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Untersuchungen zur Aktivitätskinetik des Isoenzymes CK-MB im Serum nach Myokardinfarkt

Studies of activity kinetic of isoenzyme CK-MB in serum after myocardial infarction

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Summary

We investigated the activity kinetics of CK-total and CK-MB in 83 patients with proven myocardial infarctions. Serial serum samples were taken at intervals of 2–6 h.

The activity of isoenzym CK-MB was determined by means of the immunological inhibition method.

CK-MB activity was determined in all patients. The mean peak activity of CK-MB was 65 U/l (range: 9-241 U/l). At the time of peak CK-MB activity the mean percentage CK-MB activity was 13.2% (range: 3.4–21.7%). The CK-MB activity reached its peak at 17.4 h (range: 3.0–32.5 h) after the onset of retrosternal pain. This is 1.4 h after peak CK-total activity. The mean disappearance rate constant for CK-MB (n=31) was found to be 9.3×10−4 U/min with a large individual variation. This value corresponds to a half life of 12.5 h (CK-total: 15.5 h). The determination of CK-MB activity is therefore only of diagnostic significance within 48 h of possible myocardial occurrence. Moreover, isoenzyme CK-MB is not found exclusively in myocardium. For this reason it is better to use the percentage CK-MB activity in the differential diagnosis of myocardial infarction. With 80% of the patients this value is greater than 6% within 36 h of proven myocardial infarction.

Zusammenfassung

Wir untersuchten die Kinetik der Gesamtaktivität der Creatinkinase und die des Isoenzyms CK-MB bei 83 Patienten mit gesichertem Myokardinfarkt in Serienmessungen in 2–6 stündlichen Abständen. Die Aktivität des Isoenzyms CK-MB wurde mit der immunologischen Inhibitionsmethode bestimmt.

Isoenzym CK-MB war bei allen Patienten nachweisbar.

Die maximale CK-MB Aktivität betrug im Mittel 65 U/l (Bereich: 9-241 U/l). Der mittlere prozentuale CK-MB Aktivitätsanteil an der Gesamtaktivität lag zum Zeitpunkt der maximalen CK-MB Aktivität bei 13,2% (Bereich: 3,4–21,7%). Das Maximum der CK-MB Aktivität wird im Mittel 17,4 h (Bereich: 3,0–32,5 h) nach Beginn der akuten Schmerzsymptomatik erreicht. Es liegt damit 1,4 h vor dem Gipfel der CK-Gesamtaktivität. Die Berechnung der Eliminationskonstante (n=31) für die CK-MB Aktivität ergab bei einer sehr starken individuellen Streuung einen Mittelwert von 9,3×10−4 U/min, entsprechend einer Halbwertszeit von 12,5 h (CK-Gesamt: 15,5 h). Die Bestimmung der CK-MB Aktivität hat somit meist nur innerhalb von 48 h nach einem fraglich cardialen Ereignis diagnostische Wertigkeit. Da der Nachweis von Isoenzym CK-MB im Serum nicht im strengen Sinne spezifisch für eine Herzmuskelschädigung ist, ist es sinnvoll, die Höhe des prozentualen CK-MB Aktivitätsanteiles als differentialdiagnostischen Parameter zu benutzen. Bis zu 36 h nach Myokardinfarkt liegt dieser Wert bei 80% der Patienten über 6%.

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Literatur

  1. Arnim, Th.v., Neumeier, D., Sandel, P.: Diagnostische Wertigkeit der CK-MB-Bestimmung bei Patienten mit fraglichem Myokardinfarkt. (In Vorber.)

  2. Brownlow, K., Elevitch, F.R.: Serum creatine phosphokinase isoenzyme (CPK2) in myositis. J. Am. Med. Assoc.230, 1141–1144 (1974)

    Google Scholar 

  3. Burger, A., Richterich, R., Aebi, H.: Die Heterogenität der Kreatin-Kinase. Biochem. Z.339, 305–314 (1964)

    PubMed  Google Scholar 

  4. Coleman, E.R., Klein, M.S., Roberts, R., Sobel, B.E.: Improved detection of myocardial infarction with Technetium-99m stannous pyrophosphate and serum MB creatine phosphokinase. Amer. J. Cardiol.37, 732–735 (1976)

    PubMed  Google Scholar 

  5. Coolen, R.B., Herbstman, R.: Artifactual brain (BB) creatine kinase (CK) isoenzyme in kidney transplant and renal dialysis patients. Clin. Chem.23, 1142 (1977)

    Google Scholar 

  6. Deutsche Gesellschaft f. Klinische Chemie: Standardisierung von Methoden zur Bestimmung von Enzymaktivitäten in biologischen Flüssigkeiten. Z. Klin. Chem. Klin. Biochem.10, 182–193 (1972)

    Google Scholar 

  7. Elevitch, F.R.: Fluorometric Techniques in Clinical Chemistry. Boston: Littlebrown 1973

    Google Scholar 

  8. Ettinger, E.R., Kronenberg, M.W., Sandel, P., Schenk, E., Wilson, G.A., Cohen, J.: The precision of infarct size estimation with creatinekinase in dogs. (In Vorber.)

