Abstract
Introduction: Creatine kinase-MB (CK-MB) is considered as sensitive and specific indicator for myocardial infarction. Various methods are available for CK-MB measurement but are associated with inherent shortcomings. The routinely used Immunoinhibition method is evaluated for the various interferents and their impact on the estimated CK-MB value. Materials and Methods: The CK-MB values were analyzed for 500 patient samples whose total CK values were within the normal reference interval. Immunoinhibition method (INH) & N-Acetylcysteine (NAC) methods were used for CK-MB and total CK estimation respectively. Results: The observed mean + S.D. for CK was 90.15 + 48.9 U/L and for CK-MB was 33.29 + 20.47 U/L. The box and whisker plots were used to represent the data of CK & CK-MB. The CK-MB levels were observed to exceed the total CK under certain circumstances owing to interferents. The CK-MB values were observed to exceed the total CK in 8.6% of the cases. Conclusion: The utility of CK-MB has ever been questioned. It has been categorized as over-used test. The conventional immunoassay methodology for CK-MB measurement is not free from interferences, awareness about these is important while interpreting the results so as to exclude method related artifactual values.
Highlights
Creatine kinase-MB (CK-MB) is considered as sensitive and specific indicator for myocardial infarction
It is known as creatine phosphokinase. 1,2 CK is found in high concentration in skeletal muscles, heart, urinary bladder, intestinal tract, brain, uterus and in lower concentrations in lung, liver, kidney and prostate. 1,2 It is a dimer consisting of two subunits which is either M (Muscle) or B (Brain)
The box and whisker plot obtained for CK & CK-MB values is represented in Figures 1 and 2 respectively
Summary
Creatine kinase-MB (CK-MB) is considered as sensitive and specific indicator for myocardial infarction. 2. The creatine kinase isoenzyme CKMB is cardio-specific and is accepted as the most sensitive and specific indicator of myocardial cell necrosis. Various methods have been utilized for assaying the creatine kinase MB isoenzyme. These methods can be broadly categorized as those measuring CKMB activity concentration which are - Electrophoresis, Ionexchange chromatography, Immunoinhibition (INH) and Immunoprecipitation. 12,13 In our laboratory set-up the CKMB isoenzyme is analyzed using Immunoinhibition method in which an antibody is directed against the M subunit of CK-MB. This study is an attempt to evaluate the extent of interference associated with Immunoinhibition method used for CKMB assay and to assess the possible reasons for erroneous results obtained during the routine investigations
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