Xet Nghiem Sinh Hoa Mau

CNG TY TNHH SAO VIT NAM | Red Star Vietnam Co., Ltd.
17 Phm Hng, Cu Giy, H Ni, Vit Nam

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CC XT NGHIM SINH HA MU
Bs Nguyn Vn Thnh H Y Dc TPHCM
Cc xt nghim
1. Xt nghim Ure 21. Xt nghim Ferritin
2. Xt nghim Creatinin 22. Xt nghim St huyt thanh
3. Xt nghim ALT & AST 23. Xt nghim TIBC, UIBC, Transferrin
4. Xt nghim GGT 24. Xt nghim Calcitonin
5. Xt nghim Bilirubin 25. Xt nghim Thyroglobulin
6. Xt nghim Albumin 26. Xt nghim Thyroid Antibodies
7. Xt nghim Protein ton phn 27. Xt nghim Aldosterone v Renin
8. Xt nghim RF 28. Xt nghim Cortisol
9. Xt nghim Anti CCP 29. Xt nghim Catecholamines
10. Xt nghim khng th khng nhn 30. Xt nghim Thyrotropin
11. Khng th khng DNA 31. Xt nghim T3, T4
12. Xt nghim Acid Uric 32. Xt nghim LH
13. Xt nghim Amylase 33. Xt nghim Testosterone
14. Xt nghim Lipase 34. Xt nghim Estrogens
15. Xt nghim Phosphatase kim 35. Xt nghim Progesterone
16. Xt nghim CK/ CPK 36. Xt nghim Prolactin
17. Xt nghim CK-MB 37. Xt nghim hCG
18. Xt nghim Myoglobin
19. Xt nghim Troponins
20. Xt nghim CRP

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1. Xt nghim Ure
Urea, cn c gi l carbamide, l mt hp cht c sn xut bi qu trnh trnh chuyn

ha protein trong c th, khi protein, acid amin, b ph v (thoi ha) sn xut ra Dioxid
carbon (CO 2) v ammonia trong cc t bo, Ammoniac v dioxid carbon c vn chuyn
v gan, gan chuyn i Ammoniac v dioxid carbon thnh Urea, sau Urea vo mu c
vn chuyn n thn v c o thi ra nc tiu. Urea ha tan d dng trong nc, nn
nc tiu l mt qu trnh loi b lng nit hu hiu nht ra khi c th. Mt ngi trng
thnh bi tit mi ngy trung bnh khong 30 gram Urea, ch yu qua nc tiu, nhng
mt lng nh cng c bi tit qua m hi.
Mc ur v creatinin c s dng nh gi chc nng thn v theo di bnh nhn suy

thn hoc nhng ngi c lc thn.
Urea thng c xt nghim cng vi creatinine:
Nghi ng vn v thn,
Theo di iu tr bnh thn

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Theo di chc nng thn khi dng mt s loi thuc iu tr no c nh hng trn
chc nng thn.
ngha
Bnh thng:
Nng Ure mu: 3,6 6,6 mmol/l.
Nng Ure nc tiu: 250 500 mmol/24h.
Bnh l:
Ure mu tng cao trong mt s trng hp sau: suy thn, vim cu thn mn, u tin lit
tuyn.
Ure mu 1,7 3,3 mmol/l (10 - 20 mg/dl) hu nh lun ch ra chc nng thn bnh
thng.
Ure mu 8,3 24,9 mmol/l (50 - 150 mg/dl) ch ra tnh trng suy chc nng thn nghim
trng.
2. Xt nghim Creatinin
Xt nghim ny o lng creatinine trong mu hoc nc tiu ca bn. Creatinine l mt

sn phm cht thi c sn xut trong c bp t s phn hy ca mt hp cht gi l
creatine. Creatine l mt phn ca chu trnh sn xut nng lng cn thit cho c. C hai
creatine v creatinine c sn xut trong c th vi mt tc tng i n nh. Hu
nh tt c creatinine c bi tit qua thn, do nng trong mu l mt bin php tt
nht bit thn ca bn ang lm vic nh th no. S lng sn xut ph thuc vo kch
thc ca ngi v khi lng c ca h. V l do ny, nng creatinine nam s hi
cao hn ph n v tr em.
Kt qu t mt th nghim creatinine mu v nc tiu creatinine 24 gi, c th c s
dng tnh ton thanh thi creatinin.
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Xt nghim mu creatinine c s dng cng vi xt nghim Urea, cn c gi BUN

(urea nitrogen Blood) nh gi chc nng thn. C hai thng xuyn c ra lnh nh
l mt phn ca mt bng kim tra s trao i ton din cht c bn, nhm kim tra c
thc hin nh gi chc nng ca cc c quan chnh ca c th. Creatinin v Urea c
s dng kim tra sng lc nhng ngi khe mnh trong cc k kim tra sc khe nh
k v gip nh gi bnh nhn b bnh cp tnh hay mn tnh trong phng cp cu hoc
bnh vin. Nu cc xt nghim creatinine v BUN c tm thy l bt thng hoc nu
bn c mt bnh tim n, chng hn nh tiu ng, c nghi ng c nh hng n thn,
sau hai xt nghim ny c th c s dng theo di s tin trin ca ri lon chc
nng thn v hiu qu iu tr. Creatinine mu v BUN cng c th c ch nh nh
gi chc nng thn trc khi mt s th thut, chng hn nh chp ct lp CT scan, m c
th yu cu s dng cc loi thuc c th gy tn hi thn.
Mt s kt hp ca nng creatinine mu v nc tiu c th c s dng tnh ton

thanh thi creatinin. Xt nghim ny o lng hiu qu thn ca bn, lc cc phn t
nh nh creatinine trong mu ca bn nh th no.
ngha xt nghim
Bnh thng:
Nng creatinin huyt tng (huyt thanh): 55 - 110 mmol/l.
Nc tiu: 8 - 12 mmol/24h (8000 - 12000 mmol/l).
Xt nghim creatinin tin cy hn xt nghim Ure v n t chu nh hng bi ch n, n

ch ph thuc vo khi lng c (n nh hn) ca c th.
Tng creatinin (v Ure) ni ln s thiu nng thn, gim lc ca cu thn v gim bi

tit ca ng thn.
Trong lm sng, ngi ta thng tnh ton thanh lc creatinin ca thn nh gi chc
nng lc ca thn.
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thanh lc Creatin theo cng thc Cockroft v Gault
Trong :
ClCr: thanh thi Creatinin (ml/pht)
Age: tui ca bnh nhn
BM (Body Mass): trng lng c th (kg)
GF (Gender Corretion Factor): h s gii tnh (nam = 1, n = 0.85)
PCr (Plasma Creatinin): nng Creatinin huyt tng
Constant: hng s (nam = 1.23; n = 1.04)
Bnh thng: thanh lc ca creatinin = 70 - 120 ml/pht
Bnh l: thanh lc creatinin gim

Thiu nng thn: mc gim ca thanh lc creatinin t l thun vi mc thiu
nng thn, n phn nh tn thng cu thn.

