實(shí)驗(yàn)診斷學(xué)-肝功能實(shí)驗(yàn)室檢查

1、肝功能實(shí)驗(yàn)室檢查 醫(yī)學(xué)院 Contents of Liver Function TestProtein MetabolismBilirubin MetabolismBile Acid MetabolismLipid MetabolismRelated Serum EnzymesExtraction and Excretion 物質(zhì)代謝、合成生物轉(zhuǎn)化分泌排泄糖、蛋白質(zhì)、脂質(zhì)激素、維生素儲(chǔ)存能量Protein MetabolismBilirubin MetabolismRelated Serum EnzymesProtein Metabolism:Synthesis and Storage fun

2、ctionSerum Total Protein, albumin and globulinSerum Protein ElectrophoresisSerum Prealbumin血清總蛋白STP，serum total protein血清中所含各種蛋白的總稱STPAlbuminGlobulin12othersFrom Lymphocytes and plasmacyteSynthesis in LiverSerum ProteinTP(serum total protein)including albumin and globulinReference value:TP60-80 g/LA

3、lb 40-50g/LGlo 20-30 g/LA/G ratio 1.5-2.5 : 1Total Protein80g/LHyperproteinemiaSee also Globulin35g/L, especially in -globulinhypovolemia ：e.g. Severe diarrhea, vomit, high fever、shock60g/LHypoproteinemia See also albumin 25g/Lhypervolemia: e.g. water-sodium retention 清蛋白（ albumin ,Alb）又稱為白蛋白major p

4、rotein in serum,60%Half-life: 15-19 daysSynthesis in LiverFunction：Maintain plasma osmotic pressuretransportnutritionClinical significance: Alb 35g/LMild: 28-34g/LModerate: 21-27g/LSevere: 21g/LEdema 球蛋白 (globulin ， Glo)STP-A=G made up of different proteins called alpha, beta, and gamma typesSome ar

5、e made by the liver, while others are made by the immune system （-globulin)參考值： G20-30 g/LClinical significance: Globulin Chronic liver disease M-proteinemia Multiple Myeloma, Malignant Lymphoma, MacroglobulinemiaAutoimmune disease ：SLE, rheumatic fever, rheumatoid arthritisChronic inflammation or i

6、nfections:tuberculosis, malaria, schistosomiasis Clinical significance: Globulin Physiological：infantsImmunosuppressive statelong-term treatment with glucocorticoid or immunosuppressantsCongenital gamma-globulinemiaA/G: 1.5-2.5:1A/G : Aor GLiver function damageAlb30g/L: better progosisObstructive ja

7、undice: not reverseM-proteinemia: reverseSerum Protein ElectrophoresisLiver Cirrhosis- bridgeAFP特異峰，肝癌Nephrotic SyndromeMultiple Myeloma IgG typeProtein loss through intestinePrealbumin, PABRun faster than ALB on electrophoresis gelsAcute phrase protein(half-life=2 days),more sensitive than albumin

8、for liver damageAdult: 280-360mg/LMore Sensitive than ALBMalnutrition gradingNormal: 200-400 mg/LMild: 100-150 mg/LModerate: 50-100 mg/LSevere: 50% continously：poor prognosisMonitoring the liver recipientOthers: acute infections, advanced malignant tumor Bilirubin: Secretion and Excretion functions

9、Serum Total Bilirubin, STBUnconjugated Bilirubin, UCB and Conjugated Bilirubin, CBUrine BilirubinUrobilinogenReference RangeSTB： Adult 3.4-17.1mol/LCB： 0-6.8mol/LUCB ：1.7-10.2mol/LCB/STB：1:5Urine bilirubin：陰性u(píng)robilinogen：0.84-4.2mol/24h negative or weak positiveStage of jaundice2734217134234.217117.

10、134.2Severe JaundiceModerate JaundiceMild JaundiceLatent or Subclinical JaundiceSTB (mol/L)Differential diagnosis of Jaundice typesBilirubin Metabolism Pathway/clinpath/modules/chem/tbili.htmTypes of JaundiceHemolytic Jaundice: pre-hepaticHepatic JaundiceObstructive Jaundice: Post-hepaticCommon bile

11、 duct stonesPancreatic cancerCholangiocarcinomaLiver metastasesHemolytic Jaundice Hepatic Jaundice Obstructive Jaundice The types of jaundice hemolytic hepatocellular obstructive UCB CB CB/STB0.5U-BIL +UBG , Nstooldarkerlighter paleRelated EnzymesRelated EnzymesIntra-liver：ALT, AST, LDHSynthesis in

12、liver：coagulation factor and thrombinExcreted with bile: -GT, ALPRelated to fibrosis：MAO, III-collagenase, Hyaluronic AcidRelated EnzymesALT (alanine aminotransferase) 丙氨酸氨基轉(zhuǎn)移酶AST (aspartate aminotransferase)天冬氨酸氨基轉(zhuǎn)移酶GGT (-glutamyltransferase) -谷氨酰轉(zhuǎn)移酶ALP (alkaline phosphatase) 堿性磷酸酶MAO (monoamine ox

13、idase) 單胺氧化酶Intra-liverALTAlanine aminotransferaseMost specific for hepatocyte injuryKnown formerly as GPT ASTAspartate aminotrasferaseLess specific than ALT (present outside liver, such as heart, muscles and kidney) called formerly as GOT ALT and ASTALT in cytoplasm80%AST in mitochondrion Reference

