Thaum kuaj ntshav biochemical, koj tuaj yeem pom cov kab "conjugated bilirubin". Muaj cov qauv raws li cov ntsiab lus ntawm cov tshuaj no nyob rau hauv cov ntshav yog xam tau. Nrog rau cov kab mob, qhov ntsuas tau nce, thiab tus kws kho mob tau sau ntawv kho mob. Kev nce hauv qhov ncaj thiab tsis ncaj bilirubin qhia txog cov txheej txheem pathological uas yuav tsum tau muab tshem tawm.
YYuav ua li cas yog bilirubin?
Bilirubin yog cov tshuaj liab-daj uas pom muaj nyob hauv tib neeg cov ntshav thiab yog ib feem ntawm cov kua tsib. Nws yog tsim los ntawm kev tawg ntawm hemoglobin, myoglobin thiab cytochrome proteins. Cov tshuaj tau muab faib ua conjugated bilirubin, uas yog hu ua ncaj qha, thiab unconjugated bilirubin. Cov khoom lwj nkag mus rau hauv cov kua tsib thiab tawm hauv lub cev.
Nyob rau hauv tus neeg noj qab haus huv, bilirubin muaj nyob rau hauv cov ntshav nyob rau hauv ib tug npaum li cas. Nws qhov kev nce ntxiv qhia tias kev puas tsuaj ntau dhau ntawm cov qe ntshav liab. Yog vim li cas rau qhov no yog txiav txim los ntawm tus kws kho mob raws li cov txiaj ntsig ntawm kev sim. Rau kev kuaj mob kom raug, bilirubin tau qhia hauv kev tshuaj ntsuamconjugated thiab unconjugated.
qauv ntawm bilirubin
Los ntawm cov khoom siv tshuaj, ob hom tshuaj muaj qhov txawv:
- unconjugated tsim nyob rau hauv daim ntawv ntawm ntau yam qauv;
- conjugated tshwm tom qab kev sib raug zoo nrog glucuronic acid.
Bilirubin tuaj yeem khi rau ib lossis ob lub kua qaub molecules. Kev nce siab hauv bilirubin tshwm sim nrog hemolysis - kev puas tsuaj ntawm cov qe ntshav liab.
Cov qauv ntawm conjugated bilirubin zoo li cov siv lead ua uas nyuaj rau yaj hauv dej. Cov ntaub so ntswg macrophages yog siv los thauj heme mus rau bilirubin. Txhua hnub, cov qe ntshav liab muaj hnub nyoog raug rhuav tshem hauv ib tus neeg, txog li 8 g ntawm hemoglobin raug tso tawm, uas hloov mus rau 350 mcg ntawm bilirubin.
Yuav ua li cas bilirubin tsim hauv lub cev?
Nyob nruab hnub, 9 heme-muaj proteins ua rau tib neeg. Feem ntau nws belongs rau hemoglobin ntawm erythrocytes. Erythrocytes nyob hauv cov ntshav rau 3-4 lub hlis thiab raug rhuav tshem. Hauv qhov no, hemoglobin tso tawm raug xa mus rau tus po, daim siab lossis pob txha pob txha, qhov uas nws tau oxidized los ntawm oxygen. Hauv cov txheej txheem ntawm kev lwj, hlau, cov protein thiab bilirubin raug cais tawm.
Cov tsim bilirubin rov qab mus rau hauv cov ntshav thiab khi rau cov hlau thiab cov amino acids, uas tsis tso cai rau cov khoom tawm hauv lub cev nrog cov zis. Hom no hu ua unconjugated lossis indirect bilirubin.
Albumin koom nrog bilirubin, uas nqa cov tshuaj mus rau cov kua tsib thiab cov hnyuv. Hauv qee kisThaum hloov mus, ib feem ntawm bilirubin nkag mus rau hauv cov hlab ntsha.
Hauv daim siab, hepatocyte cells ntes bilirubin thiab tshem tawm ntawm albumin. Conjugated bilirubin yog tsim los ntawm enzyme UDPHT (glucuronyl transferase).
Ntau dhau bilirubin tuaj yeem cuam tshuam kev ua haujlwm ntawm tes. paj hlwb yog cov rhiab tshaj plaws rau nws. Cov ntshav ib txwm muaj 80% ncaj qha thiab 20% ncaj qha bilirubin.