Vim cu thn cp v mn tnh.
Vim b thn - thn mn; vim b thn - thn ti pht.
Nhim Ure huyt (Ccre gim mnh).
Thiu nng tim.
Cao huyt p c tnh.
Dng mu qua thn gim, gim p lc lc cu thn.
thanh lc creatinin phn nh ng chc nng lc cu thn. Tuy nhin n cng c nhc
im l iu kin bnh l, trong qu trnh tin trin ca suy thn, khi nng creatinin
mu cao th c s bi tit mt phn ng niu, hoc khi thiu niu, lu lng nc tiu
gim th b ti hp thu.
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3. Xt nghim ALT & AST
ALT v AST l hai loi enzyme c tm thy ch yu cc t bo ca gan v thn, mt

lng nh hn ca n cng c tm thy trong c tim v c bp. ngi khe mnh,
mc ALT v AST trong mu thp. Khi gan b h hng, ALT v AST c phng thch
vo trong mu, n thng tng trc khi xy ra cc triu chng, tng r rng nht l khi c
tn thng gan, chng hn nh vng da. iu ny lm cho ALT v AST l hai th nghim
c ch pht hin tn thng gan.
Mt s nguyn nhn gy ra tn hi cho cc t bo gan, dn n s gia tng nng ALT

v AST. Xt nghim ALT v AST c ch nht trong vic pht hin cc loi thuc hoc cc
cht khc gy c cho gan. Tuy nhin, ALT v AST khng phi ch pht hin bnh ca
gan, mc tng nh v tng va cng c th c nhn thy trong cc nguyn nhn gy
nh hng n cc b phn khc ca c th.
Ch nh
Ngi c tin s tip xc vi virus vim gan
Nhng ngi nghin ru nng
C nhn c gia nh c tin s bnh gan
Ngi dng thuc m thuc c th lm ri lon chc nng gan
Ngi tha cn, hoc c bnh tiu ng
Theo di iu tr ngi b bnh gan.
ngha xt nghim
Gi tr tham chiu: Bnh thng: ALT: < 30 U/L, AST: < 30 U/L
Mc ALT v AST rt cao (hn 10 ln mc bnh thng cao) thng l do vim gan cp
tnh, do b nhim virus. Trong vim gan cp tnh, mc ALT v AST thng mc cao ko
di khong 1-2 thng, v c th tr li bnh thng sau 3-6 thng. Mc ALT va ASTcng
c th tng cao r rt khi s dng thuc hoc cc cht khc gy c cho gan, nguyn nhn
gy gim lu lng mu (thiu mu cc b) cho gan.
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Mc ALT v AST thng khng tng cao trong vim gan mn tnh, cao t hn 4 ln mc
bnh thng cao. Trong vim gan mn, mc ALT v AST cng c th bnh thng hay
tng nh, do , cc bc s thng s ra lnh kim tra thng xuyn xem din tin ca
bnh. Cc nguyn nhn khc ca lm ALT v AST tng va phi, gm cc nguyn nhn
tc nghn ng mt, x gan (thng l hu qu ca vim gan mn tnh hoc tc nghn
ng mt), v c khi u trong gan.
AST v ALT cng c th tng ln trong cn au tim v chn thng c, mc AST tng
nhiu hn l ALT
Trong hu ht cc loi bnh gan, mc ALT tng cao hn AST, v t l AST / ALT (bnh
thng l 1,2) s thp. C mt vi ngoi l,t l AST / ALT thng tng trong vim gan
do ru, x gan, chn thng c bp, v trong ngy u tin ca hai bnh vim gan cp
tnh hoc thng tch do tc nghn ng mt.
ALT thng c thc hin cng vi th nghim AST hoc nh l mt phn ca mt bng
th nghim v chc nng gan
4. Xt nghim GGT
GGT (Gamma-glutamyl Transpeptidase) l mt loi enzyme c tm thy nhiu c

quan, nh thn, l lch, gan v tuyn ty, tuy nhin, gan l ngun gc chnh ca GGT trong
mu.
GGT tng hu ht cc bnh gy ra tn thng gan cp tnh hoc ng dn mt, nhng n

khng phn bit c gia cc nguyn nhn khc nhau gy ra tn thng gan. V l do
ny, vic s dng ca GGT l gy tranh ci. Vin Hn lm Quc gia v Hip hi ha sinh
lm sng M cng bo nghin cu bnh gan, v hng dn khuyn bn khng nn s dng
thng xuyn GGT. Nhng hng dn ny ngh s dng Phosphatase kim (ALP), l
mt enzyme gan, ALP cao c th hu ch trong vic xc nh nguyn nhn bnh ca gan.
Mc GGT trong mu rt nhy cm vi nhng thay i ca chc nng gan. Bnh thng,
GGT trong mu mc thp, nhng khi gan b tn thng, mc GGT c th tng ln.
GGT l men gan tng cao trong mu khi c bt k cc ng dn mt t gan xung rut b
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tc nghn bi khi u hoc si. iu ny lm cho xt nghim GGT l enzyme gan nhy cm
nht trong vic pht hin cc vn v ng mt. Tuy nhin, cc th nghim GGT khng
phi l xt nghim chuyn bit v khng phi l hu ch trong s phn bit gia cc nguyn
nhn khc nhau ca tn thng gan bi v n c th c tng ln vi nhiu loi bnh gan
(ung th gan v vim gan siu vi), bnh khc nh bnh mch vnh tim cp tnh.
C hai GGT v ALP tng ln trong cc bnh gan, nhng ALP cng tng cao vi cc bnh
ca m xng. V vy, GGT c th c s dng gip xc nh bnh gan hoc bnh xng
khi c ALP tng.
Khi ung mt lng ru nh cng c th lm tng GGT. Tng cao hn c tm thy

trong nghin ru mn tnh, nng hn na nhng ngi tiu th 2-3 ly mi ngy hoc
nhng ngi ch ung rt nhiu vo nhng dp tic tng. Xt nghim GGT c th c s
dng trong vic nh gi mt ngi lm dng ru cp tnh hoc mn tnh.
GGT c th c s dng bit tnh trng lm dng ru mn tnh ca mt ngi (GGT

tng trong khong 75% ngi ung ru mn tnh). i khi n c th c s dng
gim st vic s dng ru hoc lm dng ru nhng ngi ang c iu tr nghin
ru, vim gan do ru.
Ch nh
Xt nghim GGT c th c ch nh khi mt ai c mt mc ALP cao. Th nghim

ALP c th xt nghim mt mnh hoc nh mt phn ca mt bng cc xt nghim gan
thng xuyn bit s thit hi gan ngay c khi khng c triu chng. Nu kt qu ca
th nghim ALP l cao nhng cc xt nghim khc ca bng xt nghim chc nng gan
bnh thng, chng hn nh AST v ALT u khng tng, th th nghim GGT c th
c ch nh gip xc nh cc nguyn nhn gy ALP cao do ri lon xng hoc bnh
gan.
GGT c th c ch nh cng vi xt nghim khc theo di, kim tra chc nng
gan khi mt ngi c du hiu hoc triu chng gi bnh gan.
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GGT c th c ch nh khi nhng ngi c tin s lm dng ru hon tt iu tr

ru, gim st s tun th vi cc chng trnh iu tr.
ngha XN
Mc GGT cao c th cho thy mt nguyn nhn no gy tn hi gan nhng khng

