etc. It is a main pathology change in clinic cardiovascular disease. There are some causes for myocardial damage, especially virus inflammation, ischemia and hypoxia. Some cardiopathy have pathological change in cardiac muscle in earlier period when have no clinical manifestation. The different degrees of myocardial damage have fairly influences for diagnosis and prognosis.The markers of myocardial damage is a series biochemistry indicatrixes appearancing in blood when the myocardial cells are damaged by inflammation, ischemia and injury, etc. At this time, the integrity and permeability of cytomembrane is changing. Macromolecule matter emits and is detected in blood eventually.From 1954, Karman and other scientists use the sensitive paper chromatography to determinate the activity of AST/GOT in AMI patients. They discovered the AST in blood-serum increasing in these patients, and the AST became the first marker of the sero-enzyme. Now there are more than ten markers of myocardial damage including AST,CK,CKMB,LDH,HBDH,isoenzyme electrophoresis,myocardial protein, they are all used in clinic. The ideal biochemistry markers must possess these features:①The markers have height cardiac specificity,②The markers increase quickly and last for a long time,③The detection methods are easy and fast,④The application value of the markers are confirmed in clinic. Now, because the detection methods of the markers have their own local and influencing factor, the diagnoses have some difficulties, sometimes even have false diagnoses. This research detected the serum enzymatic activity,isoenzymatic activity,myocardial protein of 40 cases myocardial ischemia patients and 158 cases myocarditis doubtful. Though analysis of the results, to explore the important clinical significance of the choice of different examinations to different causes in the diagnosis and differential diagnoses of cardiac injury. The results of this study show that: though detecting AST, CK, CK-MB, LDH, HBDH, CK and LDH isoenzyme and related protein, the thirty-two patients were diagnosed as acute myocardial infarction (AMI), and the eight patients were not diagnosed in the 40 patients with chest pain or chest distress, short breath. The cTnI, MMB and MYO are helpful to the early diagnosis during the early phase of AMI. And during the recover phase of AMI the CK-MB will be back to the normal within 48 hours. The patients of doubtful AMI, whose clinical symptoms are not typical, checkings are not specific detected by electrocardiogram, color Doppler echocardiography, coronary angiography, but cTnI,MMB,MYO were significantly higher, can rule out the diagnosis of AMI though detecting CK and LDH isoenzyme. Myocardial enzyme test is still commonly used and effective mean for the diagnosis of myocarditis in the children. AST,CK,CK-MB,LDH all belong to endochylema enzyme, they release into the blood when the cadiocyte are damaged, then the activity of the sero-enzyme increases. But in the cases that the change of the endochylema enzyme spectra are not typical we could not ascerted whether the cadiocyte are damaged, so we have to detect cTnI and MMB at the same time to raise diagnostic value. We could gain the result according to the clinical manifestation of the endochylema enzyme spectra,myocardial GAP-associated protein and its electrophoresis result of their isoenzyme. We have to choose the different inspection item when the cadiocyte are damaged by different reason, this have important clinical significance when to definite diagnose and differential diagnosis.Materials and methods: The experimental group 1 collected the 40 cases which visited in our hospital for acute chest pain from November 2006 to November 2007. The chest pain time is from 2 hours to 3 days and the mean lasting time is 23 hours. The diagnosis is in accordance with standards which named by the International Society of Cardiology and the WHO standardized of the Joint Task Team. And diagnosed with acute myocardial infarction (AMI) for a total of 32 cases of Group1-1, with male 19, female 13; aged between 45-78 and the average age of 58.1. The group1-2 included 8 cases which were non-acute myocardial infarction, male 6, female 2, aged between 41 to 82, the average age of 55.8. The control group1-3 for 30 cases from routine health examination who are healthy, male 18 and female 12, aged between 28 to 64 and the average age of 45. LD1 activities, CK and LDH isoenzyme electrophoresis, CTnI, CK-MB mass and MYO were detected in the serum at the same time.The experimental group 2 collected the 158 cases of suspected myocarditis from January 2007 to November 2007. All cases were newly diagnosed with the upper respiratory tract infection,cough,pharyngodynia symptoms;Some children with varying degrees of weakness, sweating, flustered, chest tightness, shortness of breath, sigh, looking pale, and other symptoms. The group 2-1: Diagnosed with acute myocarditis for a total of 41 cases, with male 24, female 17; aged between 0 to 12 and the average age of 6.6. The group2-2: Non-myocarditis for a total of 117 cases, with male 61, female 56; aged between 0 to 10 and the average age of 5.5. The diagnosis is in accordance with standards which named by the nation society of children myocarditis,cardiology academic in September 1999. The control group2-3 for 59 cases from routine health examination who are healthy, male 29, female 30, aged between 0 to 14 and the average age of 6. LD1 activities, CK and LDH isoenzyme electrophoresis, CTnI, MMB and MYO were detected in the serum.All the Patients should be taken 4ml venous blood by vacuum tube. Set 30min, by 3000r/min centrifugalized 5 min then the serum 15 taken out for measurement in -20℃. Then monitor enzyme activity,cTnI and isoenzyme. Analyze the results and approach the reasonable selection and clinical sense of different myocardial damage serum marker item.Experimental mechanism: Using continuing detection monitors the activities of AST,CK,CK-MB,LDH,HBDH. Chemiluminescence immunoassay is employed the study for the concentration analysis CTnI, MMB and MYO, electrophoresis method test CK and LDH isoenzyme.Reaults: 1. acute myocardial infarction were 32 cases which were cTnI,MMB,MYO increase quickly, statistically different with health comparison, (p <0.05); MMB increased cases which electrophoresis method CK-MB were>6%. LD1,LD2 both increase in LDH electrophoresis method, LD1>LD2.Non-acute myocardial infarction were 8 cases which were cTnI,MMB,MYO increase quickly. AST,CK,LDH activities increase, especially CK. The control group and AMI group were statistically differen(p<0.01)t.MMB increased cases which electrophoresis method CK-MB were <6%. LD5 were increased as the main performance in LDH electrophoresis method.2. The activities of AST,CK,CK-MB,LDH,HBDH and cTnI increase in blood serum of 41 children with myocarditis. The control group and AMI group were statistically different( p <0.05);CK-MB in children health control group is higher than adult's,(p <0.05).Conclusion:1. Typical myocardial infarction could be diagnostic by cTnI,MMB,MYO, Combination tests of electrophoresis of CK and LDH isoenzyme in dynamic observation. Uncertainly, myocardial infarction must be test CK isoenzyme and LDH isoenzyme to identify or diagnose.2. Typicai acute myocarditis could be definitely diagnosed by myocardial enzyme activity. Myocarditis convalescence stage and untypical myocarditis need combinating tests with cTnI.3. Healthy children have higher CK-MB than normal people. The standard reference for should be established.