title: [Pathogenesis of pulmonary thrombosis in Duchenne muscular dystrophy; a consideration from changes in serum CK and LDH levels].
abstract: We assessed the hypercoagulative state in patients with Duchenne muscular dystrophy (DMD) by measuring peripheral blood creatine kinase (CK) and lactate dehydrogenase (LDH) levels. In 76 patients with DMD who had no complications during examination, the CK and LDH levels were examined in a total of 173 times. Both enzyme levels were elevated and highly correlated (R = 0.93). We examined the temporal alteration of serum CK and LDH levels during episodes of pulmonary thrombosis experienced in 7 DMD patients who fulfilled the following diagnostic criteria: 1. sudden onset of dyspnea, chest pain, and hypoxia; 2. abnormal coagulation profile or abnormal chest CT findings, such as peripheral wedged shaped shadow and; 3. pneumothorax ruled out from X-ray findings. Throughout the episode of pulmonary thrombosis, CK and LDH levels changed within the range of those from DMD patients who had no complications, however, the CK level was significantly elevated from the basal level (2.12 times, p = 0.0075) on the first day of the episode. The LDH level rose for several days, and subsequently both CK and LDH returned to the basal level. In patients with compartment syndrome, CK levels were reportedly elevated due to muscle fiber necrosis which lead a hypercoagulative state. Therefore, we propose that muscle fiber necrosis is one of causal factors in pulmonary thrombosis. In addition, elevated CK may be helpful in predicting pulmonary thrombosis.
authors.affiliation: Department of Neurology, National Shimoshizu Hospital, Chiba, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakayama
authors.forename: Y
authors.initials: Y
authors.lastname: Saito
authors.forename: T
authors.initials: T
authors.lastname: Uchiyama
authors.forename: K
authors.initials: K
authors.lastname: Yatabe
authors.forename: M
authors.initials: M
authors.lastname: Kawai
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D003402:Creatine Kinase / Q000097:blood*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D009132:Muscles / Q000473:pathology; D009136:Muscular Dystrophies / Q000150:complications*; D009336:Necrosis; D011655:Pulmonary Embolism / Q000209:etiology*; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase