Alterations in Serum Creatine Kinase and Lactate Dehydrogenase: RESULTS part 2

Posted by James

Determination of the serum CK-MB in international units per liter showed that there were minimal eleva­tions in the group of patients that had major aortic reconstruction; however, the groups that had AMI or MES INF showed marked elevations within the first three days after their clinical events (Fig 3). Maximum values for CK-MB (IU/L) were reached approximately 16 to 24 hours after the clinical events in both those groups. There were fairly marked variations in the amount of CK-MB present within these groups. The patients with necrotic bowel and those with myocardial infarctions could not be differentiated one from an­other based on these measurements alone on day 2 and day 3 following the onset of their clinical events.

Analysis of the С К isoenzyme tracings for all three groups of patients for CK-MB showed that only the six patients who had necrotic bowel had detectable CK-BB bands in their serum within the first 24 hours of the study. None of the other patients had CK-BB bands in their sera at any time (Table 2). The serum CK-BB bands diminished by the second day after infarction. For those patients who had late serum samples available for evaluation, there were no CK- BB bands present in any of the serum samples on the third day after bowel infarction.
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Table 3—Changes in Serum LD and its Isoenzymes (Values Are Mean Maximum Determinations)

	Total LD (IU/L ± SEM)	Ratio of LD,/LD2±(SEM)	Dominant Isoenzyme Percent of Patients Showing
Acute MI (N = 15)	323 ±47	1.21 ±0.05*	LD, (15/15=100%)
Bowel necrosis (N =	424 ±69	0.74 ±0.8	LD3 (4/6 = 67%)
Major aortic reconstruction (N = 13)	201 ±21	0.68 ±0.92	LD2 (13/13=100%)

Analysis of serum total LD showed that all three groups had elevations above the upper limits of normal within 16 hours after each clinical event (Fig 4 and Table 3). All three groups of patients were somewhat overlapping within the first 24 hours of the study. The patients with MES INF and those with AMI were significantly different (p<0.01) in their serum total LD values on the day 2 and day 3 samples when compared with those recorded in patients having major AAS. They were not, however, significantly different one from the other.

FIGURE 3. Values of CK-MB (IU/L) for all three groups of patients. Bars represent standard errors of the mean. Note that significant elevations are apparent in those patients having AMI and in those who had bowel necrosis. Elevations overlap in these two groups between day 2 and day 3; however, both of these groups had significantly greater values (p<0.01) than those patients who had major aortic reconstruction.

Serum isoenzyme analyses of all three groups of patients for LD showed that the patients who had MES INF and those who had major aortic reconstruc­tion had LD/LD₂ ratios which were less than 1.00 on all samples while patients who had myocardial infarc­tions had values greater than 1.00 by 16 hours after onset of the infarction, and values remained elevated throughout the remainder of the study. The difference between the patients having AMI and those having major aortic reconstructions or bowel necrosis was significant (p<0.01) for all samples subsequent to the one taken on the evening of the day of their hospital event. Analysis of the isoenzyme tracings from the six patients who had acute bowel infarctions showed that only four had evidence of an LD₃ dominance in their isoenzyme patterns at any time following their clinical events (Table 3).
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