Kev cuam tshuam lub siab ua haujlwm feem ntau tsis tshwm sim nws tus kheej mus ntev thiab qhov kev kuaj mob ua rau qeeb. Kev kho mob hauv qhov no feem ntau twb tsis muaj txiaj ntsig. Txhawm rau ntsuas lub xeev ntawm daim siab nyob rau theem pib, ntshav biochemistry yog qhov tseem ceeb, los yog, txiav txim siab theem ntawm kev ua haujlwm ntawm hepatic transaminases. Cov kab mob siab (enzymes) no hu ua qhov taw qhia. Lawv cov dej num yog kev ntsuam xyuas qhov tseeb ntawm lub xeev ntawm lub cev.
Qhov no yog dab tsi?
Hepatic transaminases - yog dab tsi? Cov no yog cov proteins tshwj xeeb hauv siab (enzymes), lawv ua transamination hauv hlwb, uas yog, lawv muab cov metabolism hauv lawv. "Transaminases" - niaj hnub no lo lus yog obsolete, niaj hnub lub npe yog "aminotransferases".
Properties ntawm transaminases
Kev hloov pauv yog ib qho ntawm cov txheej txheem ntawm nitrogen metabolism, uas cov amino acids tshiab tau tsim los ntawm kev hloov pauv ntawm amino thiab keto acids yam tsis muaj kev sib cais.ammonia. Qhov no tau them rau xyoo 1937 los ntawm cov kws tshawb fawb M. G. Kritzman thiab A. E. Braunshtein.
Tib lub sijhawm, kev tawm tsam ncaj qha thiab rov qab tshwm sim, piv txwv li, hloov pauv hloov pauv ntawm cov amino pawg los ntawm cov amino acid mus rau keto acid. Vit yuav tsum tau ua ib coenzyme. Q6.
Lub npe ntawm hepatic transaminases (thiab muaj 2 ntawm lawv) yog txiav txim los ntawm lub npe ntawm cov kua qaub nws tus kheej koom nrog hauv kev thauj mus los ntawm pawg amino: yog tias nws yog aspartic, ces cov enzyme hu ua aspartate aminotransferase (AST. lossis AsAT), thiab yog tias nws yog alanine, ces nws yog alanine aminotransferase (ALT lossis AlAT). Txhua tus muaj nws tus yam ntxwv.
Lub luag haujlwm hauv lub cev
nce kev ua haujlwm ntawm hepatic transaminases - nws yog dab tsi? Qhov no yog qhov nce hauv lawv qib thiab nws ib txwm hais txog necrosis ntawm cov ntaub so ntswg hauv nruab nrog cev thiab muaj cov kab mob. AST (aspartate aminotransferase) yog ib qho enzyme uas nkag siab rau cov kev hloov hauv myocardium, daim siab thiab lub hlwb. Yog tias lawv cov hlwb tsis zoo thiab ua haujlwm li qub, AST tsis nce.
ALT (alanine aminotransferase) - ib qho enzyme uas yog qhov taw qhia tseem ceeb ntawm daim siab hloov pauv.
Indicator norms
Transaminase qib sib txawv ntawm poj niam txiv neej thiab hnub nyoog. Feem ntau, lawv tus lej ntawm cov poj niam yog 31 rau ALT thiab AST; Hauv cov txiv neej, ALT -37 U / l, thiab AST - 47 U / l.
Principles of diagnosis
Aminotransferases muaj nyob rau hauv tag nrho cov hlwb ntawm lub cev, tab sis lawv yog concentrated nyob rau hauv daim siab thiab lub plawv. Yog li ntawd, qhov tsis txaus ntawm cov kabmob no tau nrawm duaTxhua yam tuaj yeem txiav txim los ntawm qib ntawm cov enzymes.
Nws tuaj yeem xaus lus, hais txog kev ua haujlwm ntawm lub siab transaminases, tias cov no yog cov cim tshwj xeeb ntawm kev mob. Qhov tseeb yog tias cov tsos mob ntawm cov kab mob tshwm sim tsuas yog tom qab 2 lub lis piam, tab sis kev tuag ntawm cov hlwb hauv ntau yam kab mob hauv daim ntawv mob (mob, cirrhosis lossis MI) ua rau muaj kev tso tawm ntse ntawm cov enzymes no rau hauv cov ntshav, uas tuaj yeem siv tau. txiav txim qhov muaj teeb meem.
