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[9493(6592,13315)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[1097(440,1649)ng/mL比60(48,71)ng/mL,Z=-8.589,P<0.001]、LAC[2301(2029,2843)μmol/L比1829(1545,2173)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(0.01,0.03)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。
Objective To explore the value of serological markers in the diagnosis of pseudohypertrophy muscular dystrophy.Methods We collected cases based on certain criteria.The case group consisted of 49 patients with pseudohypertrophic muscular dystrophy who were hospitalized for the first time in The Affiliated Hospital of Neurological Research Institute of Anhui University of Chinese Medicine from January 2015 to July 2019,and 49 healthy outpatients having physical exams in the same period were included in the control group.The serological indexes of the two groups were compared,including serum muscle enzymes[alanine transaminase(ALT),aspartate transaminase(AST),creatine kinase(CK),creatine kinase MB(CK-MB),lactate dehydrogenase(LDH),alpha-hydroxybutyric dehydrogenase(α-HBDH)],other serological indicators[cardiac troponin I(cTnI),myoglobin(Mb),lactic acid(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[9493(6592,13315)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(537.0,1250.0)U/L vs.147.0(126.0,172.8)U/L,Z=-8.470,P<0.001],αHBDH[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[1097(440,1649)ng/mL vs.60(48,71)ng/mL,Z=-8.589,P<0.001],LAC[2301(2029,2843)μmol/L vs.1829(1545,2173)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 CKMB/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,αHBDH,and LDH.According to the size of AUC area,AST,CK,CK-MB,CK-MB/CK,ALT,Mb,LDH andα-HBDH had high accuracy 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 coefficients were 0.426 and 0.400(P<0.05).Conclusion In the laboratory diagnosis of pseudohypertrophic muscular dystrophy,besides 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.
作者
杨茜
范贤峰
何志超
冯文坤
吴君霞
韩永升
杨任民
YANG Qian;FAN Xianfeng;HE Zhichao;FENG Wenkun;WU Junxia;HAN Yongsheng;YANG Renmin(Department of Clinical Laboratories,The Affiliated Hospital of Institute of Neurology,Anhui University of Chinese Medicine,Hefei,Anhui 230031,China;Department of Neurology,The Affiliated Hospital of Institute of Neurology,Anhui University of Chinese Medicine,Hefei,Anhui 230031,China)
出处
《安徽医药》
CAS
2020年第6期1155-1158,共4页
Anhui Medical and Pharmaceutical Journal
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
Muscular dystrophy,duchenne
Alanine transaminase
Creatine kinase
Troponin I
Pyruvic acid
Serum muscle enzyme
Myoglobin