14、 RangeALT: 40U/LAST: 300U/L, AST200U/L, AST/ALT1Clinical SignificanceChronic Viral HepatitisALT、AST（100-200U/L）stable stage : AST/ALT1Alcoholic Liver DiseaseALT or normal 、AST , AST/ALT1指導(dǎo)治療對(duì)有病毒復(fù)制但血清LT水平持續(xù)正?；蜉p微升高患者，不需要進(jìn)行抗病毒治療，只需密切隨訪對(duì)有病毒血癥且LT在正常高限或輕微升高患者，若年齡大于40歲，應(yīng)進(jìn)行肝纖維化評(píng)估，包括肝活檢或應(yīng)用無創(chuàng)性肝纖維化診斷技術(shù)對(duì)進(jìn)展性肝纖維化

15、或肝硬化患者，無論LT水平如何，均應(yīng)考慮抗病毒治療432022/9/29指導(dǎo)治療若患者血清ALT 水平持續(xù)升高2正常值上限(ULN)，同時(shí)HBeAg 陽性者HBV DNA20000IU/ml，或HBeAg陰性者HBV DNA2000 IU/ml，則應(yīng)考慮開始抗病毒治療。對(duì)ALT持續(xù)升高或5ULN且可能出現(xiàn)重癥肝炎或肝功能失代償者，應(yīng)盡早開始抗病毒治療442022/9/29DeRitis Ratio （AST/ALT1)Acute hepatitis: 1Liver cirrhosis: 2Hepatoma: 3Enzyme bilirubin separate 重癥肝炎時(shí)，大量肝細(xì)胞在短時(shí)間內(nèi)

16、壞死，血中ALT在原有升高的基礎(chǔ)上逐漸下降，而膽紅素卻進(jìn)行性升高，兩種呈現(xiàn)反向變化趨勢(shì)，被稱為“酶膽分離”，是肝壞死的前兆。肝臟合成的酶凝血酶和多種凝血因子 肝臟受損時(shí)，凝血酶原時(shí)間延長(zhǎng)隨膽汁排出的酶： ALPMaily in liver, bone, kidney et al.pregnancy、growth and develop、bone growth: ALP 參考值： 40-150U/LClinical SignificanceCholestasis ：ALP, 5-20 ULNhepatitis, liver cirrhosisALP :2-5 ULNSTB , ALP：deter

17、iorateALP 活性增高骨骼疾?。汗琴|(zhì)疏松、骨折、骨肉瘤、骨轉(zhuǎn)移癌代謝性疾?。杭卓骸⒕S生素D缺乏、肢端肥大隨膽汁排出的酶：GGTGGT主要存在于肝細(xì)胞近毛細(xì)膽管側(cè)和整個(gè)膽管系統(tǒng)Clinical SignificanceSpecific for liver and bile duct injury 肝膽疾病檢出率最高的酶Biliary tract obstruction, cholestasis ： GGT, 5-30 ULNClinical SignificanceLiver disease：Acute hepatitis： or , 2-5ULNChronic hepatitis, li

18、ver cirrhosis: normalalcoholic liver disease, drug-induced hepatitis： 年齡、妊娠等對(duì)GGT影響不大 ALP, GGT normal: non-liver diseaseDifferention of jaundice hemolyticobstructivehepatocellularLiver carcinomaALPnormalnormal orSTB-or normalALTnormal肝臟纖維化：MAO主要分布于肝、腎、胰、心等血清MAO活性與膠原纖維的交聯(lián)相關(guān)，常用來反映肝臟纖維化程度肝內(nèi)MAO來源于線粒體Clin

19、ical Significance肝臟疾病：早期肝硬化：不敏感重癥肝硬化或肝癌伴有肝硬化: MAO 酒精性肝硬化： MAO 急性肝炎、輕度慢性肝炎：正常急性肝壞死、慢性肝炎活動(dòng)期：MAO Clinical Significance肝外疾?。?MAO 慢性心衰糖尿病甲亢等肝功能檢查總結(jié)篩查：鑒別診斷：急性肝炎、膽汁淤積以及慢性肝病評(píng)價(jià)肝硬化、肝炎的嚴(yán)重程度判斷預(yù)后隨訪Assessment of Liver functionsecretionSynthesis and storageDetoxification肝功能實(shí)驗(yàn)總結(jié) 一、篩查：探查肝細(xì)胞有無受損 ALT、AST，迄今仍以ALT最為敏感，臨

20、床上實(shí)用價(jià)值最大。前清蛋白、清蛋白膽紅素代謝肝功能實(shí)驗(yàn)總結(jié) 二、檢測(cè)排泄分泌功能障礙 1.膽紅素檢測(cè)2.膽汁淤積指示酶： 以ALP及-GT應(yīng)用較多肝功能實(shí)驗(yàn)總結(jié) 三、鑒別黃疸 1.膽紅素2.酶學(xué)檢查 ALP、GGT顯著升高僅見于阻塞性黃疸和腫瘤四、肝硬化的判斷 MAO肝功能實(shí)驗(yàn)總結(jié)五、判斷預(yù)后 1.蛋白質(zhì)代謝試驗(yàn)：血清總蛋白、白蛋白、球蛋白、清/球比值、蛋白電泳及血清免疫球蛋白，血氨的測(cè)定。2.酶學(xué)檢查: AST/ALT、GGT、MAO。Assessment of Liver functionChild-Pugh Score:Measure1 point2 points3 pointsTotal bilirubin, mol/l (mg/dl)34 (50 (3)Serum albumin ( g/l)3528-3528PT prolongation 6 secAscitesabsentMildModerate to SevereHepatic encephalopathyNoneGrade I-II (or suppressed with medication)Grade III-IV (or refractory)Assessment of Liver functionGradePointsOne-year survival (%)Two-year survival (