{"id":10132,"date":"2020-04-23T03:57:32","date_gmt":"2020-04-23T00:57:32","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/creatinkinaza-izoenzime\/"},"modified":"2025-01-31T14:03:50","modified_gmt":"2025-01-31T12:03:50","slug":"creatinkinaza-izoenzime","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/creatinkinaza-izoenzime\/","title":{"rendered":"\u0418\u0437\u043e\u0444\u0435\u0440\u043c\u0435\u043d\u0442 \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u044b"},"content":{"rendered":"

Informa\u0163ii\u00a0 generale \u015fi recomand\u0103ri pentru determinarea izoenzimelor CK<\/em><\/strong><\/p>\n

Creatinkinaza este o enzim\u0103 ce se g\u0103se\u015fte\u00a0\u00een concentra\u0163ii crescute\u00a0\u00een citoplasma celulelor de la nivelul miocardului \u015fi mu\u015fchilor scheletici \u015fi,\u00a0\u00een concentra\u0163ii mult mai mici, la nivelul creierului7<\/sup>. CK are o structur\u0103 dimeric\u0103 \u015fi apare sub 4 forme: izoenzima mitocondrial\u0103 \u015fi izoenzimele citosolice cu 3 frac\u0163iuni: CK-MM (CK3 \u2013 muscular\u0103), CK-MB (CK2 \u2013 miocardic\u0103), CK-BB (CK1 \u2013 cerebral\u0103)6<\/sup>. La nivelul mu\u015fchilor scheletici \u00eent\u00e2lnim aproape\u00a0\u00een exclusivitate CK-MM,\u00a0\u00een miocard CK-MM \u015fi CK\u2013MB, iar la nivelul creierului, tractului digestiv \u015fi tractului genito-urinar predominat CK-BB. Nivelul normal de creatinkinaz\u0103 este dat aproape \u00een totalitate de CK-MM2<\/sup>.<\/p>\n

La determinarea creatinkinazei totale pot ap\u0103rea reac\u0163ii fals pozitive, din cauza prezen\u0163ei \u00een ser a unor complexe rezultate \u00een urma reac\u0163iei antigen \u2013 anticorp \u00eentre CK-BB \u015fi IgG \u015fi mai rar CK-MM \u015fi IgA (complex macro-CK de tip I). Aceast\u0103 interferen\u0163\u0103 se produce\u00a0deoarece CK nu poate fi diferen\u0163iat\u0103 de forma macro-CK dec\u00e2t prin electroforez\u0103. Prezen\u0163a acestor complexe ar trebui suspectat\u0103 atunci c\u00e2nd nivelul CK este persistent crescut, cu valori relativ constante, iar pacientul nu prezint\u0103 manifest\u0103ri clinice concordante cu nivelul enzimei.<\/p>\n

Complexul macro-CK de tip I este asociat cu o multitudine de afec\u0163iuni: hipotiroidism, boli autoimune, neoplazii, miozite, boli cardiovasculare, put\u00e2nd fi \u00eens\u0103 \u00eent\u00e2lnit \u015fi la persoane aparent s\u0103n\u0103toase. Este mai frecvent la femei dec\u00e2t la b\u0103rba\u0163i, predomin\u00e2nd la persoanele de peste 70 ani \u00een compara\u0163ie cu grupul de v\u00e2rst\u0103 20-69 ani.<\/p>\n

Complexul macro-CK de tip II este de origine mitocondrial\u0103 \u015fi migreaz\u0103 la catod \u00een apropierea benzii CK-MM. Prezen\u0163a acestui tip de complex este asociat\u0103 cu afec\u0163iuni severe: neoplazii, boli hepatice, hipoxie tisular\u0103 \u015fi este, \u00een general, un indicator de prognostic rezervat6;7<\/sup>.<\/p>\n

Determinarea\u00a0 izoenzimelor CK este util\u0103\u00a0\u00een diagnosticul afec\u0163iunilor musculare (\u00een asociere cu aldolaza) \u015fi, de asemenea, pentru depistarea macroenzimelor CK7<\/sup>.<\/p>\n

Preg\u0103tire pacient <\/em><\/strong>\u2013 \u00e0 jeun sau postprandial4<\/sup>; \u00eenainte de recoltare pacientul nu va face exerci\u0163ii fizice4<\/sup>.<\/p>\n

