Expert consensus on the diagnosis, treatment, and management of abnormal creatine kinase (2025)
-
摘要: 肌酸激酶异常是一种常见的临床问题, 病因复杂且缺乏系统性临床研究数据, 影响患者身心健康, 给社会带来较大的经济负担。本共识由全科医学、心血管病学、检验医学等多学科专家共同撰写, 详细论述了肌酸激酶异常的定义、分类、流行病学、病因与病理生理机制, 全面总结了肌酸激酶异常的诊断方法, 包括详细问诊、体格检查和评估, 具体阐述了肌酸激酶异常的个体化治疗原则和治疗措施。共识还强调了肌酸激酶异常的社区综合管理, 包括筛查、风险评估、随访、分级转诊、健康教育等, 同时从人工智能和精准医学在肌酸激酶异常诊疗中的应用等方面提出了肌酸激酶异常诊治与管理的未来方向, 旨在为规范开展肌酸激酶异常诊治和全程管理提供帮助和指导。Abstract: Abnormal creatine kinase (CK) levels represent a prevalent clinical problem with diverse and complex etiologies, for which systematic clinical research evidence remains limited. This condition not only adversely affects patients' physical and mental health but also imposes a substantial economic burden on society. This consensus statement was collaboratively drafted by multidisciplinary panel of experts in general practice, cardiovascular disease, and laboratory medicine. It provides a comprehensive overview of the definition, classification, epidemiology, etiology, and pathophysiological mechanisms underlying CK abnormalities. Furthermore, it elaborates on standardized diagnostic strategies, encompassing patient history-taking, physical examinations, and appropriate auxiliary assessments. Additionally, individualized treatment principles and specific therapeutic measures for CK abnormalities are systematically outlined. The consensus also underscores the importance of comprehensive community-based management strategies for CK abnormalities, including screening, risk assessment, follow-up care, tiered referral systems, and health education. Moreover, it proposes future directions for the diagnosis, treatment, and management of CK abnormalities, drawing on the applications of artificial intelligence and precision medicine in CK diagnostics and therapeutics. The ultimate goal is to offer guidance for the standardized diagnosis, treatment, and holistic management of CK abnormalities in clinical practice.
-
Key words:
- Abnormal creatine kinase /
- Diagnosis /
- Treatment /
- Management /
- Expert consensus
-
图 1 肌酸激酶异常社区管理流程图
Figure 1. Flow chart of community management for abnormal creatine kinase
表 1 引起CK升高的常见药物及毒素
Table 1. Common drugs and toxins causing CK elevation
项目 类别 相关药物/毒素 药物 降脂药物 阿托伐他汀、瑞舒伐他汀、洛伐他汀、辛伐他汀、普伐他汀、氟伐他汀等他汀类降脂药，非诺贝特、苯扎贝特、氯贝特、非诺贝酸等贝特类降脂药 糖皮质激素 甲泼尼龙、泼尼松、地塞米松等 抗甲状腺药物 甲巯咪唑、丙硫氧嘧啶等 抗疟疾药物 氯喹、羟氯喹等 抗炎镇痛药物 秋水仙碱、布洛芬、塞来昔布、阿司匹林、对乙酰氨基酚等 化疗药物 多柔比星、表柔比星、柔红霉素等蒽环类化疗药物 免疫抑制剂 干扰素-α/β、TNF-α阻滞剂、青霉胺、他克莫司、环孢素等 抗精神病药物 氟哌啶醇、氯丙嗪、氟奋乃静、奥氮平、利培酮、喹硫平、氯氮平等 麻醉药物 氟烷、异氟烷、七氟烷、可卡因等 抗心律失常药物 胺碘酮、普萘洛尔等 抗生素 左氧氟沙星、莫西沙星等喹诺酮类 利尿剂 呋塞米、氢氯噻嗪等 毒素 蛇毒 神经毒素(如银环蛇毒)、细胞毒素(如眼镜蛇)、出血毒素(如五步蛇毒)、混合毒素(如眼镜王蛇毒) 蜂毒 蜜蜂、胡蜂等 毒蕈 鹅膏菌属、环柄菇、亚稀褶红菇等 有机磷农药 敌敌畏、乐果等 重金属及工业溶剂 铅、汞、砷、电池制造工人暴露、苯四氯化碳等 酒精 工业酒精、医用酒精、食用酒精等 有毒气体 CO 
下载: 导出CSV
表 2 CK异常的RICE问诊
Table 2. RICE inquiry for abnormal CK
问诊内容 提示信息 1.患者本次就诊的主要原因(reason)是什么？ 明确为何行CK检查及有无临床症状 2.患者认为自己出了什么问题(idea)？ 进一步探寻CK异常背后的可能原因 3.患者担忧(concern)什么？ 倾听患者内心的真实需求 4.患者期望(expectation)医生可以帮助他做些什么？ 了解患者对诊疗方面的意见，推动医患共同制定科学的治疗决策
下载: 导出CSV
表 3 CK异常的临床预警征及可能的急危重病因[1, 46]
Table 3. Clinical warning signs of abnormal CK and its possible acute critical etiologies
临床预警征 可能的急危重病因 肌肉剧痛、乏力、茶色尿 横纹肌溶解综合征等 对称性近端肌无力(如抬臂、爬楼困难) 多发性肌炎等 眼睑紫红色皮疹 皮肌炎等 肌无力不对称(如手指屈曲无力) 包涵体肌炎等 肌肉萎缩，伴随步态异常(如鸭步)、腓肠肌假性肥大 进行性肌营养不良等 运动后出现肌肉痉挛、无力 代谢性肌病等 胸痛、胸闷 急性心肌梗死 心悸、呼吸困难 急性心力衰竭 心悸、呼吸困难、心律失常 重症心肌炎 强直-阵挛发作，肌肉抽搐 癫痫发作等 突发头痛、偏瘫、意识障碍 急性脑卒中、颅脑损伤等 畏寒、疲劳、黏液性水肿 甲状腺功能减退症等 怕热多汗、心慌手抖、烦躁易怒 甲状腺功能亢进症等 多饮、多食、多尿伴意识改变 糖尿病酮症酸中毒、糖尿病高渗状态等 周期性麻痹 低钾血症等 CK升高超过参考区间上限10倍以上(>10 ULN) 急性、大量肌肉坏死；急性心肌梗死等
下载: 导出CSV
表 4 CK异常的体格检查
Table 4. Physical examination for abnormal CK
体格检查 体征项目 体征表现 可能的疾病 一般情况评估 体温 升高 全身感染性疾病、甲状腺功能亢进症、热射病等 降低 休克、甲状腺功能减退症、营养不良症、低温损伤等 心率 增快 全身感染性疾病、甲状腺功能亢进症、心力衰竭、哮喘等 降低 甲状腺功能减退症、心律失常等 血压 降低 全身感染性疾病、休克、心力衰竭等 精神 萎靡 全身感染性疾病、甲状腺功能减退症等 呼吸 增快 全身感染性疾病、哮喘、甲状腺功能亢进症等 皮肤 红斑、皮疹 皮肌炎、系统性红斑狼疮等风湿免疫性疾病 重点查体 肌肉系统检查-骨骼肌 肌肉变小、周径减少 肌营养不良症等疾病所致的肌肉萎缩 肌肉体积增大 真性肥大(如运动员)、假性肥大(如肌营养不良症)等 双侧肌肉不对称，萎缩或肥大 遗传性肌病(如进行性肌营养不良等)、单侧神经损伤、局部肌肉损伤或者炎症等 肌肉不自主的细小颤动 神经源性损害、甲状腺疾病等 肌肉压痛、触痛 炎症性肌病等疾病、他汀类等药物所致的肌损伤 关节活动度受限、伴肿胀或疼痛 炎症性肌病、类风湿关节炎、系统性红斑狼疮等风湿免疫性疾病 轻瘫试验阳性 脑卒中、脑出血、多发性硬化等神经病变 肌肉系统检查-平滑肌 肾区叩痛 肾结石引发的肾绞痛、或肾结石体外冲击波碎石术后等 耻骨上叩浊 膀胱尿潴留 肠鸣音亢进 肠道感染、肠梗阻、甲状腺功能亢进症、剧烈运动、药物等 肠鸣音减弱 腹腔感染、电解质紊乱、炎症性肌病、甲状腺功能减退症等 神经系统检查 痛觉、触觉、温度觉等深浅感觉异常 吉兰-巴雷综合征、脊髓肿瘤、脑卒中、糖尿病酮症酸中毒 腱反射亢进、减弱或消失 糖尿病酮症酸中毒、脊髓空洞症、神经肌肉疾病等 肌张力升高或降低 脑卒中、脑瘫(儿童多见)等或遗传性肌病、炎症性肌病、脊髓损伤等 心脏检查 心尖搏动减弱 心律失常或心力衰竭、急性心肌炎、扩张性心肌病、冠心病等 心音减弱 心力衰竭、急性心肌炎、扩张性心肌病、肥厚性心肌病等 心音强弱不等 二尖瓣狭窄或关闭不全引发心房颤动等 有杂音 心脏瓣膜疾病或心肌病变等
下载: 导出CSV
表 5 CK异常的辅助检查
Table 5. Auxiliary examinations for abnormal CK
辅助检查 项目 可能的疾病 实验室检查 血常规 感染性疾病(细菌、病毒感染)等 C反应蛋白、红细胞沉降率 感染性疾病、结缔组织病、肿瘤等 血生化(肝功能、肾功能、电解质、血糖、血脂、血尿酸等) 糖尿病(结合糖化血红蛋白)、脂代谢异常、痛风等相关肌损伤，心肌损伤、横纹肌溶解、中暑等 心肌酶谱[(CK-MB、高敏肌钙蛋白(HS-CTN)等] 急性心肌梗死、心肌炎等 甲状腺功能 甲状腺功能亢进症、甲状腺功能减退症 肌炎抗体谱 抗核抗体(ANA) 炎症性肌病 肌炎特异性抗体(MSA) 自身免疫性肌病 肌炎相关抗体(MAA) 其他结缔组织病 尿试纸 横纹肌溶解 基因检测 PYGM基因突变 MCARDLE病(糖原贮积症Ⅴ型) CPT-Ⅱ基因突变 CPT-Ⅱ缺乏症(肉碱棕榈酰转移酶Ⅱ缺乏症) 影像学检查 心电图 心肌缺血、心肌梗死及心肌炎等 心脏彩超 心肌缺血、心肌梗死及心肌炎等 肌肉灰阶超声 横纹肌溶解等 肌肉MRI 急、慢性肌炎、肌营养不良症、横纹肌溶解等 肌电图 肌源性与神经源性损害 组织病理学 肌肉活检 肌营养不良症、线粒体肌病、免疫性肌炎等
下载: 导出CSV
人群 常见原因 CK升高的幅度 注意事项 新生儿 生理性升高 多为轻度升高 正常新生儿在出生后24 h内有CK生理性升高，其升高程度与分娩方式相关，应与新生儿肌肉疾病鉴别 病理性升高 CK-MB中重度升高 提示胎儿期或出生过程中经历应激如新生儿围产期窒息 持续性高CK血症 可表现为无症状或症状轻微，如遗传性肌病等 儿童 儿童急性良性肌炎 CK轻度升高 病毒性心肌炎等 代谢性疾病 CK中重度升高 排除代谢性疾病所致的肌肉损伤，同时排除糖原积累病、脂质代谢障碍、线粒体病及Duchenne型肌营养不良 遗传性肌病 CK持续升高 进行基因检测以排除肌营养不良等疾病 运动人群 生理性升高 CK短暂升高 高强度运动后出现，需结合运动负荷试验观察动态变化 病理性升高 短期内CK急剧升高 严重时发生横纹肌溶解，可能出现肌红蛋白尿(尿液呈酱油色或浓茶色)和急性肾损伤 孕妇 生理性升高 轻度升高 妊娠期血容量增加及孕期激素水平变化可能导致CK波动需结合孕早期、中期、晚期动态监测 病理性升高 CK-MB占比超过总CK的5%~6% 需警惕心肌损伤(如心肌病、肌肉疾病) 老年人群 生理性 以CK下降多见 老年人肌肉萎缩可能导致CK水平偏低，需结合年龄校正参考值 病理性升高 CK轻度升高 估算肾小球滤过率(eGFR)＜60 mL/(min·1.73 m2)者需警惕肌酸蓄积，根据eGFR调整肌酸参考值 CK中重度升高 心肌梗死、横纹肌溶解症、慢性疾病(如甲状腺功能减退症)或药物副作用(如他汀类药物)
下载: 导出CSV
表 7 肌酸激酶异常四色分组及随访措施
Table 7. Four-color classification and follow-up measures for abnormal creatine kinase
四色分组 分组标准(CK倍数)及特征 风险特征 关键临床评估与修正因素 随访措施 蓝色组 CK正常，但既往曾有升高或目前具有高危因素或CK减少者 需预防性管理 重点评估：高危因素(如他汀类药物使用、家族史、甲状腺功能异常史)。注意：对于急性起病(如胸痛)患者，即使CK正常，也需结合心电图、肌钙蛋白等动态评估，不可因CK正常而排除急症。 健康教育、避免诱因。每6个月复查CK。CK减少者：定期复查CK趋势，同时监测体重、白蛋白、BMI等营养指标及肌肉功能变化。 黄色组 CK轻度升高(1.5~5.0倍ULN) 需警惕进展 重点评估：明确病因。询问近期运动史、药物史、感染史、有无轻微肌痛或乏力。鉴别诊断：剧烈运动、药物性肌损伤、甲状腺功能减退、早期肌病等。 病因筛查(甲状腺功能、肌炎抗体等)。监测CK变化。每2周复查，直至恢复正常或诊断明确。 橙色组 CK中度升高(5.0~10.0倍ULN) 横纹肌溶解风险 重点评估：有无横纹肌溶解的征象(如明显肌痛、肿胀、乏力、茶色/酱油色尿)。紧急处理：若伴有肌红蛋白尿或肾功能受损迹象，应立即升级为红色组管理。 社区首诊后建议转诊至专科(神经内科、肾内科等)。康复期密切随访。每周复查CK、肾功能、电解质。 红色组 1.CK重度升高(＞10.0倍ULN)；2.无论CK值，但凡存在急性心肌梗死的典型症状/体征/心电图证据或急性横纹肌溶解伴急性肾损伤、高钾血症等 多器官功能障碍风险 立即进行全面的临床评估：生命体征、意识状态、尿量、心电图、肾功能、电解质等。核心原则：处理原发病和即刻的生命威胁优先于降低CK本身。 立即转诊至急诊或相应专科。多学科协同救治(心内科、肾内科、神经内科、ICU等)。出院后每周随访，长期管理原发病。
下载: 导出CSV
表 8 特定人群CK异常管理要点
Table 8. Key management points for abnormal CK in special populations
人群 管理原则与优先任务 社区管理关键措施 新生儿 区分生理性与病理性升高，警惕遗传性疾病 如有围产期窒息史，密切监测CK-MB变化；若CK持续升高，建议遗传咨询并安排基因检测 儿童 关注病毒感染后肌炎与遗传性肌病，监测生长发育 CK持续升高需进行基因检测；指导家长识别肌无力等警示症状；保证充足蛋白质与热量摄入，避免高糖饮料；鼓励适度活动(如慢跑、散步)，避免高强度或对抗性运动 运动人群 区分运动后生理反应与运动性横纹肌溶解 指导循序渐进训练、充分热身与补水；出现茶色尿、持续肌痛等症状时及时转诊 育龄期妇女(含孕妇) 优生优育、降低妊娠风险 对有家族史或CK持续升高者主动提供孕前遗传咨询，评估遗传风险；多学科评估妊娠时机；保证孕期营养(蛋白质、铁和叶酸)；孕期鼓励轻度运动，避免腹部外伤；教育识别肌肉痉挛、视力变化等警示症状，警惕子痫前期等产科并发症 老年人 优先排查心源性事件，重视药物影响与跌倒风险 掌握紧急转诊指征，关注共病、多重用药与功能状态；加强营养支持与平衡训练；进行家庭安全评估防跌倒；评估并优化用药方案
