Bilirubin, los yog kua tsib xim, yog ib yam khoom tsim los ntawm kev tawg ntawm hemoglobin hauv daim siab hlwb. Feem ntau, nws cov concentration yog nyob rau hauv thaj tsam ntawm 3.4-22.2 micromoles ib liter. Nyob rau tib lub sijhawm, unconjugated bilirubin yog 96, thiab ncaj qha - tsuas yog 4 feem pua. Kev nce hauv nws cov concentration tshwm sim los ntawm kev puas tsuaj ntawm daim siab hlwb, nce kev tawg ntawm hemoglobin, thiab tsis ua tiav ntawm cov kua tsib los ntawm lub siab. Hauv qee tus neeg, qib siab ntawm bilirubin yog tshwm sim los ntawm cov yam ntxwv ntawm caj ces.
cov ntaub ntawv dav dav
Hauv cov hlwb ntawm daim siab thiab tus po, thaum lub sijhawm tawg ntawm cov qe ntshav liab (erythrocytes), ib qho ntawm cov ntshav tawm - hemoglobin, uas tau hloov pauv mus rau bilirubin ntxiv. Hauv ib tus neeg laus, txog 250-350 mg yog tsim nyob rau ib hnub. Thaum pib, bilirubin yog tsim nyob rau hauv plasma nyob rau hauv ib tug unconjugated daim ntawv txuam nrog albumin (indirect, dawb)bilirubin).
Nws hla tsis tau lub raum barrier. Nyob rau hauv daim siab, bilirubin yog kis los ntawm albumin mus rau lub sinusoidal nto ntawm lub cev lub parenchyma hlwb, i.e., hepatocytes. Nyob rau hauv lawv, indirect bilirubin tau txais tshuaj lom neeg cov tshuaj tiv thaiv thiab hloov mus rau hauv conjugated bilirubin, uas nkag mus rau hauv lub gallbladder los yog cov hnyuv, qhov twg nws yog hloov dua siab tshiab rau hauv urobilinogen. Ib feem ntawm cov tshuaj no yog absorbed nyob rau hauv cov hnyuv me thiab rov nkag mus rau lub siab thiab yog oxidized nyob rau ntawd. Cov kua tsib bilirubin hloov mus rau stercobilinogen hauv cov hnyuv loj. Nyob rau hauv qis qis ntawm cov hnyuv, nws oxidizes thiab ua xim av thiab kis tawm nrog quav. Ib feem me me yog nqus mus rau hauv cov ntshav, tom qab ntawd mus rau hauv lub raum thiab tawm hauv cov zis. Dawb bilirubin nkag mus rau hauv cov zis yog tias nws cov ntsiab lus siab nyob rau hauv cov ntshav cov ntshav coincides nrog kev ua txhaum ntawm permeability ntawm glomerular membrane.
Unconjugated bilirubin: qauv, tshuaj muaj zog
Hauv nws daim ntawv ntshiab, nws yog cov khoom siv crystalline uas muaj xim liab-xim av lossis xim daj-txiv kab ntxwv, insoluble hauv dej, muaju uas yog rhomboid-prismatic hauv cov duab. Hauv lwm txoj kev, nws tseem hu ua indirect los yog suprahepatic bilirubin, uas yog conjugated los ntawm daim siab enzymes ua ntej excretion. Ua ntej kev thauj mus los, uas yog nqa los ntawm plasma, nws khi rau feem ntau albumin.
Hauv daim ntawv no, nws raug xa mus rau lwm cov proteins. Raws li ib txwm muaj, kev sib raug zoo ntawm bilirubin thiab cov protein muaj zog heev. Txawm li cas los xij, fatty acids, hydrogen ions thiab qee yamCov tshuaj muaj peev xwm sib tw nrog bilirubin rau kev khi cov protein. Prehepatic bilirubin, vim nws cov khoom, tsis lim hauv glomeruli ntawm ob lub raum thiab tsis nquag pom hauv cov zis. Cov qauv ntawm cov trans-form ntawm unconjugated bilirubin yog nthuav tawm nyob rau hauv tsab xov xwm.
Diagnosis
Kev kuaj ntshav yog ua los txheeb xyuas qhov cuam tshuam tsis zoo ntawm qib bilirubin siab ntawm daim siab.
Kev kuaj ntshav txiav txim qhov nyiaj ncaj qha, tsis ncaj thiab tag nrho bilirubin. Cov ntsiab lus "direct" thiab "indirect" tuaj rau hauv siv vim yog cov tshuaj tiv thaiv uas lawv raug kuaj pom. Txhawm rau txheeb xyuas cov bilirubin conjugated, Ehrlich cov tshuaj tiv thaiv yog nqa tawm. Cov xim tam sim no nyob rau hauv cov ntshav reacts nrog cov reagent, thiab txiav txim siab ib tug dawb, ntau yam kev khiav hauj lwm yog tsim nyog, vim nws tsis soluble nyob rau hauv dej.