Specimen recoltat <\/em><\/strong>\u2013 s\u00e2nge venos4<\/sup>.<\/p>\n

Recipient de recoltare <\/em><\/strong>- <\/em>vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator4<\/sup>.<\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong>\u2013 se separ\u0103 serul prin centrifugare4<\/sup>.<\/p>\n

Volum prob\u0103<\/em><\/strong> \u2013 2 ml ser4<\/sup>.<\/p>\n

Cauze de respingere<\/em><\/strong> a probei <\/em><\/strong>\u2013 specimen hemolizat4<\/sup>.<\/p>\n

Stabilitate prob\u0103 <\/em><\/strong>\u2013 serul separat este stabil maxim 72 h <\/em>\u00a0la 4-8\u00b0C; 2 s\u0103pt\u0103m\u00e2ni<\/em> la -20\u00b0C4<\/sup>.<\/p>\n

Metod\u0103 <\/em><\/strong>- electroforez\u0103<\/span>3<\/sup>.<\/p>\n

Valori de referin\u0163\u0103:\u00a0\u00a0<\/em><\/strong><\/p>\n

\u2013 CK-MB: < 0,1 \u00b5mol\/sl<\/p>\n

\u2013 CK-MM:<\/p>\n

0-5 zi: 3.26-11.7 \u00b5mol\/sl<\/div>\n
6 zile-6 luni \u015fi jum\u0103tate: 0.68-5.51 \u00b5mol\/sl<\/div>\n
6 luni \u015fi jum\u0103tate-18 ani: 0.4-3.82 \u00b5mol\/sl<\/div>\n
Femei: \u00a0< 2,42 \u00b5mol\/sl<\/div>\n
B\u0103rba\u0163i: < 2,85 \u00b5mol\/sl<\/div>\n
<\/div>\n
\u2013 CK-BB: 0,00 \u00b5mol\/sl4<\/sup><\/div>\n

Interpretarea rezultatelor<\/em><\/strong><\/p>\n

\u00cen IMA, cre\u015fterea CK-MB <\/em><\/strong>\u00eencepe s\u0103 devin\u0103 evident\u0103\u00a0la 4-8 ore de la debutul simptomatologiei \u015fi atinge un maximum dup\u0103 15-24 ore. In primele 72 ore doar la dou\u0103 treimi din pacien\u0163i va mai persista o cre\u015ftere a CK-MB9<\/sup>. Valori crescute ale CK-MB mai pot fi \u00eent\u00e2lnite\u00a0\u00een: miocardite \u015fi cardiomiopatii; intoxica\u0163ia cu monoxid de carbon; insuficien\u0163a circulatorie \u015fi soc; hipertermie malign\u0103 sau hipotermie; hipotiroidism; traumatisme musculare \u015fi interven\u0163ii chirurgicale; distrofia musculara Duchenne; polimiozite (asociate cu turn-over crescut); rabdomioliza; febra p\u0103tat\u0103 a mun\u0163ilor st\u00e2nco\u015fi; insuficien\u0163a renal\u0103 cronic\u0103; hemoragie subarahnoidiana; sindrom Reye \u015fi rareori \u00een poliartrita reumatoid\u0103 cu titruri crescute de factor reumatoid.<\/p>\n

Alerg\u0103torii de maraton \u015fi atle\u0163ii cu mas\u0103 muscular\u0103 crescut\u0103 pot \u00eenregistra valori crescute de CK-MB, \u00een absen\u0163a infarctului miocardic.<\/p>\n

CK-MM <\/em><\/strong>asigur\u0103 nivelul normal de creatinkinaz\u0103 total\u0103 la indivizii s\u0103n\u0103to\u015fi, fiind crescut\u0103 \u00een afec\u0163iunile ce determin\u0103 modific\u0103ri ale nivelului total de creatinkinaz\u0103.<\/p>\n