下载: 导出CSV
-
[1] KYRIAKIDES T, ANGELINI C, SCHAEFER J, et al. EFNS guidelines on the diagnostic approach to pauci-or asymptomatic hyperCKemia[J]. Eur J Neurol, 2010, 17(6): 767-773. doi: 10.1111/j.1468-1331.2010.03012.x [2] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 4版. 北京: 人民卫生出版社, 2015: 287-288, 398-399.SHANG H, WANG Y S, SHEN Z Y. National Clinical Laboratory Procedures[M]. 4th ed. Beijing: People's Medical Publishing House, 2015: 287-288, 398-399. [3] 国家卫生和计划生育委员会. 临床常用生化检验项目参考区间第7部分: 血清乳酸脱氢酶、肌酸激酶: WS/T 404.7-2015[S]. 北京: 中国标准出版社, 2015.National Health and Family Planning Commission of the People's Republic of China. Clinical Common Biochemical Test Items Reference Intervals—Part 7: Serum Lactate Dehydrogenase, Creatine Kinase: WS/T 404.7-2015[S]. Beijing: Standards Press of China, 2015. [4] 吉林省卫生健康委员会. 0~3天新生儿血清乳酸脱氢酶; 肌酸激酶; 肌酸激酶同工酶MB参考区间: DB22/T 3164-2020[S]. 2020.Jilin Provincial Health Commission. Reference Intervals of Serum Lactate Dehydrogenase, Creatine Kinase and Creatine Kinase Isoenzyme MB for Neonates Aged 0-3 Days: DB22/T 3164-2020[S]. 2020. [5] 万学红, 卢雪峰. 诊断学[M]. 10版. 北京: 人民卫生出版社, 2024: 374-375.WAN X H, LU X F. Diagnostics[M]. 10th ed. Beijing: People's Medical Publishing House, 2024: 374-375. [6] VENANCE S L. Approach to the patient with hyperCKemia[J]. Continuum(Minneap Minn), 2016, 22(6): 1803-1814. [7] 班努·库肯, 吐尔逊·阿克木. 某三甲医院527例肌酸激酶升高病因构成和特点分析[J]. 临床合理用药杂志, 2020, 13(9): 173-175.Bannu·Kuken, Aerxu·Akmu. Etiological composition and characteristics analysis of elevated creatine kinase in 527 cases from a tertiary grade a hospital[J]. Journal of Clinical Rational Drug Use, 2020, 13(9): 173-175. [8] 袁玉静, 刘畅, 谢志颖, 等. 无症状和轻症高肌酸激酶血症临床及组织病理学特征分析[J]. 中国现代神经疾病杂志, 2023, 23(9): 782-788.YUAN Y J, LIU C, XIE Z Y, et al. Clinical and histopathological characteristics of asymptomatic and mild hypercreatinemia[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(9): 782-788. [9] 郑晓仙. 生化检测中肌酸激酶同工酶高于肌酸激酶的原因分析[J]. 吉林医学, 2024, 45(5): 1093-1096.ZHENG X X. Analysis of causes of creatine kinase isoenzyme higher than creatine kinase in biochemical tests [J]. Jilin Medical Journal, 2024, 45(5): 1093-1096. [10] GEORGE M D, MCGILL N K, BAKER J F. Creatine kinase in the U.S. population: impact of demographics, comorbidities, and body composition on the normal range[J]. Medicine (Baltimore), 2016, 95(33): e4344. DOI: 10.1097/MD.0000000000004344. [11] MAHMUTYAZICIOGLU J, NASH J, CLEVES A, et al. Is it necessary to adjust current creatine kinase reference ranges to reflect levels found in professional footballers?[J]. BMJ Open Sport Exerc Med, 2018, 4(1): e000282. DOI: 10.1136/bmjsem-2017-000282. [12] PANG X R, GE M. Effect of geographical factors on reference values of creatine kinase isoenzyme[J]. Int J Biometeorol, 2023, 67(4): 553-563. doi: 10.1007/s00484-023-02429-z [13] ZHANG Y, ZHENG P, SHI J Q, et al. Associations of ambient temperature with creatine kinase MB and creatine kinase: a large sample time series study of the Chinese male population[J]. Sci Total Environ, 2023, 880: 163250. DOI: 10.1016/j.scitotenv.2023.163250. [14] MOGHADAM-KIA S, ODDIS C V, AGGARWAL R. Approach to asymptomatic creatine kinase elevation[J]. Cleve Clin J Med, 2016, 83(1): 37-42. doi: 10.3949/ccjm.83a.14120 [15] ALEKSOVSKA K, KYRIAKIDES T, ANGELINI C, et al. What are the normal serum creatine kinase values for skeletal muscle? A worldwide systematic review[J]. Eur J Neurol, 2025, 32(6): e70240. DOI: 10.1111/ene.70240. [16] MUSAI J, MAMMEN A L, PINAL-FENANDEZ I. Recent updates on the pathogenesis of inflammatory myopathies[J]. Curr Rheumatol Rep, 2024, 26(12): 421-430. doi: 10.1007/s11926-024-01164-7 [17] PUELACHER C, GUALANDRO D M, GLARNER N, et al. Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery[J]. Eur Heart J, 2023, 44(19): 1690-1701. doi: 10.1093/eurheartj/ehac798 [18] 张颖. 肌钙蛋白Ⅰ、肌红蛋白和肌酸激酶同工酶检测在急性心肌梗死诊断中的价值[J]. 中国实用医刊, 2019, 46(11): 43-45.ZHANG Y. Value of troponin I, myoglobin and creatine kinase isoenzyme MB detection in the diagnosis of acute myocardial infarction[J]. Chinese Journal of Practical Medicine, 2019, 46(11): 43-45. [19] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 非ST段抬高型急性冠脉综合征诊断和治疗指南(2024)[J]. 中华心血管病杂志, 2024, 52(6): 615-646.Chinese Society Of Cardiology, Chinese Medical Association; Editorial Board Of Chinese Journal Of Cardiology. Guidelines for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome (2024)[J]. Chinese Journal of Cardiology, 2024, 52(6): 615-646. [20] 李岳华, 黄洁. 心肌炎的诊断、治疗与预后[J]. 中华心力衰竭和心肌病杂志, 2022, 6(4): 330-334.LI Y H, HUANG J. Diagnosis, treatment and prognosis of myocarditis[J]. Chinese Journal of Heart Failure and Cardiomyopathy, 2022, 6(4): 330-334. [21] 吕和平, 倪海真, 黄景勇, 等. 肌酸激酶及CT血管造影检查评估肠系膜上动脉栓塞的短期预后[J]. 中华消化外科杂志, 2016, 15(8): 840-844.LYU H P, NI H Z, HUANG J Y, et al. Evaluation of short-term prognosis of superior mesenteric artery embolism by creatine kinase and CT angiography[J]. Chinese Journal of Digestive Surgery, 2016, 15(8): 840-844. [22] 王渭鉴, 陈慧. 甲状腺功能减退相关性肌酸激酶升高的研究进展[J]. 国际检验医学杂志, 2024, 45(9): 1141-1144, 1152.WANG W J, CHEN H. Research progress on elevated creatine kinase associated with hypothyroidism[J]. International Journal of Laboratory Medicine, 2024, 45(9): 1141-1144, 1152. [23] DÍAZ-LÓPEZ E J, VILLAR-TAIBO R, RODRIGUEZ-CARNERO G, et al. Should we suspect primary aldosteronism in patients with hypokalaemic rhabdomyolysis? A systematic review[J]. Front Endocrinol, 2023, 14: 1257078. DOI: 10.3389/fendo.2023.1257078. [24] 柳彬彬, 母玉洁, 张琨, 等. 糖尿病酮症酸中毒合并高渗高血糖状态致横纹肌溶解1例[J]. 中华糖尿病杂志, 2022, 14(9): 977-979.LIU B B, MU Y J, ZHANG K, et al. A case of rhabdomyolysis caused by diabetic ketoacidosis complicated with hyperosmolar hyperglycemic state[J]. Chinese Journal of Diabetes Mellitus, 2022, 14(9): 977-979. [25] 中华医学会神经病学分会, 中华医学会神经病学分会神经肌肉病学组. 成人晚发型糖原累积病Ⅱ型(蓬佩病)诊疗中国专家共识[J]. 中华神经科杂志, 2021, 54(10): 994-1000.Chinese Society of Neurology, Chinese Medical Association; Neuromuscular Disease Group, Chinese Society Of Neurology. Chinese Expert Consensus on Diagnosis and Treatment of Adult Late-Onset Glycogen Storage Disease Type Ⅱ (Pompe Disease)[J]. Chinese Journal of Neurology, 2021, 54(10): 994-1000. [26] 中华医学会神经病学分会, 中华医学会神经病学分会神经肌肉病学组, 中华医学会神经病学分会肌电图及临床神经生理学组. 中国脂质沉积性肌病诊治专家共识[J]. 中华神经科杂志, 2015, 48(11): 941-945.Chinese Society of Neurology, Chinese Medical Association; Neuromuscular Disease Group, Chinese Society of Neurology; Electromyography And Clinical Neurophysiology Group, Chinese Society of Neurology. Chinese Expert Consensus on Diagnosis and Treatment of Lipid Storage Myopathy[J]. Chinese Journal of Neurology, 2015, 48(11): 941-945. [27] WEN H P, DENG H, LI B Y, et al. Mitochondrial diseases: from molecular mechanisms to therapeutic advances[J]. Signal Transduct Target Ther, 2025, 10: 9. DOI: 10.1038/s41392-024-02044-3. [28] 张彦, 邱文娟, 张惠文, 等. 六例肉碱棕榈酰基转移酶2缺乏症患儿临床特征及基因变异分析[J]. 