c th nguyn nhn g. Hm lng cao c th l do bnh gan, nhng GGT cao cng c th
l do cc bnh khc, chng hn nh suy tim sung huyt v tiu th ru. Mc GGT cao
s gip loi tr cc nguyn nhn ALP tng do chng ri lon xng.
Nu GGT thp hoc bnh thng, nhng ALP tng, nhiu kh nng l do bnh xng. Mt
kt qu thp hoc bnh thng cng khng loi b c ngi khng b bnh gan hoc
khng ung ru.
Thuc c th lm tng mc GGT bao gm phenytoin, carbamazepine, v an thn nh
phenobarbital. S dng nhiu loi thuc theo toa v thuc khng k n khc, bao gm
cc thuc chng vim khng steroid (NSAIDs), thuc h lipid mu, khng sinh, thuc chn
th th histamin (c s dng iu tr chng d tha acid trong d dy), cc thuc
khng nm, thuc chng trm cm, v kch thch t nh testosterone c th lm tng nng
GGT. Clofibrate v thuc trnh thai c th lm gim nng GGT.
5. Xt nghim Bilirubin
Bilirubin l mt sc t mu vng cam, mt sn phm cht thi c sn xut ch yu bi

s thoi ha bnh thng ca heme, mt cht tm thy ch yu trong hemoglobin protein
trong hng cu.
i sng hng cu bnh thng khong 120 ngy trong mu lu thng. Khi heme trong
hemoglobin b ph v, n c chuyn i thnh bilirubin, hnh thc ny cng c gi l
Bilirubin khng lin hp/ gin tip (unconjugated bilirubin). Bilirubin khng lin hp,
khng ha tan trong nc, v vy n c cc protein trong mu chuyn ch v gan, ti
y Bilirubin khng lin hp c gn vi Acid Glucuronic to thnh Bilirubin lin hp/
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trc tip (conjugated bilirubin) bilirubin lin hp ha tan trong nc. Bilirubin lin hp i
vo ng mt v chuyn t gan xung rut non, y n c tip tc chia nh bi cc
vi khun v cui cng loi b trong phn. Cc sn phm phn hy ca bilirubin lm cho
phn c mu nu c trng ca n.
Ngi ln khe mnh bnh thng sn xut khong 250-350 mg bilirubin mi ngy, trong
85% c ngun gc t cc t bo hng cu b h hng hoc gi, vi s cn li t ty
xng hoc gan. Thng thng, mt lng nh ca bilirubin khng lin hp c phng
thch vo mu, nhng hu nh khng c bilirubin lin hp trong mu. C hai loi c th
c o hoc c tnh bng cc xt nghim trong phng th nghim, v bilirubin ton phn
cng c bo co trong cc kt qu xt nghim.
Bilirubin khng kt hp cao c th l c qu nhiu Bilirubin ang c sn xut, thng

l do gia tng tiu hy (tn huyt) ca hng cu, hoc gan khng c kh nng ch bin
bilirubin do bnh gan nh x gan hoc cc vn di truyn. Bilirubin lin hp cao c th
ch ra rng gan c th x l bilirubin nhng n khng c loi b y mt cch kp
thi do vim gan cp tnh hoc tc nghn cc ng dn mt.
Bilirubin ton phn v cc bilirubin khng kt hp cng tng cao tr s sinh, thng tng
trong khong 1-3 ngy sau sinh. iu ny c gi l vng da sinh l ca tr s sinh,
nguyn nhn l do s non nt ca gan tr s sinh. Tnh trng ny thng t khi trong
vng vi ngy. Trong bnh tan huyt tr s sinh, cc t bo hng cu c th b ph hy v
mu khng tng thch gia cc em b v m, v iu tr c th l cn thit bi v nng
bilirubin khng lin hp cao c th gy ra thit hi cho no ca tr s sinh.
Tnh trng hp ng mt bm sinh him gp (khong 1 trong 10.000 ca sinh), nhng e

da tnh mng, c th gy ra tng bilirubin ton phn v bilirubin lin hp tr s sinh
phi c nhanh chng pht hin v iu tr kp thi, thng l bng phu thut, ngn
chn thit hi nghim trng v gan (x gan). yu cu ghp gan trong vng nm u tin
hoc c hai. Ngay c sau khi phu thut, mt s tr em vn c th yu cu ghp gan.
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Ch nh
C bng chng ca bnh vng da

C tin s ung qu nhiu ru
C nghi ng ng c thuc cp tnh
tip xc vi virus vim gan
Vng da s sinh.
Nghi ng c thiu mu tn huyt nh l mt nguyn nhn gy ra thiu mu.
ngha xt nghim
Bilirubin ton phn tng ch yu l bilirubin gin tip c th l mt kt qu ca:

Tn huyt, thiu mu c tnh
Phn ng truyn mu
X gan
Hi chng Gilbert, do thiu cc enzyme gn cc phn t Glucuronic vi bilirubin
Nu bilirubin trc tip tng ln cao hn bilirubin gin tip, nguyn nhn thng lin quan
n vn loi b bilirubin ca cc t bo gan. Mt s iu kin c th gy ra iu ny
bao gm:
Vim gan vi rt
Phn ng thuc
Bnh ng c ru
Tc nghn ng mt: si ti mt, khi u, vim ng mt...
6. Xt nghim Albumin
Xt nghim o lng nng ca Albumin trong mu. Albumin l mt protein c nhiu

nht trong cc thnh phn cc cht ha tan trong huyt tng. Albumin c vai tr gi cho
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cht lng (nc) khng r r ra ngoi mch mu, nui dng cc m v vn chuyn cc
hormon, vitamin, thuc, v cc ion nh canxi khp c th. Albumin c sn xut trong
gan v cc k nhy cm vi tn thng gan. Nng Albumin gim, khi gan b h hng,
khi mt ngi c bnh thn gy ra hi chng thn h, khi mt ngi b suy dinh dng,
c vim nhim, hoc b sc. Nng Albumin c th tng ln khi b mt nc. y l mt
s gia tng tng i, xy ra khi khi lng huyt tng gim.
T khi Albumin tm thy thp trong nhiu bnh v cc ri lon khc, th nghim Albumin
c s dng nh mt trong cc lot xt nghim c thc hin gip chn on bnh,
theo di nhng thay i tin trin ca tnh trng sc khe vi qu trnh iu tr bnh, v
nh l mt du chng c th ch nh cc loi th nghim cn thit khc.
ngha XN
Mc Albumin thp c th nghi ng bnh gan. Cc xt nghim men gan khc c thc
hin theo th t xc nh chnh xc loi bnh gan.
Mc Albumin thp c th phn nh bnh thn, khng th ngn chn Albumin r r t mu
vo nc tiu v b mt. Trong trng hp ny, s lng Albumin trong nc tiu cng c
th c o (xem microalbumin).
Mc thp Albumin cng c th c nhn thy trong vim, sc v suy dinh dng.
Mc thp Albumin c th c nhn thy vi nguyn nhn no c th khng hp th v
tiu ha protein ng cch, chng hn nh bnh Crohn, bnh celiac, trong khi lng
ln protein b mt qua rut.
S khc bit gia Albumin, Prealbumin, v microalbumin l g?
Albumin v microalbumin l nhng phn t tng t, trong khi prealbumin, mc d tn

nghe tng t, nhng l mt phn t hon ton khng lin quan. Xt nghim prealbumin
l xt nghim kim tra mt protein phn nh tnh trng dinh dng hin ti ca bn, c
bit l trc v sau khi phu thut, hoc nu bn ang nhp vin hoc dng thuc b sung
dinh dng. Kim tra Albumin c s dng thng xuyn hn kim tra gan hoc bnh
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thn hoc tm hiu nu c th bn khng hp th acid amin. Albumin cng c th

c s dng gim st tnh trng dinh dng v l mt th nghim rng ri hn, c sn
hn prealbumin. Tuy nhin, prealbumin thay i mt cch nhanh chng hn, lm cho n
hu ch hn cho vic pht hin nhng thay i tnh trng dinh dng trong ngn hn hn
so vi albumin. Cc xt nghim microalbumin o lng nng rt nh albumin trong
nc tiu ca bn v c th cho bit bn c nguy c pht trin bnh thn.
7. Xt nghim Protein ton phn
Protein c vai tr quan trng trong vic xy dng nn tt c cc t bo v m, Protein rt

quan trng cho s tng trng c th, pht trin, v bo v sc khe. Chng l mt thnh
phn cu trc ca hu ht cc b phn ca c th, n cng l cc enzyme v hormone c
chc nng iu ho hot ng ca c th. Xt nghim ny o lng tng s cc loi Protein
huyt tng trong mu ca bn.
C hai loi Protein chnh l Albumin, Globulin c tm thy trong mu.