CK-BB<\/em><\/strong> \u00eenregistreaz\u0103 valori crescute\u00a0\u00een: sindromul Reye; unele adenocarcinoame mamare, urinare, pulmonare, uterine, testiculare, colonice \u015fi de prostat\u0103; leziuni cerebrale \u015fi interven\u0163ii chirurgicale pe creier; \u015foc sever; miopatia alcoolic\u0103, la nou-n\u0103scu\u0163i. De asemenea constituie un \u201emarker genetic\u201d \u00een familiile cu pirexie malign\u0103. Trebuie men\u0163ionat faptul c\u0103 folosirea acestui test ca marker tumoral necesit\u0103 investiga\u0163ii ulterioare2;3;5,7<\/sup>.<\/p>\n

Limite \u015fi interferen\u0163e<\/em><\/strong><\/p>\n

Efortul fizic sus\u0163inut, ridicarea de greut\u0103\u0163i, mixedemul, crizele epileptice, traumatismele, injec\u0163iile intramusculare sau travaliul pot determina cre\u015fteri ale CK, f\u0103r\u0103 \u00eens\u0103 a determina \u015fi niveluri ridicate de CK-MB.<\/p>\n

Determinarea izoenzimelor CK nu se practic\u0103 de rutin\u0103 dac\u0103 valorile CK totale sunt sc\u0103zute, de\u015fi la v\u00e2rstnici cu mas\u0103 muscular\u0103 redus\u0103 o asemenea analiz\u0103 poate fi de mare ajutor.<\/p>\n

\u25cf Medicamente<\/em><\/strong><\/p>\n

Cre\u015fteri:<\/span><\/em><\/strong> \u00a0acid aminocaproic, amfotericina B, captopril, carbenoxolona, carteolol, clindamicina, clorpromazina, clofibrat, clonidina, colchicina, ciclopropan, danazol, diclofenac, digoxin, gemfibrozil, haloperidol, inhibitori ai 3-hidroxi 3-metilglutaril CoA reductazei (ex: lovastatin), insulina, izotretinoin, labetalol, lamivudina, levamisol, lidocaina, litiu, D-penicilamina, pindolol, proclorperazina, propranolol, streptokinaza, trimetroprim, zalcitabin.
\nSc\u0103deri:<\/span><\/em><\/strong> \u00a0<\/em>acid ascorbic, amikacin, aspirina, dantrolen, prednison, calciu, dexametazona, droperitol, fenotiazine, pindolol, sulfametoxazol.<\/p>\n

\u25cf Interferen\u0163e analitice<\/em><\/strong>
\nHemoliza poate determina cre\u015fteri ale enzimei CK2,3<\/sup>.<\/p>\n

\u00a0<\/span>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

1. Frances Fischbach. Effects of the Drugs on Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams & Wilkins, USA, 8 ed. 2009, 1234-1235.<\/span><\/div>\n
2. Frances Fischbach. Chemistry Studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams & Wilkins, USA, 8 ed. 2009, 423-426.<\/span><\/div>\n
3. Jacques Wallach. Boli metabolice si ereditare. \u00cen Interpretarea testelor de diagnostic. Editura Stiin\u0163elor Medicale, Rom\u00e2nia, 7 ed., 2001, 162-169.<\/span><\/div>\n
4. Laborator Synevo. Referin\u0163e specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog<\/span><\/div>\n
5. Laboratory Corporation of America.Directory of Services and Interpretive Guide. Creatine Kinase (CK), MB. www.labcorp.com . 2003. Ref Type: Internet Communication<\/span><\/div>\n
6. Lothar Thomas Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results, TH-Books, Frankfurt\/Main, Germany 1998, 101-107.<\/span><\/div>\n
7. Mayo Clinic, Mayo Medical Laboratories. Test Catalog. Creatine Kinase (CK) Isoenzyme Electrophoresis, Serum. www.mayomedicallaboratories.com.Ref Type: Internet Communication.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/strong><\/p>\n

\u0418\u0437\u043e\u0444\u0435\u0440\u043c\u0435\u043d\u0442 \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u044b, \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u043d\u044b\u0439 \u0434\u043b\u044f \u0442\u043a\u0430\u043d\u0438 \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e\u0439 \u043c\u044b\u0448\u0446\u044b.<\/p>\n