浙江大学学报(医学版), 2024, 53(2): 207-212.ZHANG Y, QIU W J, ZHANG H W, et al. Clinical characteristics and genetic variation analysis of six children with carnitine palmitoyltransferase 2 deficiency[J]. Journal of Zhejiang University (Medical Sciences), 2024, 53(2): 207-212. [29] TWAYANA S, SHARMA V K, RAUT M, et al. Mean serum creatine kinase among organophosphate poisoning cases in a tertiary care centre: a descriptive cross-sectional study[J]. JNMA J Nepal Med Assoc, 2022, 60(254): 881-883. doi: 10.31729/jnma.7692 [30] CALLEN J P. Relationship of cancer to inflammatory muscle diseases. Dermatomyositis, polymyositis, and inclusion body myositis[J]. Rheum Dis Clin North Am, 1994, 20(4): 943-953. doi: 10.1016/S0889-857X(21)00074-0 [31] MAMMEN A L. Paraneoplastic myopathies[J]. Handb Clin Neurol, 2024, 200: 327-332. [32] HILL C L, ZHANG Y, SIGURGEIRSSON B, et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study[J]. Lancet, 2001, 357(9250): 96-100. doi: 10.1016/S0140-6736(00)03540-6 [33] HASSELGREN P O, FISCHER J E. Muscle cachexia: current concepts of intracellular mechanisms and molecular regulation[J]. Ann Surg, 2001, 233(1): 9-17. doi: 10.1097/00000658-200101000-00003 [34] GAO F Y, XU T, ZANG F N, et al. Cardiotoxicity of anticancer drugs: molecular mechanisms, clinical management and innovative treatment[J]. Drug Des Devel Ther, 2024, 18: 4089-4116. doi: 10.2147/DDDT.S469331 [35] 常杏芝. 先天性肌病的诊断与治疗[J]. 中华实用儿科临床杂志, 2016, 31(12): 881-883.CHANG X Z. Diagnosis and treatment of congenital myopathies[J]. Chinese Journal of Applied Clinical Pediatrics, 2016, 31(12): 881-883. [36] LEIVA-CEPAS F, MONTAÑO MARTÍNEZ A, et al. Update on Duchenne muscular dystrophy[J]. Semergen, 2021, 47(7): 472-481. doi: 10.1016/j.semerg.2021.06.008 [37] 唐亮, 陈晓晴, 谭伟强, 等. 应用血肌酸激酶或肌酸激酶MM同工酶筛查新生儿杜氏肌营养不良症的系统评价/Meta分析[J]. 中国循证儿科杂志, 2022, 17(5): 343-349.TANG L, CHEN X Q, TAN W Q, et al. Systematic review/meta-analysis of serum creatine kinase or creatine kinase MM isoenzyme for screening neonatal duchenne muscular dystrophy[J]. Chinese Journal of Evidence-Based Pediatrics, 2022, 17(5): 343-349. [38] HONG K N, ESHRAGHIAN E A, ARAD M, et al. International consensus on differential diagnosis and management of patients with Danon disease: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2023, 82(16): 1628-1647. doi: 10.1016/j.jacc.2023.08.014 [39] YANG B F, LI D, LIU C L, et al. Advances in rhabdomyolysis: a review of pathogenesis, diagnosis, and treatment[J]. Chin J Traumatol, 2025: S1008-S1275(25)00010-0. DOI: 10.1016/j.cjtee.2024.10.005. [40] MASTAGLIA F L. The changing spectrum of drug-induced myopathies[J]. Acta Myol, 2020, 39(4): 283-288. [41] COUTINHO A, FONSECA N, NOVO I, et al. Corticosteroid-induced myopathy[J]. Cureus, 2023, 15(11): e49548. DOI: 10.7759/cureus.49548. [42] OSTROWSKI P, BONCZAR M, AVRAM A E, et al. Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials[J]. Clin Chem Lab Med, 2023, 61(10): 1688-1699. doi: 10.1515/cclm-2023-0313 [43] MATÉ-MUÑOZ J L, LOUGEDO J H, BARBA M, et al. Cardiometabolic and muscular fatigue responses to different CrossFit® workouts[J]. J Sports Sci Med, 2018, 17(4): 668-679. [44] ALZUETA N, MARIN M, CASTRESANA M, et al. Statin-induced autoimmune myopathy: a case report[J]. Eur J Hosp Pharm, 2021, 28(2): 115-117. doi: 10.1136/ejhpharm-2019-002102 [45] MARTI P, PITARCH-CASTELLANO I, MUELAS N, et al. Asymptomatic hyperCKemia in the pediatric population: a prospective study utilizing next-generation sequencing and ancillary tests[J/OL]. Neurology, 2025, 104(1): e210116. DOI: 10.1212/WNL.0000000000210116 .