Albumin l loi Protein cha nhiu Acid amin, c phn t lng nh, vai tr chnh ca
n l gi cho nc khng b thot ra khi mch mu thng qua p sut thm thu.
Globulin l loi protein bao gm cc enzym, khng th, v hn 500 cc protein khc.
T l Albumin/ Globulin (t l A / G) c tnh ton t cc gi tr thu c bng cch o

lng trc tip ca Protein ton phn v Albumin. T s i din cho s lng tng i
ca cc Albumin v Globulin.
Nng Protein ton phn c th phn nh tnh trng dinh dng v cng c th c s
dng sng lc v chn on bnh thn, bnh gan, cc nguyn nhn bnh l khc. Th
nghim Protein thng qui, i khi pht hin c nng Protein thay i trc khi cc
triu chng bt u xut hin. Nu Protein ton phn bt thng, cc xt nghim khc phi
c thc hin thm xc nh chnh xc nguyn nhn lm gim protein hoc tng
Protein.
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ngha xt nghim
Protein ton phn thp c th nghi ng mt ri lon gan, ri lon thn, hoc ri lon ca
s tiu ha,hp thu Protein,trong protein khng c tiu ha hoc hp th ng cch.
Mc thp c th c nhn thy trong suy dinh dng trm trng v cc nguyn nhn
gy km hp thu, chng hn nh bnh Celiac, bnh vim rut.
Protein ton phn cao c th c nhn thy tnh trng vim mn tnh hoc nhim trng
nh vim gan siu vi hoc HIV. Protein cao c th c gy ra bi chng ri lon ty
xng nh a u ty.
Mt s phng th nghim cng bo co t l tnh ton ca cc Albumin/ Globulin, gi l t

l A / G. Thng thng, Albumin c nhiu hn mt cht hn so vi Globulin, t l A /G
bnh thng khong 1 1,5. Ty trng thi bnh m n gy nh hng n nhng thay i
tng i lng Albumin v Globulin theo nhng cch khc nhau, iu ny c th cung
cp mt u mi vi bc s ca bn v nguyn nhn ca s thay i nng protein.
T l A/ G thp c th phn nh s sn xut qu mc Globulin, chng hn nh a u ty,

bnh t min dch, hoc lm gim sn xut Albumin, chng hn nh x gan, hoc lm mt
cc albumin trong lu thng, nh bnh thn (hi chng thn h).
T l A/ G cao cho thy khng sn xut u nhu cu ca globulin min dch c th c

nhn thy trong mt s thiu st di truyn v trong mt s bnh bch cu. Kim tra c th
hn, chng hn nh Albumin, kim tra men gan, v in di protein huyt thanh phi c
thc hin c mt chn on chnh xc.
8. Xt nghim RF
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Xt nghim yu t dng thp (Rheumatoid Factor). XN cn c tn: phn ng Waaler

Rose hoc/ v Latex.
Xt nghim ny pht hin v o cc yu t dng thp (RF) trong mu. RF l mt khng th

t sinh (autoantibodies), l mt protein IgM (globulin min dch M) c sn xut bi h
thng min dch ca c th. Khng th t sinh tn cng cc m ca chnh mnh, nhn nh
nhm ln cc m l "ngoi lai." Vai tr sinh hc ca RF cha c hiu r, s hin din
ca n l hu ch nh l mt ch bo v hot ng ca vim v t min dch.
Xt nghim RF l mt th nghim c gi tr khng nh vim khp dng thp (RA) hoc
hi chng Sjogren, nhng n c th dng tnh trong cc bnh l khc. Khong 75% nhng
ngi b RA v 60-70% ca nhng ngi b hi chng Sjogren s c xt nghim RF dng
tnh. Tuy nhin, RF cng c th c pht hin nhng ngi b mt lot cc ri lon
khc, chng hn nh nhim trng dai dng do vi khun, virus v k sinh trng, v bnh
ung th nht nh. i khi cng c th c nhn thy nhng ngi b bnh phi, bnh
gan, bnh thn, v cng c th c tm thy nhng ngi khe mnh vi mt t l phn
trm nh.
Xt nghim c s dng nh th no?
Xt nghim RF c s dng ch yu gip chn on vim khp dng thp (RA) hoc
hi chng Sjogren v gip phn bit chng vi cc bnh vim khp khc hoc cc bnh
l khc gy ra triu chng tng t. Trong khi chn on ca RA v hi chng Sjogren
ph thuc rt nhiu vo hnh nh lm sng, th mt s trong nhng du hiu v triu chng
c th khng c mt hoc khng in hnh, c bit l trong giai on u cc bnh ny.
Hn na, cc du hiu v triu chng khng phi lun lun c xc nh r rng v nhng
ngi c cc bnh ny cng c th c ri lon m lin kt hay bnh l khc, nh hin tng
Raynaud, x cng b, ri lon tuyn gip t min, v lupus ban h thng. Xt nghim
RF l mt trong s nhng cng c c th c s dng gip thc hin mt chn on
khi nghi ng b RA hoc hi chng Sjorgren.
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Mt kt qu xt nghim RF m tnh khng loi tr RA hoc hi chng Sjogren. Khong

20% nhng ngi b RA v nhng ngi c hi chng Sjogren c xt nghim RF m tnh
v / hoc c th c mc RF rt thp.
Kt qu xt nghim RF dng tnh cng c th c nhn thy ngi khe mnh v

nhng ngi c bnh l nh: vim ni tm mc, lupus ban h thng (lupus), bnh lao,
giang mai, sarcoidosis, ung th, nhim virus, hoc bnh gan, phi, thn. Xt nghim RF
khng c s dng chn on hay theo di cc bnh l ny.
Gi tr bnh thng < 14 UI/ml
9. Xt nghim Anti CCP
L XN nh lng t khng th IgG khng peptid citrullin mch vng (antibody to cyclic
citrullinated peptide - anti-CCP), mt k thut nh lng anti-CCP th h 2 (second-
generation anti-CCP assay) trong huyt thanh hoc huyt tng
XN ny c hiu hn so vi RF trong vim khp dng thp, gip cho vic chn on
bnh ny hiu qu hn.
Hin nay, anti-CCP c nh lng bng k thut nh lng min dch ha pht quang
(electrochemiluminescence immunoassay- "ECLIA") bng my phn tch min dch
Elecsys Cobas e.
Xt nghim anti-CCP khng c khuyn co s dng nh l mt xt nghim sng lc, n

c ch nh trong cc trng hp sau:
c ch nh cng vi xt nghim RF gip chn on vim khp dng thp.

