Yog tias cov kev tshuaj ntsuam biochemical qhia tau hais tias cov tshuaj bilirubin hauv cov ntshav, ces yuav muaj ntau yam. Kom nkag siab txog lawv, nws tsim nyog los saib cov metabolism ntawm cov khoom no.
Metabolism ntawm bilirubin
Bilirubin yog ib qho kua xaim tshaj plaws. Nws yog nyob rau hauv cov ntshav hauv ob feem me: indirect (dawb) thiab ncaj qha.
Cov qe ntshav liab (erythrocytes) nyob rau hauv tus txheej txheem ntawm tib neeg lub neej tas li tuag thiab raug hloov los ntawm cov tshiab. Tuag lub cev tawm hemoglobin, uas lov rau hauv globin chains thiab ib qho heme molecule. Cov tom kawg yog hloov dua siab tshiab los ntawm cov khoom noj rau hauv (free indiriririn). Nyob rau hauv daim ntawv no, qhov quav yog tshuaj lom, vim nws dissolves nyob rau hauv cov rog (tab sis tsis nyob hauv dej), yooj yim penetrates rau hauv hlwb thiab harms lawv ua haujlwm. Vim hais tias xwm tau muab txoj cai rau "tsis tuaj yeem tshawb" txog kev sib koom tes: nws, txuas nrog albumins ntawm cov ntshav, txav mus rau siab, thiab tom qab ntawd ces qhov kev ua ntawm cov enzymes nws ua dej-soluble thiab raug tshem tawm nrog rau hauv cov hnyuv me. Qhov no yog qhov ncaj qha bilirubin. Hauv qab, cov zauv feem ntau yog ib qho kev sib tham, thiab yog hais tias nws siab, qhov tsim nyog yuav tsum tau nrhiav thaum ua txhaum txoj hauj lwm piav qhia saum toj no.
Vim li cas thiaj paub bilirubin?
Peb muab ib qho kev hloov yooj yim.
Cov ntaub ntawv qhia ncaj ncees yuav tau nce vim yog:
- mob nyob rau hauv lub cev hematopoietic system;
- kab mob siab.
Qhov feem ntawm cov piam thaj ntawm qhov enzyme no muaj nyob hauv cov ntshav saum tus txheej txheem thaum:
- kab mob siab;
- impassability ntawm extrahepatic bile ducts.
Tam sim no xav txog txhua pab pawg hauv ntau yam.
Siab qaub ncaug
Rau kev ua txhaum ntawm lub hemopoietic system muaj xws li hemolytic anemia, uas muaj coob tus erythrocytes puas lawm. Lawv tso ntau ntawm hemoglobin, thiab yog li qhov no yog vim li cas vim li cas indirect bilirubin yog nce. Lub siab tsuas tsis muaj sij hawm los tiv thaiv nrog nws cov kev hloov mus rau hauv txoj kab ncaj nraim (qhov feem ntawm qhov feem no tseem tsis tau zoo dua qub) thiab ntxiv kev tshaj tawm.
Cov tsos mob ntawm cov ntshav tsis txaus:
- kiv taub hau;
- kev qaug zog thiab qaug zog;
- pallor;
- tsawg hemoglobin thiab pes tsawg tus qe ntshav liab;
- mob spleen.
Ib qho zoo xws li dhia hauv qhov enzyme kuj yog vim mob malaria thiab sepsis.
Ntawm cov kab mob hepatic, vim tias cov qib ntawm cov kis ntawm cov kis indirect siab, muaj xws li:
- Gilbert's syndrome ;
- Kriegler-Nayyar syndrome;
- Lucy-Driskol Syndrome;
- nrhiav tau cov kab mob uas tsis yog-hemolytic.
Xws li mob yog tsawg.
Paub ncaj ncaj bilirubin
Hauv cov kab mob siab, kev tawm ntawm cov kua qaub kuj yuav raug cuam tshuam, vim hais tias cov bilirubin uas muaj hauv nws tsis tag rau hauv cov hnyuv, tab sis muab pov rau hauv cov ntshav. Qhov no tshwm sim nrog tus kab mob siab hepatitis, kab mob, qhov tshuaj lom thiab nws qhov mob.
Lwm yam kev ua rau ntawm txoj hlab roj ntsha nyob rau hauv cov ntshav:
- intrahepatic cholestasis;
- thawj biliary cirrhosis;
- jaundice ntawm cov poj niam cev xeeb tub vim yog cov poj niam ua rau cov ntsiab lus siab ntawm estrogens;
- daim siab qog.
Phaus nplooj tawm hauv daim duodenum los ntawm ib tus ciav, thiab yog hais tias nws cov lumen kaw lawm, tus kws kho mob kis tau ncaj qha mus rau hauv cov ntshav. Qhov no tshwm sim thaum:
- compression ntawm lub bile ducts ntawm sab nraum vim mob ntev los sis mob o ntawm txiav (pancreatitis);
- echinococcus siab (kab mob parasite);
- diverticulum ntawm lub duodenum (niam qhuav txiv qhuav anomaly);
- qog ntawm duodenum los yog pancreas;
- aneurysm ntawm txoj hlab ntsws;
- cholelithiasis;
- mob ntev thiab mob cholangitis ;
- qog ntawm lub bile ducts.
Txoj kev kho kom paub cov bilirubin nyob rau hauv cov ntshav yog sau raws li qhov ua rau tshwm sim los ntawm kev nce hauv qhov concentration ntawm no enzyme.