[46] SILVESTRI N J, WOLFE G I. Asymptomatic/pauci-symptomatic creatine kinase elevations (hyperCKemia)[J]. Muscle Nerve, 2013, 47(6): 805-815. doi: 10.1002/mus.23755 [47] 李建萍. 轻微症状/无症状高肌酸激酶血症诊断方法指南解读及最新进展[J]. 神经病学与神经康复学杂志, 2016, 12(2): 64-70.LI J P. Interpretation of guidelines for diagnostic methods and latest progress in mild/asymptomatic hypercreatinemia[J]. Journal of Neurology and Neurorehabilitation, 2016, 12(2): 64-70. [48] ECHANIZ-LAGUNA A, LORNAGE X, LAFORET P, et al. A new glycogen storage disease caused by a dominant PYGM mutation[J]. Ann Neurol, 2020, 88(2): 274-282. doi: 10.1002/ana.25771 [49] BOUGHDAD S, LATIFYAN S, FENWICK C, et al. 68Ga-DOTATOC PET/CT to detect immune checkpoint inhibitor-related myocarditis[J]. J Immunother Cancer, 2021, 9(10): e003594. DOI: 10.1136/jitc-2021-003594. [50] GAUDINO M, JAFFE A S, MILOJEVIC M, et al. Great debate: myocardial infarction after cardiac surgery must be redefined[J]. Eur Heart J, 2024, 45(39): 4170-4177. doi: 10.1093/eurheartj/ehae416 [51] MARZOLA F, VAN ALFEN N, DOORDUIN J, et al. Deep learning segmentation of transverse musculoskeletal ultrasound images for neuromuscular disease assessment[J]. Comput Biol Med, 2021, 135: 104623. DOI: 10.1016/j.compbiomed.2021.104623. [52] RAYNER J J, PETERZAN M A, CLARKE W T, et al. Obesity modifies the energetic phenotype of dilated cardiomyopathy[J]. Eur Heart J, 2021, 43(9): 868-877. [53] MIGLIORE B A, ZHOU L R, DUPARC M, et al. Evaluation of the GSP creatine kinase-MM assay and assessment of CK-MM stability in newborn, patient, and contrived dried blood spots for newborn screening for Duchenne muscular dystrophy[J]. Int J Neonatal Screen, 2022, 8(1): 12. DOI: 10.3390/ijns8010012. [54] PARK S, MALONEY B, CAGGANA M, et al. Creatine kinase-MM concentration in dried blood spots from newborns and implications for newborn screening for Duchenne muscular dystrophy[J]. Muscle and Nerve, 2022, 65(6): 652-658. doi: 10.1002/mus.27533 [55] GOZDE KANMAZ KUTMAN H, KADIOGLU ŞIMSEK G, CERAN B, et al. Troponin I, CK-MB, and inotropic score in hypoxic-ischemic encephalopathy and associated infant mortality[J]. BMC Pediatrics, 2023, 23(1): 511. DOI: 10.1186/s12887-023-04311-8. [56] 蔡科达, 郑晓彤, 林智摸, 等. 岭南头皮针对小儿脑瘫患者血清VEGF、CK-BB及运动功能的影响[J/OL]. 中华中医药学刊, 2025: 1-7. (2025-07-04). [2025-11-23]. https://link.cnki.net/urlid/21.1546.R.20250704.1521.014.html .CAI K D, ZHENG X T, LIN Z M, et al. Effect of lingnan scalp acupuncture on serum VEGF, CK-BB and motor function in children with cerebral palsy[J/OL]. Chinese Archives of Traditional Chinese Medicine, 2025: 1-7. (2025-07-04). [2025-11-23].https://link.cnki.net/urlid/21.1546.R.20250704.1521.014.html .[57] MAJAVA E, RENKO M, KUITUNEN I. Benign acute childhood myositis: a scoping review of clinical presentation and viral etiology[J]. Eur J Pediatr, 2024, 183(11): 4641-4647. doi: 10.1007/s00431-024-05786-y [58] SAAD F A, SICILIANO G, ANGELINI C. Advances in dystrophinopathy diagnosis and therapy[J]. Biomolecules, 2023, 13(9): 1319. DOI: 10.3390/biom13091319. [59] 陈曦, 邹琪, 张新超, 等. 老年人横纹肌溶解症的临床特点及病因分析[J]. 中华老年医学杂志, 2021, 40(1): 87-91.CHEN X, ZOU Q, ZHANG X C, et al. Clinical characteristics and etiological analysis of rhabdomyolysis in the elderly[J]. Chinese Journal of Gerontology, 2021, 40(1): 87-91. [60] JEHLE D V, SCHULTZ H, KHATRI R, et al. Creatine kinase elevations and risk of renal failure and dialysis in patients with rhabdomyolysis[J/OL]. Cureus, 2025[2025-09-03]. https://pubmed.ncbi.nlm.nih.gov/40698228/ .