Cng c ch nh tip sau mt xt nghim RF (-) tnh, nhng bnh nhn c cc triu
chng lm sng nh au khp v vim khp i xng, lm cho ngi thy thuc nghi ng
bnh nhn b vim khp dng thp.
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Cng c th c ch nh gip nh gi s tin trin vim khp dng thp cc

bnh nhn vim khp khng c hiu, c mt s triu chng lm sng gi nhng khng
hi cc tiu chun ca mt vim khp dng thp.
Gi tr bnh thng:
Gi tr ca anti-CCP huyt tng ngi khe mnh bnh thng l < 17 U/mL); cc gi
tr anti-CCP 17 U/mL c coi l (+) tnh.

i vi bnh nhn vim khp dng thp, vi ngng ti u (optimal cut-off) ca anti-
CCP l 17 U/mL, nhy ca xt nghim l 67,4 % v c hiu l 97,0 %.
ngha lm sng: nh gi trong s kt hp vi cc triu chng lm sng v RF
Nu c anti-CCP (+) tnh v RF (+) tnh, bnh nhn nhiu kh nng b vim khp dng
thp v c th bnh ang tin trin nng hn.
Nu anti-CCP (+) tnh nhng RF (-) tnh v cc triu chng lm sng th hin b vim
khp dng thp, bnh nhn c th b vim khp dng thp giai on sm hoc vim khp
dng thp s tin trin trong tng lai. Theo mt nghin cu Hoa K, khong 95% cc
bnh nhn c anti-CCP (+) tnh s tin trin thnh vim khp dng thp trong tng lai.
Nu anti-CCP (-) tnh nhng RF (+) tnh v cc triu chng lm sng th hin b vim
khp dng thp, bnh nhn c th b vim khp dng thp hoc b mt s cc vim khc.
Nu c anti-CCP v RF u (-) tnh, t c kh nng bnh nhn b vim khp dng thp.
Tuy nhin, cn nhn mnh rng, vic chn on vim khp dng thp ch yu da vo lm
sng, do vim khp dng thp c th c chn on vi cc triu chng lm sng in
hnh ngay c khi cc khng th t min (-) tnh.
Mt iu cn ch na l khi kt hp gia cc xt nghim chn on vim khp dng thp
nh anti-CCA, RF, mu lng v CRP trong chn on, nhng bnh nhn c chn
on vim khp dng thp, cc xt nghim anti-CCP v RF ( (+) tnh) khng cn lm li
na. theo di s tin trin ca vim khp dng thp v nh gi hiu qu iu tr, ch
cn theo di mu lng v CRP theo thi gian l .
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10. Xt nghim khng th khng nhn
Khng th khng nhn (ANA Antinuclear Antibody): xc nh s hin din ca khng

th khng nhn (ANA) trong mu (ANA c gi l "khng th khng nhn v ANA l t
khng th chng li mt s thnh phn c tm thy trong nhn ca mt s t bo). ANA
l mt nhm ca cc khng th c bit c sn xut bi h thng min dch ca mt
ngi khi n khng phn bit thch hp gia "cng loi " v "khc loi." Nhng t khng
th tn cng cc t bo ca c th, gy ra cc du hiu v triu chng nh vim m v c
quan, au khp v c bp, v mt mi. S hin din ca ANA l mt du hiu ca mt qu
trnh t min dch v c lin kt vi mt s bnh t min dch, nhng ph bin nht
c thy trong lupus ban ri lon t min dch h thng (SLE).
Xt nghim ANA c thc hin bng cch s dng nhng phng php xt nghim khc
nhau (knh hin vi min dch hunh quang gin tip hoc bng cc th nghim min dch
hp th lin kt men (Enzyme linked immunosorbant assay, ELISA), kt qu c bo co
l mt chun (t l pha long), thng th nghim immunofluroscence mc chun
c hiu (dng tnh). mc chun thp hn c xem l m tnh, khi chun tng
ln, chng hn nh mc 1:320, dng tnh, cho thy nng cao ca cc khng th khng
nhn.
Xc nh ANA trong min dch hunh quang gin tip l cc m hnh hunh quang trong
cc t bo c c nh vo mt slide c nh gi di knh hin vi. Cc m hnh khc
nhau c lin quan vi mt lot cc ri lon t min dch, mc d s chng cho ln nhau
c th xy ra. Mt s cc m hnh ph bin bao gm:
ng nht (khuch tn) - lin quan vi bnh SLE v m lin kt hn hp

Lm m (speckled) lin quan vi SLE, hi chng Sjogren, x cng b, polymyositis,
vim khp dng thp, v bnh m lin kt hn hp
Nucleolar - lin quan vi x cng b v polymyositis
M hnh trung tm (Centromere pattern) - lin quan vi x cng b v CREST

(Calcinosis, hi chng Raynaud, Esophogeal dysmotility, Sclerodactyly, Telangiectasia)
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Kt qu xt nghim ANA dng tnh c th nghi ng mt bnh t min, nhng th nghim

c th thm na l cn thit h tr trong vic a ra mt chn on cui cng. Kt qu
xt nghim ANA c th dng tnh nhng ngi m h khng c bt k bnh t min
dch c bit n. Nhng iu ny khng phi l ph bin, tn s ca mt kt ANA dng
tnh gi tng nhng ngi ln tui.
Khong 95% nhng ngi c SLE c kt qu xt nghim ANA dng tnh. Nu mt ngi
no cng c triu chng ca SLE, chng hn nh vim khp, pht ban, v gim tiu cu
t min dch, v sau ngi y c th b SLE. Trong trng hp nh vy, mt kt qu
ANA dng tnh c th hu ch h tr chn on SLE. Hai tp hp xt nghim cho cc
loi hnh c hiu ca t khng th, chng hn nh Anti dsDNA v Anti-SM, c th c
ch nh (thng l mt bng xt nghim ENA) gip xc nhn rng nguyn nhn l SLE.
Cc nguyn nhn khc c th c nhn thy trong mt kt qu xt nghim ANA dng
tnh bao gm:
Hi chng Sjogren: 40% n 70% ca nhng ngi c nguyn nhn ny c kt qu xt

nghim ANA dng tnh, kt qu ny h tr chn on, nhng khi kt qu m tnh cng
khng loi tr c bnh. Bc s c th cho xt nghim hai tp con ca ANA: Anti-SS-A
(Ro) v Anti-SS-B (La). Khong 90% hoc nhiu hn nhng ngi b hi chng Sjogren
c t khng th SSA.
X cng b (x cng h thng) (Scleroderma (systemic sclerosis)): Khong 60% n
90% nhng ngi c x cng b pht hin c ANA dng tnh. Trong nhng ngi c th
c nguyn nhn ny, xt nghim tp hp ANA con c th gip phn bit hai hnh th ca
bnh, gii hn ngc vi khuch tn. Cc hnh th khuch tn l nghim trng hn. Bnh
c gii hn lin quan cht ch vi cc m hnh nhum anticentromere ANA (v cc xt
nghim anticentromere), trong khi hnh th khuch tn lin quan vi t khng th chng
SCL-70.
Mt kt qu ANA dng tnh cng c th xut hin nhng ngi c bnh Raynaud,
vim khp dng thp, vim da hoc polymyositis, bnh m lin kt hn hp, v cc nguyn
nhn t min dch khc.
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Mt kt qu ANA m tnh khng ngh n c SLE,thng khng cn thit phi lp li ngay