Cov yam ntxwv ntawm bilirubin, hu ua conjugated
Direct bilirubin tau txais nws lub npe rau cov cuab yeej muab cov tshuaj tiv thaiv ncaj qha nrog cov tshuaj reagent siv hauv kev tshuaj xyuas. Lub mechanism ntawm kev tsim ntawm conjugated bilirubin tshwm sim nyob rau hauv daim siab. Feem ntau ntawm nws raug tso tawm los ntawm txoj hnyuv, ib qho me me yog tawm los ntawm lub raum nrog cov zis hauv daim ntawv ntawm urobinogen.
Ib yam ntawm ncaj qha bilirubin yog nws cov tshuaj lom tsawg, tsis zoo li tsis ncaj. Ib qho tshwj xeeb ntawm bilirubin ncaj qha yog qhov ua tau ntawm kev tawm ntawm lub cev vim yog solubility. Kev tsim ntawm conjugated bilirubin tshwm sim nyob rau hauv lub hauv paus ntawm unconjugated.
Indirect bilirubin yog xyaum insoluble hauv dej. Nws xav tau cov rog, vim li no, qhov sib txuam tshwm sim hauv cov ntaub so ntswg adipose thiab hlwb lipids. Indirect bilirubin raug tshem tawm tsuas yog tom qab hloov mus rau conjugated.
Lub siab koom nrog hauv kev tsim cov bilirubin. Tab sis qhov tshwj xeeb ntawm bilirubin ncaj qha yog tsim hauv cov hlwb tshwj xeeb - hepatocytes. Tsis tas li ntawd, ib feem ntawm indirect bilirubin yog tsim sab nraum lub siab.
Kev nce hauv bilirubin tsis yog ib txwm qhia tias muaj kab mob, qee zaum kev nce hauv qhov ntsuas tshwm sim nrog lub siab ua haujlwm zoo.
Txoj kev tshem tawm bilirubin
Kev tawg ntawm hemoglobin thiab nws txoj kev hloov mus rau hauv bilirubin tshwm sim hauv cov kab ke reticuloendothelial. Txog li 80% yog tsim nyob rau hauv daim siab hlwb, seem nyob rau hauv tus po, pob txha pob txha thiab cov ntaub so ntswg.
Txhua bilirubin tsim yuav tsum tau tawm ntawm lub cev, vim tias nws muaj tshuaj lom rau lub cev. Tab sis vim yog insolubility ntawm bilirubin, nws tsis tuaj yeem raug tshem tawm yam tsis muaj kev hloov pauv. Cov tshuaj insoluble yuav tsum nkag mus rau hauv conjugated bilirubin.
Ib zaug nyob rau hauv cov kua tsib, cov kua dej bilirubin raug tso tawm mus rau hauv txoj hnyuv, qhov chaw hloov dua siab tshiab. Ib feem ntawm cov tshuaj nruab nrab yog absorbed rov qab rau hauv cov ntshav. Txhawm rau kom tsis txhob ua mob rau lub cev, lub siab rov ntes cov "fugitives" thiab hloov mus rau bilirubin ncaj qha, thiab tom qab ntawd mus rau cov hnyuv.
Bilirubin tus qauv
Yuav kom nkag siab qhov txaus ntshai npaum li cas ntawm bilirubin nyob rau hauv cov ntshav, nws yog ib qho tsim nyog los txiav txim siab cov qauv ntawm cov ntsuas uas nyob ntawm lub hnub nyoog ntawm tus neeg mob.
Thaum yug, kuaj ntshav los ntawm tus menyuam thiab kuaj cov qib bilirubin. Tag nrho bilirubin suav nrog conjugated thiab unconjugated. Thaum yug los, qhov taw qhia dav dav yog 51-60 µmol / l. Hnub ob, nws nce thiab nce mus txog 170-200 μmol / l. Maj mam, tag nrho bilirubin rov qab mus rau qhov qub thiab thaum kawg ntawm thawj lub hlis nws txo qis rau cov txiaj ntsig dav dav. Cov menyuam yaus hnub nyoog tshaj 1 hlis thiab cov neeg laus yuav tsum muaj tus nqi ntawm 8.5-20.5 µmol/L.
YUnconjugated bilirubinmuaj txog li 75% ntawm tag nrho thiab tsis ntau tshaj 15.4 µmol / l. Thaum lub sij hawm ncov, qhov feem pua hloov mus rau 90%.
