床旁即时检测仪用于野外军训检测尿液肌红蛋白的应用研究

史文杰; 李春宝; 张春燕; 张朋军; 蒋涛; 许璐; 张蔓丽; 崔佳奕; 桑培培; 程昱璇; 檀旭东; 舒杨; 张民杰; 朱雨; 孙荣距; 田亚平

doi:10.3969/j.issn.2095-5227.2020.12.003

床旁即时检测仪用于野外军训检测尿液肌红蛋白的应用研究

Point-of-care testing for detection of urine myoglobin in field training

摘要

摘要:
目的分析野外军训中床旁即时检测仪(point of care testing，POCT)检测尿液肌红蛋白(myoglobin，Mb)的应用价值。
方法选取2019年10月8 - 10月19日某军校参加野外军训的新学员，采集其第1天训练后和最后1天训练后的血清和尿液样本，比较第1天和最后1天训练后的血清Mb和尿液Mb；以血清肌酸激酶(creatine kinase，CK)为检测肌肉损伤的标准，比较第1天训练后血清Mb与尿液Mb的敏感度和准确度。
结果 65名新学员，均为男性，平均年龄18岁。相较于第1天，最后1天训练后POCT仪检测的尿液Mb水平明显下降(下降90.4%)，差异有统计学意义(P＜0.01)。第1天训练后，血清检测CK阳性40例，血清Mb阳性2例，POCT仪检测尿液Mb阳性19例；血清Mb诊断肌肉损伤的敏感度为5.0%，显著低于尿液Mb的敏感度47.5%（P<0.001）；血清Mb和尿液Mb的特异性均为100%；血清Mb的准确度小于尿液Mb的准确度(41.5% vs 67.7%, P =0.003)。
结论相较于检测血清Mb，POCT仪检测尿液Mb敏感度和准确度更高，且尿液样本获取方便，POCT仪容易携带，因此POCT仪检测尿液Mb适用于野外军训条件下身体训练状态的预警监测。

Abstract:
Objective To analyze the application value of the point of care testing (POCT) in detecting urine myoglobin (Mb) in cadet during field training.
Methods We enrolled new cadets from one university who took part in field training from October 8, 2019 to October 19, 2019. All cases were male with mean age of 18 years. The serum and urine specimen in 65 cases were collected after the first day training and the last day training, and then the serum Mb and urine Mb were also compared between the first day training and the last day training. Serum creatine kinase (CK) was used as the standard of muscle damage to compare the sensitivity and accuracy of serum Mb and urine Mb after the first day training.
Results Totally 65 cadets were selected. All the cases were male with mean age of 18 years. Using POCT, urine Mb level of the last day decreased by 90.4% compared with the first day, with significant difference (P < 0.001). After first day training, serum CK is positive in 40 cases, serum Mb was positive in 2 cases, and urine Mb was positive in 19cases. The sensitivity of serum Mb was 5.0%, less than that of urine Mb (47.5%. P<0.001); the specificity of serum and urine Mb was 100%; and the accuracy of serum Mb was 41.5%, less than that of urine Mb (67.7%, P=0.003).
Conclusion Compared with the biochemical test of serum myoglobin, the POCT test of urine myoglobin have the advantages of high sensitivity and high accuracy. The urine sample is easy to obtain, and the POCT instrument is easy to carry. Therefore, testing urine Mb by POCT is worthy to apply in the monitoring of physical tstatus in field training.

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