lp tc khi c mt th nghim ANA m tnh, tuy nhin, do tnh cht nhiu t ca cc bnh
t min dch, nn c th lp li cc xt nghim ANA vo mt ngy trong tng lai nu cc
triu chng khng gim.
Mt s thuc v mt s bnh nhim trng (nh vim gan siu vi mn tnh, x gan ng
mt nguyn pht) cng nh cc nguyn nhn khc c cp trn c th cho kt qu
dng tnh gi cho cc th nghim ANA.
Khong 3% - 5% ngi da trng c th c ANA dng tnh v n c th t t l cao nht

khong 10% - 37% ngi khe mnh tui 65.Mt s thuc c th l nguyn nhn gy
ra cc triu chng SLE, c gi l lupus do thuc gy ra.
Khi thuc c dng li, cc triu chng thng bin mt. Mc d nhiu loi thuc
c bo co gy ra lupus do thuc, r rng nht vi hi chng ny bao gm hydralazine,
isoniazid, procainamide, v mt s thuc chng co git.
Mc d mt s phng th nghim c th s dng mt xt nghim min dch kim tra

ANA, khng th hunh quang (IFA) gin tip vn c coi l tiu chun vng. Thng
thng, cc phng th nghim s i chiu bng cch s dng xt nghim min dch v xc
nhn kt qu dng tnh hoc khng r rng bng cch s dng IFA.
Cc bnh l c khng th khng nhn dng tnh

T l dng tnh
STT Bnh l
(%)
Nhm bnh l ANA rt c gi tr chn on:
01 + Lupus h thng 95 100

60 - 80
+ X cng b
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Bnh l ANA c gi tr chn on:
02 + Hi chng Sjogren 40 70
30 - 80
+ Vim c v cn (vim a c v vim da c)
Bnh l m ANA c gi tr theo di v tin lng:
03 + Vim khp mn tnh thiu nin c vim mng mt. 20 50
+ Hin tng Raynaud 20 - 60

Bnh l m ANA l mt trong cc tiu chun chn on:
+ Lupus do thuc. 100

04
+ Vim gan t min. 100
+ Bnh m lin kt hn hp. 100

Bnh l m ANA khng gip ch chn on:
+ Vim a khp dng thp. 30 50

+ X cng b. 25
+ Xut huyt gim tiu cu v cn. 10-30
+ Bnh tuyn gip. 30-50
+ Discoid lupus. 5-25
05
+ Bnh nhim trng. Thay i
+ Bnh l c tnh Thay i
+ n ngc vi ti silicon. 15-25
+ Fibromyalgia. 15-25
+ Ngi nh ca bnh nhn c bnh t min (lupus h thng hay 5-25
vim a khp)
Ngi khe mnh bnh thng

20-30
06 1/40
10-12
1/80
5
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1/160 3
1/320
11. Khng th khng DNA
Khng th khng DNA (Antibody to dsDNA): o lng khng th deoxyribonucleic acid

si kp (anti-dsDNA) c th xut hin trong mu. Anti-dsDNA l mt t khng th, to ra
khi h thng min dch ca mt ngi khng phn bit c thnh phn t bo ca"chnh
mnh " hay "khng ca chnh mnh". N nhm ln mc tiu v tn cng h di truyn c
hiu ca c th, gy vim, tn thng m, v cc du hiu v triu chng c lin quan vi
mt ri lon t min dch.
Anti-dsDNA l mt khng th khng nhn (ANA), mt nhm cc khng th trc tip chng
li cc cht c tm thy trong nhn ca cc t bo. Cc khng th c th c mt mc
thp vi mt s ri lon, anti-dsDNA ch yu lin quan n lupus ban ri lon t min
dch h thng (SLE Lupus). SLE c th nh hng n thn, khp, mch mu, da, tim,
phi, v no.
Mt trong nhng bin chng c bit nghim trng ca SLE l vim thn lupus, mt tnh
cnh c trng l vim thn, c th dn n protein trong nc tiu, huyt p cao, v suy
thn. N xy ra khi cc t khng th lin kt vi cc khng nguyn v lng ng trong thn.
Vic nh gi mt ngi no vim thn lupus, mt chun cao ca Anti dsDNA
thng gn lin vi vim lin tc v tn thng thn.
Xt nghim c s dng nh th no?Cc th nghim Anti-dsDNA c s dng trong

h tr chn on lupus ban h thng (SLE) v phn bit n vi cc ri lon t min
khc. Xt nghim ny thng c ch nh, sau th nghim ANA dng tnh nhng
ngi c du hiu lm sng cho thy SLE. N c th c ch nh cng vi mt t khng
th lin kt vi SLE l xt nghim Anti Sm (Smith antibody), thng c thc hin nh
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l mt phn ca mt b khng nguyn nhn b sung (Extractable Nuclear Antigen

Antibodies, ENA). Ty thuc vo cc du hiu lm sng v nghi ng ca bc s, t khng
th b sung c th c ch nh gip phn bit gia, v loi tr, ri lon t min khc.
Cc th nghim Anti dsDNA c th c s dng theo di hot ng bnh mt ngi
c chn on SLE. Nhng ngi c SLE thng c bng pht triu chng xu i v
sau ln xung. Mc khng dsDNA tng c th c nhn thy trc v trong t
bng pht.Khi no c ch nh?Mt th nghim Anti dsDNA ch nh khi mt ngi
c du hiu v triu chng c th l do SLE v c mt th nghim ANA dng tnh,
c bit l khi ANA trnh by mt m hnh hunh quang "thun nht" hoc "lm m".
(Xem bi vit xt nghim ANA bit thm v iu ny). SLE lin quan cht ch vi mt
ANA dng tnh, c nhn thy trong khong 95% cc trng hp SLE. Tuy nhin, ANA
dng tnh cng c nhn thy trong nhiu iu kin khc, trong khi Anti dsDNA dng
tnh l kh c hiu cho SLE. Mc d anti-dsDNA c hiu hn ANA, nhng th nghim
ny cng khng thng c ch nh khi ANA m tnh.Kt qu xt nghim c ngha
l g?Kt qu ca th nghim Anti dsDNA thng c xem xt cng vi tin s bnh ca
mt ngi, cc du hiu, triu chng, v kt qu cc xt nghim t khng th khc.
Mt mc cao ca anti-dsDNA lin quan cht ch vi SLE v thng tng ln ng k
trong hoc ngay trc khi mt t SLE bng pht. Nu Anti dsDNA dng tnh v ngi
c kim tra c du hiu lm sng lin quan vi SLE, v sau ngi y c kh nng b
SLE. iu ny chc chn ng nu th nghim Anti Sm cng dng tnh.
Mt mc rt thp ca anti-dsDNA c coi l m tnh nhng khng loi tr mt chn on
SLE. Ch c khong 50-60% nhng ngi c SLE s c anti-dsDNA. Thp n mc
va phi ca t khng th c th c nhn thy vi cc ri lon t min khc, chng hn
nh hi chng Sjogren v bnh m lin kt hn hp (MCTD = Mixed Connective Tissue
Disease)
Xt nghim Anti-dsDNA l bn nh lng v c th c thc hin bng cch s dng

cc phng php xt nghim khc nhau. Nhiu phng th nghim s dng th nghim anti-
dsDNA bng phng php ELISA (enzyme-linked immunoabsorbent kho nghim), mt
th nghim rt ng tin cy v nhy cm.iu g khc cn bit?Anti-dsDNA i khi c
tm thy cc bnh nh vim gan mn tnh, x gan mt nguyn pht v bnh truyn nhim.
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N cng c th c nhn thy trong nhng loi thuc nh procainamide v hydralazine.

