| Thrombolytic therapy results in recanalization of the occluded vessel and restores coronary flow after AMI, which reduces infarct size, improves myocardial function and reduces mortality rate. Blood serum protein of creatine kinase isoenzyme MB (CK-MB mass) is one of the indicators of myocardial damage which is not only sensitive but also specific, so we can make use of it in the diagnosis of AMI. However, there is few study on the dynamic changes of CK-MB mass on cornary artery recanalization in AMI, and few applies the changes to calculate the quantity of the injured myocardial. In this research, we should measure not only CK-MB mass, but also CK-MB activity and CK activity in control, then study the values of them in caculating the quantity.Research Object:Choose 60 patients with AMI in Qianfoshan Hospital of Shandong Province from Fre. 2003 to Feb. 2005. 28 patients of them were treated with thrombolysis while the others with routine drugs. Then the former is the study group, and the latter is the control group.Methods:1. Time: All the patients should be taken 2ml venous blood immediately after coming into the hospital. The patients of the study group need be taken 2ml venous blood every 2~4 hours a day, then every 6~8 hours a day. The patients of the control group need be taken 2ml venous blood every 6—8 hours a day untill the concentration of CK-MB is normal. The blood samples centirfuged for 5 minutes by 3000r/min and then the serum is taken out for measurement.2. Items: CK-MBmass, CK-MBactivity, CK activity, etc.3. Methods:(1) computor procedure: In this research we applied VISUAL BASIC into editing the procedure.(2) Mathematical model:We can receive the quantity through inputing the time, the concentrations of CK-MBmass, CK-MB activity or CK activity and the weight of the patient, etc. into the mathematical model.CK-MBr = I f{t)dt = E{T) + kd jf E{t)dt CKr=The quantity is caculated by gram and we can caculate the quantity which is performanced by CK-MBmass-g, CK-MB-g or CK-g in according to CK-MB mass, CK-MB activity, or CK activity.Results: There are 22 patients whose cornary arteries are recanalized in study group treated with thrombolysis and there are 4 patients whose cornary arteries are spontaneously recanalized in control group treated with routine drugs. So there are 26 patients in the cornary artery recanalization group (CARgroup) and there dre 34 patients in the non-cornary artery recanalization group (NCAR group) .(— ) Dynamic changes of CK-MBmass, CK-MB activity and CK activity1. The abnormal values of CK-MB mass, CK-MB activity or CK activity appeared 0.5h, lh, 2h in CAR group and lh, 2h, 3h in NCAR group respectively. The abnormal values appeared earlier in CAR group.2. The maximum values of CK-MBmass, CK-MB activity, CK activity appeared 9.4h, 10.2h, 12.2h in CAR group and 20.8h, 23.7h, 29.6h in NCAR group respectively. The maximum values appeared earlier in CAR group.3. The rising rates were 0.276h'', 0.253h"', 0.162h"' in CAR group and 0.094h'!, 0.085b:1, 0.063h"' in NCAR group. The rising rates were larger in CAR group.4. The peak lasted for 6.5h, 9.3h, 15.3h in CAR group and 15.lh, 17.4h, 22.8h in NCAR group. The peak lasted shorter in CAR group. Among those, the duration of CK-MB mass is shorten by 8.6h in average.5. Above three indicators dropped to normal within 28.7h, 36.5h, 50.8h in CAR group and 42.3h, 50.3h, 68.7h respectively in NCAR group respectively. Thethree indicators dropped to normal obviously faster in CAR group. Among those, the time of CK-MBmass is shorten by 13.6h in average.6. The dropping rates were 0.061 h'1, 0.056h"', 0.03511"1 in CAR group and 0.045h"1, 0.039h"', 0.028h"' in NCAR group respectively. The dropping rates were larger in CAR group.7. The total time were 48.2h, 54.4h, 86.6h in CAR group and 76.9h, 84.7h, 104.5h in NCAR group. The total time in CAR group is shorten. Among those, the total time of CK-MB mass is shorten by 28.7h in average.(— ) The quantity of injured myocardial1. CK-MBmass: the average quantity of injured myocardial was 29.6 CK-MB mass-g in CAR group and 46.5 CK-MBmass-g in NCAR group if caculated in according to CK-MBmass. The quantity was far less in CAR group.2 . CK-MB activity: the average quantity of injured myocardial was 34.3CK-MB-g in CAR group and 50.4 CK-MB-g in NCAR group if caculated in according to CK-MB activity. The quantity was far less in CAR group.3. CK activity: the average quantity of injured myocardial was 40.5 CK-g in CAR group and 59.3 CK-g in NCAR group if caculated in according to CK activity. The quantity was far less in CAR group.4. The quantity of injuerd myocadial and the prognosis: the quantity of injuerd myocadial was related to the incidence of the complications closely. The average quantity of the patients without complications was 32.8CK-MB mass-g and the average quantity of the patients with complications was 57.5CK-MBmass-g. The study tells us the quantity of injuerd myocadial is related to the gravity of illness, the incidence of the complications and the prognosis closely.CONCLUTION( — ) The dynamic changes of blood serum protein of creatine kinase isoenzyme MB on cornary artery recanalization in acute myocardial infarction:1. CAR group: After recanalization, CK-MB mass reaches the maximum in 9.4h in average and the rising rate is 0.276h*'. It drops to normal in 28.7h and the dropping rate is 0.061h"'. The total time is 48.2h in average.2. NCAR group: CK-MB mass reaches the maximum in 20.8h in average and the rising rate is 0.094h~'. It drops to normal in 42.3h and the dropping rate is 0.045b"1. The total time is 76.9h in average.It is a significant difference between the two groups. (—) The quantity of injuerd myocadial:1. The quantity of injuerd myocadial: The quantity is 29.6 CK-MB mass-g in CAR group in average and 46.5 CK-MB mass-g in NCAR group in average. It is far less in CAR group obviously.2. The quantity of injuerd myocadial and the prognosis: The average quantity of the patients without complications was 32.8CK-MBmass-g and the average quantity of the patients with complications was 57.5CK-MB mass-g. So the quantity of injuerd myocadial was related to the incidence of the complications closely.The study tell us after recanalization, CK-MB mass reaches the maximum and then drops to normal rapidly after a short duration. The rising rate and the dropping rate both become larger. That is the characteristic of cornary artery recanalization in acute myocardial infarction. According to the dynamic changes of CK-MB mass, we can caculate the quantity of injuerd myocadial and we have known that the quantity is far less in CAR group. Therefor, CK-MB mass can be used as an indicator for successful recanalization of coronary artery in patients with AMI. It can also help us judge the gravity of illness and evaluate the prognosis. |
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