Conjugated bilirubin ib txwm nce mus txog 5.1 µmol / L hauv cov ntshav. Qhov no yog 25% ntawm tag nrho, ntawm qhov siab tshaj ntawm tsawg kawg yog 10%.
Ntau qib ntawm bilirubin hauv cov menyuam yug tshiab hu ua "physiological jaundice". Nws tshwm sim los ntawm hom tshwj xeeb ntawm hemoglobin uas tus neeg laus tsis muaj. Ntxiv excretion yog vim lub immaturity ntawm daim siab thiab enzymes uas hloov bilirubin rau soluble.
Kev kuaj mob thiab kuaj
Kev kuaj ntshav yog qhov tseem ceeb rau kev kuaj mob. Kev hloov pauv hauv bilirubin raug kuaj pom los ntawm kev kuaj ntshav biochemical.
Kev txiav txim siab ncaj qha bilirubin yog qhov tseem ceeb, vim tias qhov ntsuas no yog ib hom cim hauv kev kuaj mob. Muab piv cov txiaj ntsig nrog cov qauv, koj tuaj yeem pom daim duab tseeb.
Yog tias qhov sib xyaw ua ke bilirubin nce ntau dua 2 zaug, ces tej zaum yuav muaj kev ua txhaum ntawm cov kua tsib, ncaj qha bilirubin tso tawm tag nrho. Txhawm rau tshem tawm qhov yuam kev, tus kws kho mob, thaum kuaj xyuas, saib lwm qhov ntsuas ntawm kev tshuaj ntsuam - transaminases, phosphatase, sediment.
Thaum kuaj mob, 4 pawg ntawm siab bilirubin raug txiav txim:
- Ua kom tsis muaj kev sib txuas ntawm bilirubin sab nraum kev kho mob. Ib qho loj ntawm bilirubin yog tsim, uas lub siab noj qab haus huv tsis tuaj yeem ua.
- nce conjugated bilirubin sab nraum lub siab. Feem ntau yuav muaj, qhov tso tawm ntawm cov kua tsib cuam tshuam.
- Hepatic unconjugated bilirubin nce. Yog vim li cas lub siab tsis tuaj yeem hloov bilirubin.
- nce siab ncaj rau lub siab-hom bilirubin. Muaj kev ua txhaum ntawm cov kua tsib.
Cov tsos mob ntawm nce bilirubin
Nrog rau kev nce hauv bilirubin, cov tsos mob tshwm sim uas qhia txog tus mob pathological ntawm tus neeg mob. Kev tshuaj ntsuam xyuas kom paub meej qhov kev kuaj mob thiab tso cai rau koj kom pom qhov ua rau mob. Cov tsos mob qhia tias ncaj qha conjugated bilirubin nce:
- mob taub hau;
- nausea, pa phem;
- muaj grey txheej ntawm tus nplaig;
- mob hauv txoj cai hypochondrium;
- hnyav tom qab noj zaub mov muaj roj;
- quav quav;
- daim tawv nqaij daj thiab cov mucous;
- piss xim beer;
- teeb quav;
- kiv taub hau;
- xav.
Kub tuaj yeem nce hauv qee kis.
Yog vim li cas tus neeg laus nce
Muab tag nrho bilirubin thiab conjugated bilirubin nce siab, cov kab mob jaundice hauv qab no yog qhov txawv:
- parenchymal;
- mechanical;
- hemolytic;
- mixed.
nce tag nrho bilirubin tshwm sim vim muaj ntau yam ntawm lub cev thiab lub hlwb. Cov ciam teb ntawm tag nrho cov nqi ntawm bilirubin, txawm nyob rau hauv ib tug neeg noj qab nyob zoo, yog mobile. Muaj ntau yam uas cuam tshuam qhov nce ntawm tag nrho bilirubin:
- kev ua lub cev;
- overeating;
- kev noj qab nyob zoo.
Kev nce hauv tag nrho cov bilirubin qhia tias daim siab puas. Feem ntau, daim tawv nqaij hloov daj. Cov tsos mob no tshwm sim nrog cov kab mob hauv qab no:
- kab mob siab;
- mob siab;
- cirrhosis ntawm daim siab;
- qog nqaij hlav;
- kev quav cawv.
