Thaum ua tiav cov kev kuaj ntshav biochemical, peb lub npe ntawm cov bilirubin yog qhov txawv: kev ncaj qha, feem seem sis, tag nrho bilirubin (tus lej ntawm qhov ncaj qha thiab tsis ncaj ncees). Tus tsim ntawm ncaj qha thiab indirect bilirubin proceeds raws li kev sib txawv mechanisms, yog li ntawd, thiaj li tsim kom muaj tus mob nyob rau hauv biochemical ntsuam ntawm venous ntshav, nws yog qhov tsim nyog los qhia qhov txawv uas yog bilirubin yog nce - ncaj qha los yog indirect. Xav txog qhov ncaj qha (ua txhua yam, sib thooj) bilirubin, dab tsi yog qhov tseem ceeb ntawm qhov ntsuas no, thiab nws txhais tau li cas yog hais tias tus kws kho mob nyob hauv cov ntshav nce siab.
Qhov tsim ntawm ncaj qha bilirubin nyob rau hauv lub cev
Qhov feem ntawm cov hmoov txhuam hniav bilirubin yog ib hom tshuaj lom neeg uas tsim los ntawm hepatocytes (daim siab hlwb), tom qab uas feem ntau ntawm nws tau nrog rau hauv cov hnyuv. Muaj, nws yog split thiab excreted los ntawm lub cev, mas nrog feces thiab me me - los ntawm ob lub raum. Ib qho me me ntawm qhov ncaj qha bilirubin los ntawm lub siab lub hlwb rau hauv cov hlab ntsha.
Txoj kev ncaj qha bilirubin yog ib qho tshuaj lom tsawg (piv rau cov txhuam cov hlab ntses), qhov feem no yog dej zoo. Lub npe hu ua "direct" bilirubin los ntawm qhov tseeb tias qhov khoom no muab kev ncaj ncees nrog lub tshuaj diazo reagent (kev tov kua diazophenylsulphonic acid) uas siv los tshuaj ntsuam kev sib tham ntawm biochemical.
Tus naj npawb thiab kuaj xyuas tus nqi ncaj qha ntawm cov bilirubin
Qhov taw qhia ntawm cov ncaj qha bilirubin ntawm cov ntshav yog ib qho kev ntsuas ntawm daim siab pathologies. Nws cov cai rau cov neeg laus yog nyob rau hauv qhov ntau ntawm 0.86 mus rau 5.3 μmol / l, uas yog kwv yees li ntawm peb lub hlis ntawm tus nqi ntawm tag nrho cov bilirubin hauv cov ntshav. Nws yog tsim nyog sau cia tias qhov siab tshaj plaws txwv tsis pub tshaj ntawm cov cai nyob ntawm lub reagents uas tau siv los txiav txim qhov kev txheeb xyuas no, tab sis qhov yuam kev tsis tshaj 10-15%.
Los ntawm nws tus kheej, txoj cai ncaj nraim tsis yog qhov tseeb rau tib neeg kev noj qab haus huv, tk. nws yog kev cob cog rua, thiab, li, yog tau ua kom tsis raug thiab yuav tsum tawm hauv cov ntshav. Tab sis nws yog ib qho tseem ceeb uas tsis muaj teeb meem hauv nws txoj kev, thiab qhov kev txuas rau kev thim yog tsis rov qab rov qab.
Ua rau kom paub meej txog txoj kev ncaj ncaj ntawm cov bilirubin (conjugation hyperbilirubinemia) pib ntsig txog kev mob ntsws. Nyob rau hauv rooj plaub no, ncaj qha cov hmoov txhawj xeeb hauv bilirubin nyob rau hauv cov ntaub so ntswg ntawm lub cev, qhov muag, daim tawv nqaij. Clinically nyob hauv cov neeg mob, qhov no yuav qhia tau los ntawm cov tsos mob xws li darkening ntawm cov zis, mob ntawm txoj kev hypochondrium, tawv khaus, jaundice.
Dab tsi ncaj qha bilirubin txhais li cas?
Yog hais tias qhov ncaj qha rau tus kabmob hauv cov ntshav nce siab, qhov laj thawj ntawm qhov no yuav muaj feem xyuam rau ntau hom kabmob pathological, uas yog:
- nrog rau cov kab mob ua kom muaj zog (rhuav) ntawm cov ntshav ntawm erythrocytes, ua rau tshaj li tus bilirubin;
- nrog rau kev ua txhaum ntawm metabolic hloov ntawm bilirubin hauv hepatocytes;
- nrog rau kev ua txhaum cai ntawm kev tshaj tawm ntawm bilirubin los ntawm lub cev.
Cov kab mob uas hu tau ua rau muaj cov ntsiab lus ntawm cov kab mob ncaj qha nyob hauv cov ntshav muaj xws li:
- kis mob rau daim siab (nrog rau kab mob viral thiab kab mob siab);
- tshuaj lom thiab tshuaj yeeb-tshuaj;
- autoimmune kab mob siab (nrog rau cov uas muaj kev puas tsuaj nrog rau lwm yam kab mob hauv lub cev);
- intrahepatic cholestasis;
- biliary cirrhosis ;
- pancreatic hlav;
- cholelithiasis;
- helminthic lesions;
- daim siab hlav (nrog rau kev mob qog nqaij hlav);
- metastases rau lub siab;
- Dabin-Johnson syndrome;
- Rotor Syndrome;
- sclerosing cholangitis;
- jaundice ntawm cov poj niam cev xeeb tub, thiab lwm yam.