肝脏疾病的实验室检查.ppt

LaboratoryfindingsindifferenttypesjaundicesSerumtotalbilirubin(μmol/L)ExaminationofurinedirectindirecturobilinogenbilirubinNormalsubjectsHemolyticjaundiceHepatocellularjaundiceObstructjaundice0～6.8High↑High↑↑High↑↑↑1.7～13.7High↑↑↑High↑↑High↑NormalHigh↑↑↑High↑↑downNegativeNegativepositiveStronglypositiveENZYMES血清酶及同功酶检查肝细胞内酶的定位血清酶及同功酶检查肝脏酶的器官定位酶存在浓度较高的器官肝细胞与血浆相对比值ASTALTLDHALPGGT心脏,肝脏,肌肉,肾肝脏,肾肝脏,红细胞,心脏,肌肉,白细胞,肿瘤肝脏,骨,肠道,胎盘肝脏,胰腺,肾脏,前列腺78002850150正常/异常正常/异常Alkalinephosphatase(ALP)Alkalinephosphatase213Tissuenon-specificproteinIntestinalproteinPlacentalprotein4placental-likeproteinAlkalinephosphataseTypicalRIsforALPactivityNewborn1month1month～3years3～16years16～60yearsPregnancy(3rdtrimester)30～100U/L70～250U/L70～220U/L70～350U/L30～120U/L50～250U/LAlkalinephosphataseSerumALPactivityisraisedin:physiological:children/teenagers,pregnancyLiverdisease:cholestasisBonedisease:Paget’sdisease,Hyperparathyroidism,osteomalasia(骨软化）,malignancymalignancy:bronchus,gut,testesother:transienthyperphosphatasaemiaofinfancy碱性磷酸酶[原理]碱性磷酸酶存在于细胞表面，梗阻和药物直接引起的反应损害胆小管，引起细胞膜破裂溶解，导致碱性磷酸酶在到达高峰前几天逐渐上升，升高程度与梗阻期限正相关。[参考值]连续监测法：成人40-100U/L，儿童250U/L[临床意义]1、肝胆系统疾病2、黄疸的鉴别诊断3、骨骼疾病4、生长中儿童、妊娠中晚期血清ALP生理性升高。5、其他6、碱性磷酸酶的活性需要阳离子（锌、镁等），输血和EDTA抗凝可引起假性碱性磷酸酶降低。CaseexampleA26-year-oldwomanwithjaundice,andadarkurine.ALT1495U/L(50)ALP242U/L(30～120)Totalbili89μmol/L(20)TP75g/L(60～80)Alb42g/L(30～50)Glob33g/L(25～35)CaseexampleA61-year-oldwomanwithadvancedcarcinomaofthebreast,andradiologicalevidenceofmetastaticliverdisease.ALT30U/L(50)ALP637U/L(30～120)γ-GT599U/L(30)Ca2.27mmol/L(2.15～2.55)Totalbili13μmol/L(20)TP70g/L(60～80)Alb37g/L(30～50)Glob33g/L(25～35)CaseexampleA51-year-oldwomanpresentingwithdeepjaundice,biliarycolic