Nyob rau hauv kev nce hauv bilirubin ncaj qha, qhov ua rau yog mob hauv lub gallbladder lossis ducts. Hom jaundice no suav hais tias yog tshuab. Muaj tshwm sim ntawm cov kab mob hauv qab no:
- pob zeb pob zeb;
- plab zais zis spasms;
- kev ua txhaum ntawm cov qauv npuas;
- cholangitis;
- helminthiases;
- bile duct disorder;
- bladder raug mob;
- teeb meem tom qab phais;
- gall zais zis qog.
Yog tias conjugated bilirubin yog ib txwm, thiab unconjugated bilirubin nce siab, qhov no qhia tau hais tias kev tawg sai ntawm cov qe ntshav liab. Tus mob no yog ib yam rau cov me nyuam mos. Hauv cov neeg laus, nws tshwm sim vim raug mob. Cov teeb meem tshwm sim hauv kev ua haujlwm ntawm cov hlab ntsha, yog li jaundice hu ua suprahepatic. Cov kab mob tseem ceeb ua rau muaj kev nce hauv bilirubin:
- hlau deficiency vim yog caj ces;
- hnyav hlau lom;
- kev hloov ntshav tsis sib xws;
- Rhesus teeb meem thaum cev xeeb tub;
- noj tshuaj hormonal;
- kab mob sib kis;
- typhoid.
Ua rau tus menyuam yug tshiab
Thaumkev nce hauv bilirubin nyob rau hnub thib 3 los ntawm ntau dua 200 μmol / l, neonatologists siv ntsuas los txo nws. Kev nce hauv qhov ntsuas no tuaj yeem cuam tshuam rau tus menyuam tus mob. Nyob rau tib lub sijhawm, conjugated bilirubin yuav luag tsis loj hlob, thiab tag nrho cov nyiaj nce mus txog 300-400 μmol / l.
Qhov ua rau muaj tus kab mob jaundice yog:
- xeeb tub;
- Ygestational diabetes mellitus;
- yug nyuaj;
- hypoxia thaum yug menyuam.
Kev nyeem ntawv ntau dua 300 muaj qhov cuam tshuam tsis zoo rau tus menyuam lub paj hlwb thiab tuaj yeem qhia tias muaj kev cuam tshuam hormonal, teeb meem hauv siab, plab hnyuv, lossis kab mob caj ces.
Kev kho mob, yuav tsum nrhiav kom paub qhov tseeb. Tus me nyuam tau txais kev kho mob phototherapy, yog tias tsim nyog, muab cov tshuaj tua kab mob. Ntev jaundice, yog tias tsis kho, ua rau kev loj hlob qeeb.
nce bilirubin hauv cov poj niam cev xeeb tub
Nrog rau kev nce hauv bilirubin hauv cov poj niam cev xeeb tub, kev hloov pauv hauv kev sib xyaw thiab tsis sib xyaw bilirubin piv. Nyob ntawm cov txiaj ntsig thiab kev mob dav dav, cov poj niam txiav txim siab qhov laj thawj ntawm kev nce hauv kev ua haujlwm.
Cov poj niam cev xeeb tub tsim hyperbilirubinemia rau cov laj thawj hauv qab no:
- mob toxicosis thaum ntxov;
- eclampsia;
- fatty daim siab tsim thaum cev xeeb tub;
- kab mob gallstone;
- cev xeeb tub cholestasis.
Nrog cholestasis ntawm cev xeeb tub, tag nrho cov tsos mob ploj tom qab yug me nyuamme nyuam.
txo qis hauv bilirubin
Kev txo qis hauv bilirubin tsawg dua li qhov nce. Yog tias qhov ntsuas ntawm bilirubin ncaj qha hloov mus rau hauv qab, nws yog qhov tsim nyog los nrhiav seb yog vim li cas.
Yog vim li cas rau qhov txo qis hauv bilirubin ncaj qha yog:
- kev quav cawv;
- noj tshuaj hormonal;
- kev kho mob ntev ntev;
- ntau dhau ntawm ascorbic acid.
Txo qis hauv kev ncaj qha bilirubin tshwm sim thaum:
- xeeb tub;
- nyob rau lub sijhawm menyuam mos.
Kev txo qis hauv cov tshuaj bilirubin tsis tuaj yeem qhia tau tias lub raum tsis ua haujlwm. Kev nce hauv lub raum, nce ntshav siab txo qis bilirubin.