T. e. aminotransferases zoo li leukocytes hauv qhov nrawm ntawm lawv cov tsos, tab sis nws tsis tuaj yeem txiav txim siab qhov xwm txheej ntawm pathology los ntawm lawv.
Cov no tsis yog cov kev sim tshwj xeeb, tab sis kev ntseeg siab ntawm daim siab thiab lub plawv pathologies. Kev sib xyaw ua ke ntawm cov cim qhia tias tus kws kho mob ua rau pab txiav txim siab ntau yam kab mob thiab txo qis. Piv txwv li, kev nce hauv ALT + bilirubin feem ntau yog sau nrog cholecystitis.
Yog vim li cas nce
Hepatic transaminases tau nce siab nrog kev txhim kho ntawm kab mob siab thiab plawv pathologies. Qhov no tuaj yeem ua rau muaj kev phom sij heev. Lawv hais tias:
- kab mob siab (txhua daim ntawv);
- Reye's Syndrome - kab mob siab mob siab vim kev noj tshuaj aspirin;
- steatosis;
- fibrosis;
- cirrhosis;
- cholestasis;
- tumors;
- metastases los ntawm lwm yam kabmob mus rau lub siab;
- Wilson's disease lossis hepatocerebral dystrophy (kev tsis sib haum xeeb ntawm tooj liab metabolism);
- myocardial infarction (nyob rau hauv uas hepatic transaminases yeej ib txwm nce siab);
- kab mob ntxeem tau, vim tias nyob rau hauv lawv lub neej, cov kab mob zais ciaco toxins nrog kev puas tsuaj ntawm hepatocytes;
- mob siab kuj ua rau cell necrosis.
Nyob rau hauv cholestasis, cov kua tsib stasis ua rau lub siab ua haujlwm ntau dhau ntawm cov hlwb, lawv cov metabolism raug cuam tshuam thiab, nyob rau hauv cov kab mob kawg, cov hlwb raug necrosis.
Lub siab rog kuj ua rau lub siab ib txwm raug rhuav tshem thiab hloov cov rog rog. Nyob rau hauv cirrhosis, cell ua necrotic thiab hloov los ntawm coarse connective ntaub so ntswg. Cov qog ua kom tsis yog tsuas yog hepatocytes xwb, tab sis kuj cov ntaub so ntswg ib puag ncig, ua rau lawv o.
Pov thawj cov txheej txheem tshuaj lom hauv lub siab tom qab siv cov tshuaj ntev, thiab kev nce hauv transaminases tshwm sim thaum siv txhua hom kev tso tawm ntawm cov tshuaj - ob ntsiav tshuaj thiab infusions yog qhov sib npaug. Ntawm lawv:
- tshuaj tua kab mob, statins, tshuaj tua kab mob;
- anabolic steroids;
- NSAID;
- "Aspirin", "Paracetamol", MAO inhibitors ("Selegiline", "Imipramine");
- hormones;
- sulfonamides;
- barbiturates;
- Ycytostatics, immunosuppressants;
- hlau thiab tooj liab npaj kuj necrotize daim siab daim siab.
Txog tam sim no peb tau tham txog kev pheej hmoo enzyme nce ntxiv. Tab sis muaj lwm hom kev nce ntxiv - periodic.
Lub sijhawm lossis ncua sijhawm nce hauv daim siab ua haujlwm transaminase kuj tuaj yeem tshwm sim los ntawm lwm yam kab mob ntxiv. Nws tuaj yeem tshwm sim nrog mob pancreatitis, hypothyroidism, rog rog, mononucleosis, nqaij raug mob, kub hnyiab, myodystrophy, bronze diabetes.
me ntsis hauv siabtransaminases feem ntau tshwm sim. Nws tuaj yeem tshwm sim los ntawm kev noj qab haus huv tsis zoo, kev noj cov zaub mov uas nplua nuj, piv txwv li, nitrates, tshuaj tua kab, cov rog rog. Txawm li cas los xij, kev sib txawv ntawm cov qauv ntawm cov enzymes hauv daim ntawv ntawm lawv qhov nce yuav tsum tau mus ntsib kws kho mob thiab ua tiav kev kuaj mob. Tshwj xeeb tshaj yog thaum ntxiv hnyav thiab mob nyob rau hauv txoj cai hypochondrium.