\u041a\u0430\u0442\u0430\u043b\u0438\u0437\u0438\u0440\u0443\u0435\u0442 \u043e\u0431\u0440\u0430\u0442\u0438\u043c\u044b\u0439 \u043f\u0435\u0440\u0435\u043d\u043e\u0441 \u0444\u043e\u0441\u0444\u043e\u0440\u0438\u043b\u044c\u043d\u043e\u0433\u043e \u043e\u0441\u0442\u0430\u0442\u043a\u0430 \u0441 \u0410\u0422\u0424 \u043d\u0430 \u043a\u0440\u0435\u0430\u0442\u0438\u043d \u0438 \u0441 \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u0444\u043e\u0441\u0444\u0430\u0442\u0430 \u043d\u0430 \u0410\u0414\u0424. \u041c\u043e\u043b\u0435\u043a\u0443\u043b\u0430 \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u044b-\u041c\u0412 \u0441\u043e\u0441\u0442\u043e\u0438\u0442 \u0438\u0437 \u0434\u0432\u0443\u0445 \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0445 \u0441\u0443\u0431\u044a\u0435\u0434\u0438\u043d\u0438\u0446 – \u0412 \u0438 \u041c. \u0421\u043e\u0434\u0435\u0440\u0436\u0438\u0442\u0441\u044f \u0438\u0441\u043a\u043b\u044e\u0447\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u0432 \u043c\u0438\u043e\u043a\u0430\u0440\u0434\u0435.<\/p>\n

\u0421 \u043a\u0430\u043a\u043e\u0439 \u0446\u0435\u043b\u044c\u044e \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u044e\u0442 \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u041a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u044b-\u041c\u0412<\/strong><\/p>\n

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\u0414\u043b\u044f \u0430\u0434\u0435\u043a\u0432\u0430\u0442\u043d\u043e\u0439 \u043e\u0446\u0435\u043d\u043a\u0438 \u0441\u043e\u043e\u0442\u043d\u043e\u0448\u0435\u043d\u0438\u044f \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u041a\u0424\u041a-MB \u0438 \u043e\u0431\u0449\u0435\u0439 \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u044b \u0432\u0432\u0435\u0434\u0451\u043d \u0440\u0430\u0441\u0447\u0451\u0442\u043d\u044b\u0439 \u043e\u0442\u043d\u043e\u0441\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0438\u043d\u0434\u0435\u043a\u0441 RI = \u041a\u0424\u041a-MB (\u043d\u0433\/\u043c\u043b) \/ \u041a\u0424\u041a \u043e\u0431\u0449. (\u0415\u0434\/\u043b) \u0445 100 (%). \u0414\u043b\u044f \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u044f \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e\u0439 \u043c\u044b\u0448\u0446\u044b \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0435\u043d RI > 2,5 – 3%.<\/p>\n

\u0414\u0438\u0430\u0433\u043d\u043e\u0437 \u043e\u0441\u0442\u0440\u043e\u0433\u043e \u0438\u043d\u0444\u0430\u0440\u043a\u0442\u0430 \u043c\u0438\u043e\u043a\u0430\u0440\u0434\u0430 \u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0430\u0435\u0442\u0441\u044f \u0442\u0430\u043a\u0436\u0435 \u043d\u0430\u0431\u043b\u044e\u0434\u0435\u043d\u0438\u0435\u043c \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u043d\u043e\u0439 \u0434\u0438\u043d\u0430\u043c\u0438\u043a\u0438 \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044f, \u0441\u0435\u0440\u0438\u0439\u043d\u043e\u0435 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u041a\u0424\u041a-MB \u0441 \u0438\u043d\u0442\u0435\u0440\u0432\u0430\u043b\u043e\u043c 3 \u0447\u0430\u0441\u0430 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 6 – 9 \u0447\u0430\u0441\u043e\u0432\u043e\u0433\u043e \u043f\u0435\u0440\u0438\u043e\u0434\u0430 \u043f\u0440\u0438 \u043d\u0435\u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u044f\u0445 \u042d\u041a\u0413 \u0431\u043e\u043b\u0435\u0435 \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0442\u0438\u0432\u043d\u043e, \u0447\u0435\u043c \u0435\u0434\u0438\u043d\u0438\u0447\u043d\u043e\u0435 \u0438\u0437\u043c\u0435\u0440\u0435\u043d\u0438\u0435.<\/p>\n

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