Unconjugated bilirubin yog qhov sib txawv ntawm tag nrho thiab khi xim.
Kev txiav txim siab ntawm bilirubin hauv cov zis kuj tseem muaj txiaj ntsig zoo rau kev kuaj mob thiab yog ib qho kev ntsuam xyuas tshwj xeeb tshaj plaws. Hauv cov tshuaj siv tau, jaundice ntawm qee hom hauv nws daim ntawv ntshiab yog qhov tsis tshua muaj, feem ntau ua ke ntawm ntau hom. Yog li ntawd, thaum kuaj kab mob siab, qhov no yuav tsum tau coj mus rau hauv tus account. Piv txwv li, nrog hemolytic jaundice, nyob rau hauv uas theem ntawm indirect bilirubin nce, ntau yam kabmob cuam tshuam, nrog rau lub siab. Nyob rau hauv rooj plaub no, tus neeg mob muaj cov tsos mob ntawm parenchymal kab mob siab (qhov concentration ntawm ncaj qha bilirubin nce nyob rau hauv cov zis thiab ntshav).
nce ntxiv dawb bilirubin hauv cov menyuam mos
Qhov xwm txheej no tau pom hauv cov menyuam yug tshiab hauv thawj peb hnub ntawm lub neej. Vim tsis muaj kev loj hlob ntawm daim siab enzymes thiab nce kev tawg ntawm cov qe ntshav liab nrog fetal hemoglobin, physiological jaundice tshwm sim. Yog hais tias tus me nyuam muaj tus kab mob no rub, ces tus kws kho mob ua kev tshawb fawb kom tsis txhob congenital pathology ntawm biliary ib ntsuj av thiab daim siab, kab mob hemolytic.
Rhesus kev tsis sib haum xeeb ntawm leej niam thiab tus menyuam ua rau muaj kev tawg ntawm cov qe ntshav liab ntau ntxiv nyob rau tom kawg. Yog li ntawd, unconjugated bilirubin nce. Qhov tshwm sim tsis zoo ntawm qhov tshwm sim no yog cov tshuaj lom rau ntawm cov ntaub so ntswg ntawm lub paj hlwb, uas tuaj yeem ua rau lub hlwb puas tsuaj rau tus menyuam mos (bilirubin encephalopathy). Cov kab mob hemolytic hauv cov menyuam mos yuav raug kho tam sim ntawd. Tsis tas li ntawd, kab mob siab tau kuaj pom hauv crumbs nrog ob qho tib si nce qib ntawm cov dawb thiab ncaj qha bilirubin. Qhov ua rau mob daj ntseg thiab kev xaiv kev kho mob tactics yog nyob ntawm daim duab kho mob, nrog rau kev hloov pauv hauv cov theem ntawm cov feem ntawm conjugated thiab unconjugated bilirubin. Hauv INVITRO, nws lub chaw kuaj mob tau sawv cev hauv ntau lub nroog, koj tuaj yeem kuaj ntshav thiab zis ntawm tus nqi pheej yig.
Cov khoom ua rau hyperbilirubinemia
Feem ntau, kev nce hauv bilirubin hauv cov ntshav ntawm tus neeg laus qhia txog kev noj qab haus huv. Txawm li cas los xij, ntawm cov menyuam yaus, nws qhov kev nce ntxiv tsis yog ib txwm muaj pathology. Piv txwv li, nyob rau hauv cov me nyuam mos, qhov ua rau ntawm qhov tshwm simlub cev nqaij daim tawv. Feem ntau ntawm cov kab mob nyob rau hauv uas qhov ntsuas no yog saum toj no tus qauv yog kis tau thiab amenable rau kev kho mob. Ib qho ntawm cov ntsiab lus tseem ceeb cuam tshuam rau qhov nce hauv unconjugated bilirubin yog qib qis ntawm albumin proteins hauv cov ntshav, nrog rau qhov tsis muaj peev xwm ntawm albumin los khi cov kua tsib xim tag nrho. Cov tshuaj xws li tshuaj tua kab mob ntawm cephalosporin, penicillin series, nrog rau Furosemide, Diazepam, tuaj yeem ua rau muaj kev nce hauv bilirubin hauv cov ntshav. Qhov tshwm sim no yog vim qhov tseeb tias cov tshuaj uas tsim cov tshuaj, sib tw nrog cov xim, khi rau albumins.
Cov kab mob uas tshwm sim ntau tshaj plaws uas tshwm sim tawm tsam keeb kwm ntawm kev nce qib ntawm cov kua tsib xim hauv cov ntshav yog kab mob siab, gallbladder thiab lwm yam kab mob hauv plab.