N khng phi l th nghim chn on hoc theo di nhng nguyn nhn ny.
Ngoi xt nghim anti- ds DNA, cng c mt th nghim khng DNA si n (anti-single-
stranded DNA (Anti ss DNA)). T khng th ny c th nghim t ph bin hn v
khng lin quan cht ch vi SLE nhng c th c nhn thy vi cc ri lon t min
khc.
12. Xt nghim Acid Uric
Acid Uric (AU) l sn phm do s phn hy ca purin (Adenylic v Guanilic), l nhng

hp cht c cha Nit c tm thp trong cc cht nh DNA, purin vo mu ch yu t
s phn hy bnh thng ca cc t bo trong c th, mt phn t hn t s tiu ha cc
thc phm nh tht, c, gan, u Ha Lan, cc ung nh bia, ru vang. Hu ht cc
Acid Uric c o thi ra nc tiu, phn cn li loi b ra phn.
Nu qu nhiu AU c sn xut hay gim s loi b n c th tch ly li trong c th v

gy tng nng AU trong mu (tng AU mu). S hin din ca AU d tha c th gy
ra bnh Gout, biu hin c trng l tnh trng vim xy ra cc khp khi tinh th AU xut
hin trong dch khp. D tha AU cng c th dn n bnh thn.
S tch t AU qu nhiu do mt trong hai, sn xut tng, gim s loi b hay c hai. Sn
xut tng c th do t bo cht gia tng nh iu tr ung th. Gim thi tr do bnh thn.
Trong nhiu trng hp tng AU khng r nguyn nhn.
Ch nh
Bc s nghi ng mc AU cao
Bnh Gout
au khp thng xuyn nht l ngn chn, cc khp khc khng au.
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Bnh nhn tri qua ha tr v x tr
Th nghim AU nc tiu ch nh cho nhng ngi si thn ti pht. hoc ngi bnh
gout pht hin sm s hnh thnh vin si trong thn.
ngha
c gi tng AU khi nng > 7 mg/dL (416 mcmol/L), nguyn nhn c th do tng sn
xut AU hay kh nng bi tit ca thn gim.
Nguyn nhn thng gp:

Ung th di cn
a u ty xng
Bnh bch cu
Ha tr, x tr ung th
Bnh thn mn tnh
Nhim toan mu
Nhim c thai nghn
Nghin ru
n nhiu tht, ni tng
Khi nng AU tng trong mu c th gy ra s hnh thnh cc tinh th cc khp, c th

dn n vim khp v au nhc l mt c trng ca bnh gout. AU cng c th hnh thnh
tinh th thn, gy si thn lm tn thng thn.
Nc tiu
Nng AU nc tiu cao > 0.8 gam / 24 gi (47,5 mmol/24 gi) c nhn thy trong
bnh nhn gout, a u ty xng, ung th di cn, bnh bch cu v ch n nhiu tht, ni
tng, nhng ngi c nguy c si thn.
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Nhiu loi thuc c th lm tng hay gim AU, thuc li tiu Thiazide lm tng AU mu,
Aspirin liu thp lm tng AU nhng liu cao tr vim khp dng thp li c tc dng lm
gim AU mu.
13. Xt nghim Amylase
Amylase l mt enzyme sn xut bi tuyn ty gip tiu ha cht tinh bt

(carbohydrate). N c tit ra qua ng ty vo t trng, n gip ph v carbohydrate t
thc n ung. Amylase cng c sn xut bi cc c quan khc, c bit l tuyn nc
bt.
Amylase bnh thng hin din trong mu v nc tiu vi s lng nh. Khi cc t bo
trong tuyn ty b tn thng, vim ty, ng ty b chn do si hoc him hn khi c mt
khi u tuyn ty, s lng amylase tm ng vo mu lm tng nng trong mu v ra
nc tiu, nc tiu l con ng bi tit amylase t mu.
Xt nghim amylase mu c ch nh cng vi xt nghim lipase, gip chn on v

theo di vim ty cp tnh hoc mn tnh v cc ri lon khc c th lin quan n tuyn
ty. Xt nghim amylase nc tiu cng c th c ch nh. Thng thng, nng
amylase nc tiu s phn nh nng amylase mu. i khi xt nghim creatinine trong
nc tiu cng c th c ch nh cng vi amylase nc tiu gip nh gi chc
nng thn, chc nng thn gim c th dn n gim tc bi tit amylase ra nc tiu.
Trong mt s trng hp, th nghim amylase c th c thc hin trn dch phc mc
gip chn on vim ty.
ngha XN
Gi tr tham kho:
Amylase mu= 15 85 U/L
Amylase nc tiu= < 485 U/L

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Trong vim ty cp, amylase trong mu thng tng ln gp 4-6 ln so vi gi tr tham

kho cao nht, i khi c gi l gii hn trn ca mc bnh thng. S gia tng ny xy
ra trong vng 12-72 gi sau khi tuyn ty b tn thng v ni chung vn cn cao cho n
khi nguyn nhn c iu tr thnh cng. Cc gi tr amylase s tr li bnh thng trong
mt vi ngy sau . Trong vim ty mn tnh, nng amylase ban u tng cao va
phi, nhng thng gim theo thi gian vi s tin trin ca tn thng tuyn ty.
Mc Amylase cng c th c tng ln ng k nhng ngi tc nghn ng ty v
ung th tuyn ty.
Mc tng ca amylase trong dch phc mc c th xy ra trong vim ty cp nhng cng
c th xy ra trong cc ri lon bng khc, chng hn nh tc nghn rut hoc gim lu
lng mu n rut (nhi mu).
Nng amylase mu v nc tiu gim mt ngi c cc triu chng vim ty c th
cho bit cc t bo sn xut amylase ca tuyn ty b tn thng vnh vin. Mc amylase
tng trong mu, nng amylase nc tiu bnh thng hay thp c th ch ra s hin din
ca macroamylase, mt phc hp lnh tnh gia amylase v cc protein khc tch t trong
mu.
14. Xt nghim Lipase
Lipase l mt enzyme sn xut bi tuyn ty gip tiu ha cht bo trong thc n ung.
N c vn chuyn thng qua cc ng ty vo t trng, ni m n s gip ph v cht
bo trung tnh (mt dng cht bo) trong thc n ung thnh cc acid bo.
Lipase bnh thng hin din trong mu vi mt s lng nh. Khi cc t bo trong tuyn
ty b tn thng, vim ty, ng ty b chn do si hoc him hn l mt khi u tuyn ty,
s lng lipase vn chuyn vo trong mu tng, lm tng nng lipase trong mu.
Xt nghim lipase mu thng c ch nh cng vi xt nghim amylase, gip chn

