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目的探讨急性毒鼠强(TEM)中毒时心肌酶变化的规律及其临床意义。方法动态观察67例急性TEM中毒患者及67例对照人群的心肌酶活力及心电图(ECG)变化。结果急性TEM中毒患者天冬氨酸转氨酶(AST)、肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶同工酶(CK-MB)活力,在中毒1 d内均有不同程度升高,中毒组患者5种心肌酶活力与对照组的差异有统计学意义(P＜0．01)；轻、中、重度中毒患者各时点心肌酶活力对应比较,差异均有统计学意义(P＜0．01)；病情越重,酶活力越高,ECG异常率也越高。CPK活力升高最早,升降幅度最大,升高持续时间最长；心肌酶活力改变早于ECG的改变。在中毒第3天,中毒组患者的AST、CPK、CK-MB、LDH、α-HBDH活力异常率分别为86．6%、98．5%、94．0%、89．6%、79．1%,ECG异常率为49．3%。结论急性TEM中毒可致心肌损害；CPK表现典型,可考虑作为临床上重要监测指标之一；TEM对心肌的损害是可逆的。
Objective To investigate the changes of myocardial enzymes in acute tetramine poisoning (TEM) and its clinical significance. Methods Dynamic changes of myocardial enzyme activity and electrocardiogram (ECG) were observed in 67 patients with acute TEM and 67 control subjects. Results Aspartate aminotransferase (AST), creatine phosphokinase (CPK), lactate dehydrogenase (LDH), a-hydroxybutyrate dehydrogenase (aHBDH), creatine kinase isoenzyme (CK-MB) activity increased to different extents in 1 day after poisoning. There were significant differences in the activities of 5 kinds of enzymes between the poisoning group and the control group (P <0.01); mild, moderate and severe poisoning Patients at each time point corresponding to myocardial enzyme activity, the differences were statistically significant (P <0.01); the more serious the disease, the higher the enzyme activity, the higher the rate of ECG abnormalities. CPK increased the earliest activity, the largest increase and decrease the longest duration; changes in myocardial enzyme activity earlier than ECG changes. On the third day of poisoning, the abnormal rates of AST, CPK, CK-MB, LDH and α-HBDH in poisoning group were 86.6%, 98.5%, 94.0%, 89.6%, 79 respectively. 1%, ECG abnormality rate was 49.3%. Conclusions Acute TEM poisoning can cause myocardial damage. CPK can be considered as one of the most important clinical indicators for monitoring. The damage of TEM to myocardium is reversible.