Ritis ratio
Tus kws tshawb fawb Italian Fernando de Ritis tau npaj txoj hauv kev sib txawv los ntsuas kev ua haujlwm ntawm transaminases. Hauv lwm lo lus, ntxiv rau qhov kev suav ntau ntawm txhua lub enzyme, qhov piv ntawm cov enzymes txheeb ze rau ib leeg yuav tsum tau txiav txim siab - Ritis coefficient.
Qhov piv ntawm 0.9-1.7 tsis yog kab mob, feem ntau qhov taw qhia yog 1.33. Yog tias qhov sib piv hloov pauv ib puag ncig 0-0.5, qhov no qhia tau tias muaj kab mob siab ntawm tus kab mob etiology.
Thaum qhov muaj nuj nqis yog 0.55-0.83, ib tus tuaj yeem xav txog qhov exacerbation ntawm kab mob siab. Hauv lwm lo lus, tus coefficient <1 qhia tias kis mob thiab mob.
Yog K≧1 - qhov no yuav qhia txog daim siab dystrophy thiab kab mob siab ntev; K≧2 - kab mob siab muaj cawv etiology, lossis nws qhia txog kev txhim kho ntawm myocardial infarction. Tus de Ritis coefficient yog raws li qhov tseeb hais tias txawm hais tias ALT thiab AST raug suav hais tias yog hepatic transaminases, ALT muaj ntau dua nyob rau hauv daim siab, thiab AST tau faib nyob rau hauv yuav luag sib npaug ntawm lub plawv thiab daim siab.
Symptomatic manifestations of disorders
Nws yuav tsum tau muab sau tseg tias cov tsos mob ntawm cov kab mob no ib txwm zoo ib yam, tsis hais hom kab mob. Nrog rau kev nce hauv daim siab transaminases, cov tsos mob yog:
- mob nkees thiab qaug zog;
- tawm tsam ntawm qhov tsis muaj zog tam sim; poob qab los thiab xeev siab tsis muaj laj thawj;
- mob plab;
- hnyav hauv txoj cai hypochondrium;
- bloating thiab gas;
- kev khaus khaus nocturnal;
- nosebleeds;
- tso zis tsaus thiab acholic quav;
- ua tau daj ntawm daim tawv nqaij;
- Txo kev ua si thiab tsaug zog yog qhov tshwm sim.
Txawm hais tias muaj ib qho tsos mob, nws tsis cuam tshuam nrog kev mus ntsib kws kho mob. Lub sijhawm ntawm kev kho mob yuav tso cai rau koj kom tshem tau tus kab mob kom tiav. Txwv tsis pub, cov kab mob ua rau tsis quav ntsej thiab feem ntau hloov tsis tau.
Kev faib tawm
Txhawm rau txiav txim siab qib ntawm hyperenzymemia, siv qhov ntsuas tshwj xeeb:
- Qib Nruab Nrab - qib nce me ntsis. Qhov no ua tau nrog kab mob siab ntawm cawv lossis kab mob kis.
- Average - cov ntsuas tau nce 6 npaug los ntawm cov qauv - cov txheej txheem necrotic hauv siab.
- High theem - nce hauv cov cai los ntawm 10 npaug lossis ntau dua - daim siab ischemia.
Ib yam mob hnyav tshwm sim los ntawm tus kab mob ua rau kev ua haujlwm ntawm transaminase: piv txwv li, hauv kab mob siab, hyperfermentemia tau sau tseg rau hnub 14-20 ntawm kev mob, thiab tom qab ntawd hauv ib hlis, qhov ntsuas tau txo qis mus rau qhov qub.
