摘要
目的探讨急性一氧化碳中毒(ACOP)致横纹肌损伤的发生情况与心肌损伤的关系以及肌酸激酶(CK)活力升高在反映横纹肌与心肌损伤方面的临床意义。方法收集2001年1月至2003年4月某医院收治的280例ACOP患者的临床资料,根据有无横纹肌损伤的症状、体征(肿胀、疼痛或极度肌无力等)将患者分为显性损伤组与非显性损伤组,并结合CK及肌酸激酶心型同工酶(CK-MB)活力、心电图(ECG)及心肌钙蛋白I(CTnI)测定结果进行临床分析。结果显性肌损伤组(43例)ECG异常率及CTnI阳性率分别为73.8%、77.8%,较非显性肌损伤组明显升高(43.4%、20.9%),差异均有统计学意义(P<0.01)。两组患者血清CK与CK-MB峰值均呈正相关(r=0.819、r=0.795,均P<0.01);但CK-MB%(CK-MB/CK)与CK峰值在显性损伤组无相关性(P>0.05)、在非显性损伤组呈负相关(r=-0.298,P<0.01)。多元回归分析显示,CK及CK-MB峰值均只与横纹肌损伤相关,而不受心肌损伤指标(ECG、CTnI)的影响;非显性损伤组CK、CK-MB峰值均与就诊时昏迷时间呈正相关,后者同时还受CTnI的影响。显性肌损伤的发生率随CK活力的升高而增加;但ECG异常率在CK升高5倍以下组与5倍以上组间差异无统计学意义(P>0.05);CTnI阳性率在CK正常组与升高5倍以下组间差异无统计学意义(P>0.05)。结论ACOP致横纹肌损伤并不少见,并常与心肌损伤合并出现;CK及CK-MB活力的升高更大程度上提示横纹肌的损伤,在反映心肌损伤方面其特异性不高。
Objective To investigate the incidence of rhabdomyolysis, the relationship between striated mnsclar injury and mycardiac injury,and the role of elevated serum creatine kinase（CK） played in screening these two complications following acute carbon monoxide poisoning（ ACOP）. Methods 280 patients with ACOP from January 2001 to April 2003 were analyzed retrospectively. According to the clinical manifestations of striated muscular injury（swelling, pain or serious myasthenia）, the patients were divided into two groups： the evident injury group and non-evident injury group. Results The abnormality rate of electrocardiogram（ECG） and cardiac troponin Ⅰ （CTnI） in the evident injury group（43 patients） were significantly higher than in the non-evident injury group （73.8% vs 43.4%, P 〈 0.001 ;77.8% vs 20.9%, P 〈 0.001）.There was a positive correlation between peak CK and MB isoenzyme（CK-MB） in beth groups,respectively（ r = 0.819, r = 0.795, P 〈 0.01 ） .There was no correlation in the evident injury group（ P 〉 0.05） and only negative correlation in the non-evident injury group（ r = -0.298,P 〈 0.01） between peak CK and MB ratio（CK-MB/CK）. Multiple regression analysis indicated that peak CK and CK-MB were only related with the striated muscular injury and were not affected by the indexes of the myocardial injury（ECG and CTnI） ;Both peak CK and CK-MB were positively correlated with the coma time before consultation in the non-evident injury group and the latter was also affected by CTnI .The incidence of positive muscular injury symptoms increased with the elevation of CK activity. There was no significant difference either in the ECG abnormality rate between the 〈 5 times elevated CK level subgroup and the 〉 5 times elevated CK level subgroup（P 〉 0.05）,or in the CTnI positive rate between the normal CK level subgroup and the 〈 5 times elevated CK level subgroup（ P 〉 0.05）. Conclusion Striated muscular injury is not a rare complication of ACOP, and always accompanied by myocardial injury .The strikingly elevated serum level of CK in patients with ACOP might be more likely to indicate the striated muscle not myocardiac injury.
出处
《中华劳动卫生职业病杂志》
CAS
CSCD
北大核心
2005年第6期435-437,共3页
Chinese Journal of Industrial Hygiene and Occupational Diseases
