| Abstrakt: |
Nutritional status of surgical patients is widely assessed using anthropometrics, visceral proteins, and urinary nitrogen losses. Since assay of muscle-specific marker 3-methylhistidine (3MH) is currently limited to research laboratories, routine use of serum creatinine phosphokinase (CPK) and myoglobin is potentially useful in monitoring nutritional repletion of stressed patients. An acute and a temporal phase human studies were done to test this hypothesis. After an overnight fast, nondiabetic, noncardiac patients were given an IVGTT (0.5 g/kg) 3 days after a standard abdominal midline operation. Glucose, insulin, total CPK, myoglobin, and 3-methylhistidine were measured serially. Baseline CPK was elevated threefold above normal range of upper limits, whereas myoglobin was at the upper limit of normality. After the IVGTT insulin rose, (P less than 0.005) and CPK and 3MH fell (P less than 0.005) whereas myoglobin rose and remained elevated throughout the study (P less than 0.05). As long as insulin levels remained elevated, CPK remained depressed. With sufficient TPN to induce positive nitrogen balance (35 kcal and 0.2 g N/kg/day), elevated CPK levels fell and remained depressed in direct correlation with elevated insulin. Greater than 95% of total serum CPK consisted of the isoenzyme CPK-MM. These initial studies indicate that total serum CPK is useful in monitoring the short-term responses of postoperative catabolic patients who receive nutritional repletion. |