  9. Itano, M.: The detection of CPK1 (BB) in serum: A summary of sixteen cases. Am. J. clin. Pathol.65, 351–355 (1976)

    PubMed  Google Scholar 

  10. Jockers-Wretou, E., Pfleiderer, G.: Quantitation of creatine kinase isoenzymes in human tissues and sera by an immunological method. Clin. Chim. Acta58, 223–232 (1975)

    PubMed  Google Scholar 

  11. Ljungdal, L., Hofvendahl, S., Gerhardt, W., Börjesson, J.: Creatine kinase B-subunit activity in human serum. II. Evaluation of S-CK B-subunit activity in the diagnosis of acute myocardial Infarction. Clin. Chim. Acta.78, 43–53 (1977)

    PubMed  Google Scholar 

  12. Mathey, D., Bleifeld, W., Buss, H., Hanrath, P.: Creatine kinase release in acute myocardial infarction: correlation with clinical, electrocardiographic and pathological findings. Brit. Heart J.37, 1161–1168 (1975)

    PubMed  Google Scholar 

  13. Mercer, D.W.: Separation of tissue and serum creatine kinase isoenzymes by ion-exchange column chromatography. Clin. Chem.20, 36–40 (1974)

    PubMed  Google Scholar 

  14. Neumeier, D., Knedel, M., Würzburg, U., Hennrich, N., Lang, H.: Immunologischer Nachweis von Creatinkinase-MB im Serum beim Myokardinfarkt. Klin. Wschr.53, 329–333 (1975).

    PubMed  Google Scholar 

  15. Neumeier, D., Prellwitz, W., Würzburg, U., Brundobler, M., Olbermann, M., Just, H.-J., Knedel, M., Lang, H.: Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity — activity kinetics and diagnostic significance in myocardial infarction. Clin. Chim. Acta73, 445–451 (1976)

    PubMed  Google Scholar 

  16. Neumeier, D., Hofstetter, R.: Radioimmunoassay of subunit B in isoenzymes CK-MB and CK-BB of creatine phosphokinase. Clin. Chim. Acta79, 107–113 (1977)

    PubMed  Google Scholar 

  17. Neumeier, D., Kemkes, B., Glück, B., Knedel, M.: Verteilung der Creatinkinase-Isoenzyme in Skelett- und Herzmuskulatur des Menschen. Z. Clin. Chem. Klin. Biochem.15, 179–180 (1977)

    Google Scholar 

  18. Neumeier, D., Siegele, B., Glück, B., Knedel, M.: Verwendung von Primaten-Gewebshomogenaten zur Qualitätskontrolle der Bestimmung von Creatinkinase-MB mit inhibierenden Antikörpern. Z. Klin. Chem. Klin. Biochem.15, 389–391 (1977)

    Google Scholar 

  19. Norris, R.M., Whitlock, R.M.L., Barratt-Boyes, C., Small, C.W.: Clinical measurement of myocardial infarct size, modification of a method for the estimation of total creatine phosphokinase release after myocardial infarction. Circulation51, 614–620 (1975)

    PubMed  Google Scholar 

  20. Ogunro, E.A., Hearse, D.J., Shillingford, J.P.: Creatine kinase isoenzymes: Their separation and quantitation. Cardiovasc. Res.11, 94–102 (1977)

    PubMed  Google Scholar 

  21. Prellwitz, W., Neumeier, D., Lang, H.: Isoenzyme der Creatinkinase im Serum bei Erkrankungen und Schädigungen der Skelettmuskulatur. Klin. Wschr.

  22. Rao, P.S., Lukes, J.J., Ayres, S.M., Mueller, H.: New manual and automated method for determining activity of creatine kinase isoenzyme MB, by use of dithiothreitol. Clinical applications. Clin. Chem.21, 1612–1618 (1975)

    Google Scholar 

  23. Roark, S.F., Wagner, G.S., Izlar, H.L., Roe, C.R.: Diagnosis of acute myocardial infarction in a community hospital. — Significance of CPK-MB determination. Circulation53, 965–969 (1976)

    PubMed  Google Scholar 

  24. Roberts, R., Henry, P.D., Sobel, B.E.: An improved basis for enzymatic estimation of infarct size. Circulation52, 743–754 (1975)

    PubMed  Google Scholar 

  25. Roe, C.R., Cobb, F.R., Starmer, F.C.: The relationship between enzymatic and histologic estimates of the extent of myocardial infarction in conscious dogs with permanent coronary occlusion. Circulation55, 438–449 (1977)

    PubMed  Google Scholar 

  26. Shell, W.S., Kjekshus, J.K., Sobel, B.E.: Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serial creatine phosphokinase activity. J. Clin. Invest.50, 2614–2625 (1971)