[61] 王雨婷, 何燕, 王爱玲. 适度有氧运动联合放松训练对妊娠期高血压患者的影响[J]. 心理月刊, 2025, 20(12): 187-189.WANG Y T, HE Y, WANG A L. Effect of moderate aerobic exercise combined with relaxation training on patients with hypertensive disorder complicating pregnancy[J]. Psychological Monthly, 2025, 20(12): 187-189. [62] MARRUFO-GALLEGOS K C, VILLAFAN-BERNAL J R, ESPINO-Y-SOSA S, et al. Influential serum kinases (non-sFlt-1) and phosphatases in preeclampsia: systemic review and metanalysis[J/OL]. Int J Mol Sci, 2023, 24(16): 12842. DOI: 10.3390/ijms241612842 .[63] BAEZA-TRINIDAD R. Rhabdomyolysis: a syndrome to be considered[J]. Med Clin (Barc), 2022, 158(6): 277-283. doi: 10.1016/j.medcli.2021.09.025 [64] PEARSON A G, HIND K, MACNAUGHTON L S. The impact of dietary protein supplementation on recovery from resistance exercise-induced muscle damage: a systematic review with meta-analysis[J]. Eur J Clin Nutr, 2023, 77(8): 767-783. doi: 10.1038/s41430-022-01250-y [65] XIAO F Y, KABACHKOVA A V, JIAO L, et al. Effects of cold water immersion after exercise on fatigue recovery and exercise performance: meta analysis[J]. Front Physiol, 2023, 14: 1006512. DOI: 10.3389/fphys.2023.1006512. [66] 葛均波, 王辰, 王建安. 内科学[M]. 10版. 北京: 人民卫生出版社, 2024.GE J B, WANG C, WANG J A. Internal Medicine[M]. 10th ed. Beijing: People's Medical Publishing House, 2024. [67] 朱佳宏, 刘颖, 任菁菁. 以乏力为表现的未分化疾病全科诊疗思路[J]. 中华全科医学, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926ZHU J H, LIU Y, REN J J. General practice diagnosis and treatment thinking of undifferentiated diseases presenting with fatigue[J]. Chinese Journal of General Practice, 2023, 21(4): 539-543. doi: 10.16766/j.cnki.issn.1674-4152.002926 [68] 张渝婧, 仉培臻, 奉飘, 等. 脾肾阳虚型慢性疲劳综合征的中医治疗研究进展[J]. 长春中医药大学学报, 2024, 40(10): 1156-1161.ZHANG Y J, ZHANG P Z, FENG P, et al. Research progress of Traditional Chinese Medicine treatment for chronic fatigue syndrome of spleen-kidney Yang Deficiency Type[J]. Journal of Changchun University of Chinese Medicine, 2024, 40(10): 1156-1161. [69] EDWARDS V, VARI C, ROSE M, et al. Participant experiences of guided self-help acceptance and commitment therapy for improving quality of life in muscle disease: a nested qualitative study within the ACTMus randomized controlled trial[J]. Front Psychol, 2023, 14: 1233526. DOI: 10.3389/fpsyg.2023.1233526. [70] BLUM J, EPSTEIN R, WATTS S, et al. Importance of nutrient availability and metabolism for skeletal muscle regeneration[J]. Front Physiol, 2021, 12: 696018. DOI: 10.3389/fphys.2021.696018. [71] HIGGINS M R, IZADI A, KAVIANI M. Antioxidants and exercise performance: with a focus on vitamin E and C supplementation[J]. Int J Environ Res Public Health, 2020, 17(22): 8452. DOI: 10.3390/ijerph17228452. [72] PRADO C M, LANDI F, CHEW S T H, et al. Advances in muscle health and nutrition: a toolkit for healthcare professionals[J]. Clin Nutr, 2022, 41(10): 2244-2263. [73] 中国血脂管理指南修订联合专家委员会. 中国血脂管理指南(基层版2024年)[J]. 