Zoo li cov xwm txheej uas muaj cov qe ntshav liab ntau zuj zus.
Yog vim li cas rau qhov nce hauv cov bilirubin dawb saum toj no
Qhov nce hauv unconjugated bilirubin yog tshwm sim los ntawm qee cov txheej txheem pathological tshwm sim hauv lub cev. Kev tso tawm siab ntawm cov dawb bilirubin tshwm sim los ntawm hemolysis provoked los ntawm cov kab mob xws li:
- tshuaj lom lom;
- malaria;
- caj ces tsis xws luag hauv cov qe ntshav liab thiab hemoglobin;
- cov txheej txheem autoimmune cuam tshuam nrog cov qe ntshav liab;
- hemolytic anemia, ob qho tib si congenital thiab kis tau.
Tsi,ua rau nws nce kev puas tsuaj rau daim siab cov ntaub so ntswg hauv cov kab mob hauv qab no:
- txhua yam kab mob siab;
- cirrhosis ntawm daim siab;
- leptospirosis;
- kis kab mob mononucleosis;
- daim siab puas los ntawm kev siv cov tshuaj mus ntev;
- mob qog noj ntshav;
- kev quav cawv.
Ntau dhau dawb bilirubin tshwm sim los ntawm hemolysis
Yog tias qhov ua rau muaj bilirubin siab cuam tshuam nrog hemolysis, ces tus neeg mob yuav mob jaundice suprahepatic. Lub dermis tau txais lub teeb daj daj. Tawm tsam keeb kwm yav dhau ntawm tus po loj, uas tau kuaj pom los ntawm ultrasound, qhov mob syndrome yuav tshwm sim nyob rau sab laug. Hauv kev txheeb xyuas - txo qis ntawm cov qe ntshav liab, kev hloov pauv ntawm lawv cov duab thiab qhov loj me.
Kev kho mob yog nqa tawm ob qho tib si conservatively (enzyme thiab hormonal therapy, immunosuppressants) thiab phais. Thaum muaj qhov tsis xws luag hauv cov qe ntshav liab tawm tsam keeb kwm ntawm tus kab mob, cov kws kho mob pom zoo kom tshem tawm tus po. Kev xaiv cov tshuaj ncaj qha nyob ntawm qhov ua rau ntawm pathology.
Ntau dawb bilirubin tshwm sim los ntawm kev puas tsuaj rau daim siab
Tus mob daj ntseg hauv qhov no yog tshwm sim los ntawm cov xim daj-saffron ntawm cov mucous daim nyias nyias thiab dermis. Cov xib teg tau txais cov xim liab thiab hu ua kab laug sab leeg tshwm rau lawv. Lub siab yog loj. Cov quav yuav tsis muaj xim. Hauv qee cov kab mob mus sij hawm ntev, varicose leeg ntawm txoj hlab pas thiab lub plab tshwm sim, thiab cov kua dej nkag mus rau hauv lub plab kab noj hniav.
YIndirect bilirubin
Bilirubin unconjugated dissolveszoo nyob rau hauv cov rog, tab sis nws yog insoluble nyob rau hauv dej. Nws tsis raug tso tawm hauv cov zis, vim nws tsis tuaj yeem dhau los ntawm lub raum pom qhov system. Tus nqi ntawm cov bilirubin dawb, uas ntsuas hauv micromoles ib liter, thaj tsam ntawm 15.4 txog 17.1. Nws cov ntsiab lus hauv lub cev, ntawm tag nrho, yog 96 feem pua.
Pub dawb bilirubin nkag mus rau hauv cov hlwb, qhov twg nws cuam tshuam nrog lipids ntawm cov cell membranes, nkag mus rau mitochondria thiab ua rau tsis ua haujlwm hauv lawv cov txheej txheem metabolic thiab ua pa ntawm tes, nkag mus ntawm cov poov tshuaj ions los ntawm cov cell membrane, thiab. raws li kev tsim cov protein. Qhov yooj yim tshaj plaws rau cov qib siab dawb bilirubin yog cov ntaub so ntswg hlwb.
Zoo kawg
Unconjugated bilirubin, uas yog tsim los ntawm kev tawg ntawm hemoglobin, yog tshuaj lom heev, yooj yim soluble hauv cytolemma rog. Nkag mus rau hauv nws, nws cuam tshuam nrog cov txheej txheem ntawm cellular metabolism thiab cuam tshuam lawv. Los ntawm tus po mus rau daim siab, nws kis nrog albumin, qhov twg nws cuam tshuam nrog glucuronic acid. Qhov tshwm sim yog dej-soluble, ncaj qha bilirubin, uas tsis muaj tshuaj lom.
