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Indonesian Journal of Clinical Pathology and Medical Laboratory

ISSN 0854-4263

Vol. 17 / No. 3 / Published : 2011-01

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Original Article :

The creatine kinase myocardial band, myeloperoxidase, matrix metalloproteinase-9 activities and troponin t in myocardial infarction

Author :

  1. IA Hutagalung*1
  2. I Patellongi*2
  3. R Pakasi*3
  4. M Arif*4
  5. AA Mappahya*5
  1. Bag PK FK-UNHAS Makassar
  2. Departemen Fisiologi, Fakultas Kedokteran, Univ. Hasanuddin Jl. Perintis Kemerdekaan Talamanrea, Makassar
  3. Bag PK FK-UNHAS Makassar
  4. Bag PK FK-UNHAS Makassar
  5. Departemen Penyakit Dalam, Divisi Kardiovaskular, Fakultas Kedokteran, Univ. Hasanuddin Jl. Perintis Kemerdekaan Talamanrea, Makassar

Abstract :

  In many patients presenting with chest pain symptoms at the emergency room, cardiac markers are measured not only to detect acute myocardial infarction (AMI) but to exclude them too. Presently, the only biochemical markers used for diagnosis of MI are creatine kinase myocardial band (CKMB) and troponin T (cTnT) as the markers of myocardial necrosis. Other biochemical markers have been sought to find marker which can reflect the important, upstream processes in the pathophysiology of MI that therefore might give an earlier signal of ongoing MI. These markers are myeloperoxidase (MPO) and matrix metalloproteinase-9 (MMP-9) as markers of plaque destabilization. The aim of this study was to analyze the CKMB, MPO, MMP-9 activityies and troponin T level in MI. A cross sectional study had been done at the Cardiovascular Centre Unit and Internal Ward of Dr. Wahidin Sudirohusodo Hospital during April up to August 2010 period. The laboratory tests were done at the Clinical Pathology Laboratory of Dr. Wahidin Sudirohusodo Hospital, Makassar and the Research and Esoteric Unit of Prodia Clinical Laboratory, Jakarta.  Ffifty-three patients with AMI had been examined. The results showed that the means of CKMB, cTnT, MPO and MMP-9 were 52.4 U/L, 2.0 ng/mL, 217.9 ng/mL and 920.3 ng/mL, respectively. MMP-9 had positively value (69.8%) higher than cTnT (60.4%), MPO (58.5%) and CKMB (45.3%). Troponin T and MMP-9 were higher in patients with high CKMB. The higher level of CKMB will be the higher MPO, MMP-9 and cTnT. There were strong correlation between MPO and MMP-9, also between CKMB and Troponin T. Troponin T and CKMB were lower in inferior wall infarction compared with anterolateral/anteroseptal wall infarction.  The most sensitive biochemical marker in patients with AMI is the MMP-9. The MMP-9 usage is suggested to assist the diagnosis of AMI. It is suggested a further study to establish the specificity of MMP-9 in all patients suffering with chest pain.       Pasien yang datang dengan nyeri dada di instalasi rawat darurat, biasanya diperiksa petanda jantungya, bukan hanya untuk mendiagnosis IMA akut, tetapi juga untuk menyingkirkan keberadaan IMA. Petanda yang umum digunakan adalah CKMB dan cTnT, yaitu sebagai petanda kematian jaringan otot jantung (nekrosis miokard). Beberapa petanda lain yang telah ditemukan belakangan ini berhubungan dengan penyakit faali (patofisiologi) sebelum IMA terjadi, antara lain MPO dan MMP-9, sebagai petanda destabilisasi plak. Penelitian ini bertujuan untuk menganalisis kegiatan CKMB, MPO, MMP-9 dan kadar cTnT pada IMA akut.       Penelitian dilakukan di Cardiovascular Center Unit (CVCU) dan Ruang Perawatan Penyakit Dalam RSUP Dr. Wahidin Sudirohusodo. Pemeriksaan laboratorik dilakukan di Instalasi Laboratorium Patologi Klinik RSUP dr. Wahidin Sudirohusodo, Makassar dan Unit Riset dan Esoterik Laboratorium Klinik Prodia Kramat, Jakarta. Penelitian bersifat potong silang (cross sectional) yang dilakukan selama masa waktu April-Agustus 2010.       Hasil telitian terhadap 53 subjek IMA akut menunjukkan nilai tengah CKMB, cTnT, MPO dan MMP-9 berturut-turut adalah 52,4 U/L, 2,0 ng/mL, 217,9 ng/mL dan 920,3 ng/mL. Kadar MMP-9 memiliki nilai positif (69,8%), lebih tinggi bila dibandingkan dengan cTnT (60,4%), MPO (58,5%) dan CKMB (45,3%). Kadar cTnT dan MMP-9 lebih tinggi daripada penderita dengan CKMB yang tinggi. Semakin tinggi CKMB, semakin tinggi pula kadar MPO, MMP-9 dan cTnT. Kenasaban MPO dengan MMP-9, serta CKMB dengan cTnT adalah yang paling kuat. Kadar CKMB dan cTnT lebih rendah di jaringan mati bawah (infark inferior) daripada jaringan mati samping depan (infark anterolateral)/sekat depan (anteroseptal).       Kepekaan MMP-9 tertinggi dibandingkan petanda lain, sehingga perlu dipertimbangkan penggunaan MMP-9 untuk membantu menetapkan diagnosis IMA akut. Disarankan meneliti lebih lanjut untuk menguji kekhasan MMP-9 di semua kasus dengan keluhan nyeri dada.

Keyword :

Myocardial infarction, biochemical markers, CKMB, troponin T, MPO,


References :

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