肝脏疾病的实验室检查.ppt

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1、LABORATORY EXAMINATION OF LABORATORY EXAMINATION OF LABORATORY EXAMINATION OF LIVER DISEASELIVER DISEASELIVER DISEASEEmphasisTo understand:The function of the liver The classification of jaundice The laboratory assessment of liver diseaseThe function of the liverCarbohydrate metabolism:Synthesis and

2、 storage of glycogenGlycogenolysis and gluconeogenesisProtein metabolism:Synthesis and degradation of proteins(not immunoglobulins)Amino acid metabolism and urea formationLipid metabolism:Synthesis of lipoproteins,phospholipids,cholesterolFatty acid metabolismBile acid synthesisExcretion and detoxif

3、ication:Bilirubin and bile acid excretionDrug detoxification and excretionSteroid hormone inactivation and excretionMiscellaneous:Iron storageVitamin A,D,E,B12 storage and metabolism肝脏病常用的实验室检查肝脏的基本功能一.碳水化合物的代谢 1.糖原的合成和储存 2.糖原的分解和糖异生二.蛋白质的代谢 1.蛋白质的合成和降解 2.氨基酸的代谢和尿素的生成三.脂类代谢 1.脂蛋白,磷脂和胆固醇的合成 2.脂肪酸的代谢

4、3.胆汁酸的代谢四.生物转化,分泌和排泄 1.胆红素和胆汁酸的排泌 2.药物的解毒和排泌 3.激素的灭活和排泌五.其他 1.铁储存 2.维生素A,D,E,B12的储存和代谢Laboratory investigation of liver diseasesLaboratory investigation:Routine liver function testsTrue liver function testsSpecial testsRoutineliver function testsBilirubinsTotal proteinAlbuminTransaminases Alkaline p

5、hosphatase-glutamyltransferaseBile acid levelsTrue liver function tests:BilirubinAlbuminBile acid levelsBromosulfophthalein(四溴酚酞磺酸钠)excretion testCoagulation studiesblood ammoniaSpecial tests:1-antitrypsin -fetoproteinHepatitis markersSpecific autoantibodiesImmunoglobulinsCaeruloplasmin(铜蓝蛋白)ferriti

6、n肝脏病常用的实验室检查一.常规肝功能实验 1.胆红素 2.总蛋白 3.白蛋白 4.转氨酶 5.碱性磷酸酶 6.r-谷氨酰转移酶二.“真正的”肝功能实验 1.四溴酚酞磺酸钠或靛氰绿排泌实验 2.血浆胆汁酸浓度 3.凝血研究 4.血氨 5.胆红素 6.白蛋白 三.特殊实验 1.抗胰蛋白酶 2.甲胎蛋白 3.肝炎标志物 4.特异性自身抗体 5.免疫球蛋白 6.铜蓝蛋白 7.铁蛋白肝脏病常用的实验室检查目的:1.了解肝细胞有无损伤以及损伤程度 2.对肝胆系统疾病进行病原、病种、病型的诊断 3.对肝脏功能状态作动态比较,观察疗效及估计预后 4.手术前的准备和用药监护,评价肝脏的储备功能 5.健康普查

7、BILIRUBIN METABOLISM 1.Production2.Transport to the liver3.Hepatocyte uptake4.Conjugation5.Biliary secretion6.Gut degradation and excretion胆红素的代谢过程Classification of bilirubin(HPLC)1.(Alpha)fraction bilirubin:unconjugated bilirubin+albumin free bilirubin-kernicterus2.(Beta)fraction bilirubin:monoconj

8、ugated bilirubin3.(Gamma)fraction bilirubin:biconjugated bilirubin4.(Delta)fraction bilirubin:conjugated bilirubin+albuminClassification of jaundicePre-hepatic:liver diseases not presentHepatic:hepatocellular disease Posthepatic:cholestasis(obstruction)溶血性黄疸时的胆红素代谢肝细胞性黄疸时的胆红素代谢梗阻性黄疸时的胆红素代谢Laboratory

9、 findings in different types jaundicesSerum total bilirubin(mol/L)Examination of urinedirectindirecturobilinogenbilirubinNormal subjectsHemolytic jaundiceHepatocellular jaundiceObstruct jaundice06.8HighHighHigh 1.713.7High HighHighNormalHigh HighdownNegativeNegativepositiveStrongly positiveCase exam

10、pleSpherocytosis in a female aged 16 years,patient was jaundiced,with enlargment of the spleen,bilirubin was not in the urine.Total Bili54mol/L(20)Direct Bili 10mol/L(10)Alb40g/L(3050)ALT14U/L(35)ALP106U/L(30120)Pre-hepatic：liver diseases not presentWhen the liver is presented with bilirubin in an a

11、mount that exceeds the conjugating mechanism 1.increased bilirubin production Haemolysis 2.congenital hyperbilirubinaemia Ineffective erythropoiesis Gilberts syndromeCase exampleAn 11-year-old boy was jaundiced and generally unwell.his urine,which become dark the day before the onset of jaundice,was

12、 positive for bilirubin.Total Bili85mol/L(20)Direct Bili 25mol/L(10)TP78g/L(6080)Alb41g/L(3050)ALT3140U/L(35)ALP144U/L(30120)Hepatic：hepatocellular disease When the causal abnormality is in the liver 1.hepatitis acute:viral hepatotoxins chronic:chronic active chronic persistent 2.Intra-hepatic chole

13、stasis Cirrhosis space occupying lesions 3.congenital hyperbilirubinaemia Dubin-Johnson syndrome Rotor syndromeCase exampleA 45-year-old female with a past history of cholelithiasis,now presenting with right upper abdominal pain.At operation several stones were removed from the common bile duct.Tota

14、l Bili139mol/L(20)Direct Bili 75mol/L(10)TP77g/L(6080)Alb41g/L(3050)ALT35U/L(35)ALP550U/L(30120)Posthepatic:cholestasis(obstruction)When there is obstruction to the biliary system 1.extrahepatic cholelithiasis胆石症 tumours stricture狭窄 biliary atresia闭锁 cholangitis胆管炎 2.intrahepatic viral hepatitis dru

15、gs infiltrations浸润 cirrhosis cholangitis biliary atresiaLaboratory findings in different types jaundicesENZYMES 血清酶及同功酶检查 肝细胞内酶的定位 血清酶及同功酶检查 肝脏酶的器官定位酶存在浓度较高的器官肝细胞与血浆相对比值ASTALTLDHALPGGT心脏,肝脏,肌肉,肾肝脏,肾肝脏,红细胞,心脏,肌肉,白细胞,肿瘤肝脏,骨,肠道,胎盘肝脏,胰腺,肾脏,前列腺78002850150正常/异常正常/异常Alkaline phosphatase(ALP)Alkaline phosph

16、atase1.Tissue non-specific protein2.Intestinal protein3.Placental protein4.placental-like proteinAlkaline phosphataseTypical RIs for ALP activityNew born1 month1 month3 years3 16years16 60yearsPregnancy(3rd trimester)30 100U/L70 250U/L70 220U/L70 350U/L30 120U/L50 250U/LAlkaline phosphataseSerum ALP activity is raised in:1.physiological:children/teenagers,pregnancy2.Liver disease:cholestasis3.Bone disease:Pagets disease,Hyperparathyroidism,osteomalasia(骨软化）,malignancy4.malignancy:bronchus,gut,te