中华心血管病杂志, 2024, 52(4): 330-337.Chinese Lipid Management Guideline Revision Joint Expert Committee, WANG Z W, LI J J, et al. Chinese Guidelines for Lipid Management (Primary Care Version 2024)[J]. Chinese Journal of Cardiology, 2024, 52(4): 330-337. [74] CHEN Q, ZHANG J, FENG H, et al. An update on statins: pleiotropic effect performed in intracerebral hemorrhage[J]. Atherosclerosis, 2019, 284: 264-265. doi: 10.1016/j.atherosclerosis.2019.01.020 [75] SHAIKH S, GONZALEZ-ZAPATA A, MUJEEB A, et al. Asymptomatic hyperCKemia: a diagnostic trap[J]. Cureus, 2021, 13(1): e12791. DOI: 10.7759/cureus.12791. [76] SHEHATA R S, RADWAN N A, BAKRY H M, et al. Assessment of serum CK-MM level as a bioindicator for work-related musculoskeletal injuries among emergency hospital workers[J]. Toxicol Ind Health, 2022, 38(1): 11-18. doi: 10.1177/07482337211042727 [77] 庄红艳, 刘珊珊, 杜海霞, 等. 临床药师对1例喹硫平致肌酸激酶重度升高不良反应的监护[J]. 中国药师, 2019, 22(4): 702-704.ZHUANG H Y, LIU S S, DU H X, et al. Monitoring of severe elevation of creatine kinase induced by quetiapine: a case report by clinical pharmacists[J]. Chinese Pharmacist, 2019, 22(4): 702-704. [78] KIM E J, WIERZBICKI A S. Investigating raised creatine kinase[J]. BMJ, 2021, 373: n1486. DOI: 10.1136/bmj.n1486. [79] GEMELLI C, TRAVERSO M, TREVISAN L, et al. An integrated approach to the evaluation of patients with asymptomatic or minimally symptomatic hyperCKemia[J]. Muscle Nerve, 2022, 65(1): 96-104. doi: 10.1002/mus.27448 [80] KANU I M, SULE P C, CHUKWURAH U A, et al. Enhancing health outcomes through community-based health education programs for underserved populations[J]. World J Adv Res Rev, 2024, 24(3): 3260-3283. [81] 冯丽丽, 李芳芳, 郑秀, 等. 健康宣教清单在骨科创伤患者中的应用效果研究[J]. 中国现代医药杂志, 2023, 25(5): 75-78.FENG L L, LI F F, ZHENG X, et al. Study on the application effect of health education checklist in orthopedic trauma patients[J]. Chinese Journal of Modern Medicine, 2023, 25(5): 75-78. [82] 陈春梅, 徐奕胜, 邹春生. 血清CK-MB、NT-proBNP、Cys C联合检测在尿毒症合并心力衰竭中的诊断价值[J]. 中国医学创新, 2025, 22(15): 146-150.CHEN C M, XU Y S, ZOU C S. Diagnostic value of combined detection of serum CK-MB, NT-proBNP and Cys C in uremia complicated with heart failure[J]. Chinese Medical Innovation, 2025, 22(15): 146-150. [83] CHAEMSAITHONG P, GIL M M, CHAIYASIT N, et al. Accuracy of placental growth factor alone or in combination with soluble fms-like tyrosine kinase-1 or maternal factors in detecting preeclampsia in asymptomatic women in the second and third trimesters: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2023, 229(3): 222-247. [84] TIMÓN R, OLCINA G, CAMACHO-CARDEOSA M, et al. 48-hour recovery of biochemical parameters and physical performance after two modalities of CrossFit workouts[J]. Biology of Sport, 2019, 36(3): 283-289. [85] PENDYAL S, KOCH R L, JONES H N, et al. An assessment of dietary intake, feeding practices, growth, and swallowing function in young children with late-onset pompe disease: a framework for developing nutrition guidelines[J]. Nutrients, 2025, 17(11): 1909. DOI: 10.3390/nu17111909. [86] GOKER-ALPAN O, KASTURI V G, SOHI M K, et al. Pregnancy outcomes in late onset pompe disease[J]. Life (Basel), 2020, 10(9): 194. DOI: 10.3390/life10090194. [87] MORIN A G, SOMME D, CORVOL A. Rhabdomyolysis in older adults: outcomes and prognostic factors[J]. BMC Geriatr, 2024, 24(1): 46. DOI: 10.1186/s12877-023-04620-8. [88] KATSIKI N, MIKHAILIDIS D P, BAJRAKTARI G, et al. Statin therapy in athletes and patients performing regular intense exercise-Position paper from the International Lipid Expert Panel(ILEP)[J]. Pharmacol Res, 2020, 155: 104719. DOI: 10.1016/j.phrs.2020.104719. [89] PANDEY S N, MOGLAD E, GUPTA G, et al. Creatine kinase in prostate cancer: a biosensor-driven diagnostic paradigm[J]. Clin Chim Acta, 2025, 576: 120402. DOI: 10.1016/j.cca.2025.120402. -
点击查看大图
图(2) / 表(8)
计量
- 文章访问数: 35
- HTML全文浏览量: 22
- PDF下载量: 12
- 被引次数: 0