Nyob rau hauv lub sijhawm ntev ntawm tus kab mob, thaum lub sijhawm tshem tawm, hyperenzymemia tsis tau pom thiab cov ntsuas tau qis qis lossis nce me ntsis. Cirrhosis nyob rau theem kawg yuav tsis pom qhov nce hauv transaminases.
rauKev kuaj mob, tus kws kho mob yuav tsum ntsuas tsis tsuas yog qhov nce hauv transaminases, tab sis kuj lawv ua ke nrog lwm cov qauv. Cov ntsuas no ua rau nqaim ntau yam ntawm pathologies. Piv txwv li, jaundice lossis mob siab tsis ua haujlwm yuav tsum ua rau muaj kev nce hauv bilirubin. Hauv qhov no, qhov concentration ntawm enzymes tuaj yeem nce me ntsis. Qhov no hu ua bilirubin aminotransferase dissociation. Xws li subtleties tsuas yog txiav txim siab los ntawm tus kws tshaj lij. Yog li ntawd, kev kuaj tus kheej thiab kho tus kheej tsis suav nrog.
Ntau ntau ntawm hepatic transaminases lossis hyperfermentemia yog qhov qhia txog teeb meem hauv daim siab, qhia tias necrosis ntawm daim siab hlwb. Lub xeev no tuaj yeem tshwm sim dua, hloov qhov normalization. Qhov no feem ntau qhia txog qhov pib ntawm qhov mob tshiab lossis rov qab los ntawm cov kab mob ntev.
YYuav ua li cas nrog nce aminotransferases?
Cov lus nug no tsis tsim nyog, vim tias kev tshem tawm cov kab mob pathology tseem yuav txo qis cov enzymes. Tsis tas yuav tsim lwm txoj hauv kev. Cov lej transaminase siab qhia tau tias yuav tsum tau tshawb fawb ntxiv thiab mus pw hauv tsev kho mob sai.
Ntxiv rau, tej zaum yuav raug muab:
- kuaj ntshav ntau yam;
- electrolyte tshuav;
- ECG;
- ultrasound;
- CT.
Yog tias tsim nyog los txiav txim siab DNA ntawm cov kab mob hauv kab mob siab, PCR raug ua, nrog rau ELISA rau cov tshuaj tiv thaiv. Txij li cov kev xeem no kim, lawv tsis raug txiav txim yam tsis tsim nyog.
Nyob ntawm kev tshem tawm cov hauv paus hniav, tuaj yeem txo tausiab enzyme theem. Hauv qhov no, lub cev rov qab los yuav tsum tso tseg cov tshuaj transaminases rau hauv cov ntshav.
Raws li kev kho ntxiv, koj tuaj yeem siv cov tshuaj pej xeem. Nws yog ib qho tseem ceeb uas yuav tsum koom tes nrog txhua qhov kev ua cuam tshuam txog kev kho mob nrog tus kws kho mob ua ntej. Ua ntej siv, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas thiab txheeb xyuas qhov tseeb vim li cas. Txhawm rau txhim kho daim siab tuaj yeem pab:
- Oatmeal. Oatmeal pab ntxuav lub cev ntawm cov tshuaj phem.
- Pumpkin yuav pab txo qis cov roj cholesterol. Txhawm rau npaj nws, koj yuav tsum tau boil nws los ntawm kev ntxiv zib mu ua ntej.
- Haus ib khob dej nrog 5 g ntawm turmeric thiab 10 g ntawm zib mu peb zaug ib hnub twg.
- kua txiv beetroot kuj zoo heev rau lub siab. Noj nws tom qab noj mov 3 zaug hauv ib hnub.
Tus nqi kho mob
Kev kuaj lub siab ua haujlwm yog nkag siab rau kab mob siab, yog li nws feem ntau siv nrog rau lwm yam kev tshawb fawb los ntsuas kev ua tiav hauv kev kho.
kab mob siab nrog hyperenzymemia ib txwm xav kom lawv saib xyuas hauv kev ua kom muaj zog thiab kho kom tsim nyog. Cov kws kho mob coj mus rau hauv tus account tias cov qauv ntawm cov enzymes tsis ib txwm qhia txog kev rov zoo. Latent cirrhosis, piv txwv li, yog tus cwj pwm los ntawm cov ntsiab lus ntawm cov enzymes hauv cov ntshav. Yog li ntawd, koj yuav tsum tau kuaj thiab kho los ntawm kws kho mob.