    Google Scholar 

  27. Shell, W.E., Lavelle, J.F., Covell, J.W., Sobel, B.E.: Early estimation of myocardial damage in conscious dogs and patients with evolving acute myocardial infarction. J. Clin. Invest.52, 2579–2590 (1973)

    PubMed  Google Scholar 

  28. Silvermann, L.M., Mendell, J.R., Sahen, Z., Fontana, M.B.: Significance of creatine phosphokinase isoenzymes in Duchenne dystrophy. Neurology26, 561–569 (1976)

    PubMed  Google Scholar 

  29. Smith, A.F.: Separation of tissue and serum creatine kinase isoenzymes on polyacrylamide gel slabs. Clin. Chim. Acta39, 351–359 (1972)

    PubMed  Google Scholar 

  30. Smith, A.F., Radford, D., Wong, G.P., Oliver, M.F.: Creatine kinase MB isoenzyme studies in diagnosis of myocardial infarction. Brit. Heart J.38, 225–232 (1976)

    PubMed  Google Scholar 

  31. Sobel, B.E., Shell, W.E., Klein, M.S.: An isoenzyme of creatine phosphokinase associated with rabbit heart mitochondria. J. Mol. Cell. Cardiol.4, 367–380 (1972)

    PubMed  Google Scholar 

  32. Sobel, B.E., Shell, W.E.: Diagnostic and prognostic value of serum enzyme changes in patients with acute myocardial infarction. Progr. Cardiol.4, 165–198 (1975)

    Google Scholar 

  33. Sobel, B.E., Infarct size, prognosis, and causal contiguity. Circulation (Suppl. I)53, 146–149 (1976)

    Google Scholar 

  34. Somer, H., Konttinen, A.: Demonstration of serum creatine kinase isoenzymes by a fluorescence technique. Clin. Chim. Acta40, 133–138 (1972)

    PubMed  Google Scholar 

  35. Schweizer, W.: „Enzymatischer“ Herzinfarkt? Dtsch. Med. Wschr.102, 331 (1977)

    Google Scholar 

  36. Thorstensson, A., Elwin, K., Sjödin, B., Karlsson, J.: Isoenzymes of creatine phosphokinase and myokinase in human heart and skeletal muscle. Scand. J. Clin. Lab. Invest.36, 821–826 (1976)

    PubMed  Google Scholar 

  37. Vladutiu, A.O., Venuto, R.C.: Creatine kinase MB and lactatdehydrogenase 5 isoenzymes in rhabdomyolysis. Clin. Chem.23, 1366 (1977)

    Google Scholar 

  38. Wevers, R.A.: Creatine kinase isoenzymes in human serum. Z. Klin. Chem. Klin. Biochem.15, 196–197 (1977)

    Google Scholar 

  39. Willerson, J.T., Stone, M.J., Ting, R.M.A., Gomez-Sanchez, C.E., Lewis, P.H., Louis, B.: Radioimmunoassay of creatine kinase-B isoenzyme in human sera: Results in patients with acute myocardial infarction. Proc. Nat. Acad. Sci. USA74, 1711–1715 (1977)

    PubMed  Google Scholar 

  40. Witteveen, S.A.G.J., Sobel, B.E., DeLuca, M.: Kinetic properties of the isoenzymes of human creatine phosphokinase. Proc. Nat. Acad. Sci. (Wash.)71, 1384–1389 (1974)

    PubMed  Google Scholar 

  41. Würzburg, U., Hennrich, N., Lang, H., Prellwitz, W., Neumeier, D., Knedel, M.: Bestimmung der Aktivität von Creatinkinase MB im Serum unter Verwendung inhibierender Antikörper. Klin. Wschr.54, 357–360 (1976)

    PubMed  Google Scholar 

  42. Würzburg, U., Hennrich, N., Orth, H.-D., Lang, H., Prellwitz, W., Neumeier, D., Knedel, M., Rick, W.: Quantitative determination of creatine kinase isoenzyme catalytic concentrations in serum using immunological methods. Z. Klin. Chem. Klin. Biochem.15, 131–137 (1977)

    Google Scholar 

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Authors and Affiliations

  1. Institut für Klinische Chemie, Klinikum Großhadern, Universität München, Germany

    D. Neumeier, P. Sandel & M. Knedel

  2. Zentrallaboratorium der Medizinischen Kliniken, Universität Mainz, Mainz

    W. Prellwitz

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  1. D. Neumeier
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  2. W. Prellwitz
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  3. P. Sandel
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  4. M. Knedel
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Mit freundlicher Unterstützung der Deutschen Forschungsgemeinschaft im Rahmen des Schwerpunktes „Klinische Enzymologie“ (Pr 66/7)

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Neumeier, D., Prellwitz, W., Sandel, P. et al. Untersuchungen zur Aktivitätskinetik des Isoenzymes CK-MB im Serum nach Myokardinfarkt. Klin Wochenschr 56, 449–456 (1978). https://doi.org/10.1007/BF01477059

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