on v theo di vim ty cp, vim ty mn tnh, v cc ri lon khc c lin quan n
tuyn ty.
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Th nghim lipase thnh thong cng c s dng trong chn on v theo di cc bnh
x nang, bnh celiac v bnh Crohn.
ngha XN
Gi tr tham kho: Lipase / mu: < 60 U/L
Trong vim ty cp tnh, mc lipase thng rt cao, thng cao hn gp 5-10 ln so vi

gi tr tham kho cao nht (thng c gi l gii hn trn ca mc bnh thng). Nng
lipase thng tng trong vng 24-48 gi sau khi tuyn ty b tn thng cp tnh v vn
cn cao khong 5-7 ngy. Nng cng c th tng ln do tc nghn ng ty, ung th
tuyn ty, v cc bnh v ty khc.
Mc lipase gim c th do tn thng vnh vin cc t bo sn xut lipase trong tuyn
ty. iu ny c th xy ra trong cc bnh mn tnh gy nh hng n tuyn ty nh x
nang.
Trong vim ty cp, nng lipase thng tng song song vi nng amylase mu, mc
d mc amylase c xu hng tng v gim sm hn mt cht so vi mc lipase.
15. Xt nghim Phosphatase kim
Phosphatase kim (Alkaline phosphatase ALP) l mt loi enzyme c tm thy trong

cc m khp c th, bao gm c gan, xng, thn, rut, v trong nhau thai ca nhng ph
n ang mang thai. Tuy nhin, ALP c nhiu nht trong cc t bo ca xng v gan.
Trong gan, n c tm thy cc cnh ca cc t bo to thnh ng dn mt - ng nh
dn mt t gan xung rut, rut n gip tiu ha cht bo t thc n. ALP trong xng
c sn xut bi cc t bo c bit gi l "nguyn bo xng c lin quan n s hnh
thnh ca xng. Mi loi m khc nhau sn xut cc dng ALP khc nhau c gi l
isoenzymes.
Hm lng cao ca ALP trong mu nguyn nhn ph bin nht l bnh gan hoc ri lon
xng. Nng cc men c th c tng ln rt nhiu, trong trng hp mt hoc nhiu
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ng dn mt b tt nghn. Nng trong mu tng t hn c nhn thy trong ung th gan

v x gan, s dng thuc gy c cho gan, v vim gan. Bt k nguyn nhn no gy ra s
hnh thnh xng qu mc, bao gm cc ri lon xng nh bnh Paget v nhng nguyn
nhn khc nh vim khp dng thp v cha tr bnh gy xng, c th gy ra mc tng
ALP. Tr em v thanh thiu nin thng c nng ALP trong mu cao hn bi v xng
ca chng vn ang pht trin.
Ngi ta c th phn bit cc dng khc nhau (isoenzymes) ca ALP. Nu khng c du

hiu v triu chng lm sng r rng, cho d ngun gc ALP t bnh gan hoc bnh xng
th kt qu xt nghim ALP vn cao, sau mt xt nghim khc c th c thc hin
xc nh isoenzyme no tng ln trong mu. iu ny c th gip xc nh c tng l do
xng hoc bnh gan.
Xt nghim phosphatase kim (ALP) c s dng gip pht hin bnh gan hoc ri
lon xng. Trong cc nguyn nhn nh hng n gan, cc t bo gan b h hng phng
thch s lng ALP vo mu tng. Xt nghim ny thng c s dng pht hin cc
ng dn mt b tt nghn v ALP c bit c nhiu cc cnh ca cc t bo tham gia to
thnh ng mt. Nu mt hoc nhiu ng dn mt b cn tr, nh mt khi u gy chn p
lm nng ALP trong mu thng s rt cao.
Bt k nguyn nhn no c nh hng n s pht trin xng hoc gy tng hot ng
ca cc t bo xng c th nh hng n mc ALP trong mu. Mt th nghim ALP
c th c s dng, pht hin ung th di cn n xng hoc gip chn on
bnh Paget. Xt nghim ny i khi c th cng c s dng theo di iu tr bnh
Paget hoc cc bnh xng khc, chng hn nh thiu vitamin D.
Nu kt qu ALP c tng ln, nhng n khng bit r rng nguyn nhn l do bnh gan
hoc xng, mt xt nghim cho kim tra isoenzyme ALP c th c thc hin xc
nh nguyn nhn. Mt th nghim GGT v / hoc th nghim 5'-nucleotidase cng c th
c thc hin phn bit gia bnh gan v cc bnh xng. GGT v 5'-nucleotidase
tng trong bnh gan nhng khng tng trong ri lon xng.
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Ch nh:
RL chc nng gan
RL xng: gy xng, bin dng xng, au khp
ngha
ALP cao thng c ngha l hoc gan b h hi hoc mt iu kin gy ra s gia tng hot
ng t bo xng. Nu cc xt nghim gan khc nh bilirubin, aspartate aminotransferase
(AST), alanine aminotransfere (ALT) cng cao, ALP cao n t gan. Nu xt nghim canxi
v pht pho l bt thng, ALP cao n t xng. Nu GGT hoc 5'-nucleotidase cng
tng ln, ALP cng cao c th l do bnh gan. Nu mt trong hai xt nghim ny l bnh
thng, m ALP cao c th l do tnh trng ri lon xng.
Nu khng c cc du hiu v triu chng r rng hoc t cc xt nghim thng xuyn

khc khng xc nh c ALP cao l do gan hoc xng, th mt th nghim isoenzymes
cho ALP c th l cn thit phn bit gia xng v gan.
ALP trong bnh gan: kt qu ALP thng c nh gi cng vi cc xt nghim khc i
vi bnh gan. Trong mt s hnh thc ca bnh gan, nh vim gan, ALP thng t hn cao
hn AST v ALT. Khi cc ng dn mt b chn (thng l do si mt, nhng vt so t si
mt trc hoc phu thut, hoc ung th), ALP v bilirubin c th tng nhiu hn AST
hoc ALT. N cng c th c tng ln trong bnh ung th gan.
ALP trong bnh xng: trong mt s bnh xng, chng hn nh bnh Paget, xng tr
nn m rng v bin dng, hoc trong mt s bnh ung th di cn n xng, ALP c
th tng ln.
Nu mt ngi ang c iu tr bnh Paget thnh cng, mc ALP s gim i hoc

tr v bnh thng. Nu ai c ung th xng hay ung th gan p ng vi iu tr, th
ALP gim.
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Mc thp ca ALP c th c nhn thy tm thi sau khi truyn mu hoc phu thut
tim. S thiu ht km c th gy ra mc gim. Mt di truyn him gp ri lon chuyn
ha xng c gi l hypophosphatasia c th gy nghim trng, mc ALP thp ko
di.
Mang thai c th lm tng mc ALP. cao tm thi cng thy khi cha tr bnh gy
xng.
Tr em v thanh thiu nin thng c mc ALP cao hn ngi ln v xng ca h

ang pht trin, v ALP thng rt cao trong qu trnh pht trin mnh m, xy ra cc
la tui khc nhau nam v n.
Mt s loi thuc c th nh hng n mc ALP. V d, thuc trnh thai c th lm

gim nng trong khi chng ng kinh c th lm tng mc .
16. Xt nghim CK/ CPK
Creatine kinase (CK) hay Creatine phosphokinase (CPK) l mt enzyme c tm thy

trong tim, no, c xng, v cc m khc. Enzym l nhng protein gip cc t bo thc
hin cc chc nng bnh thng ca c th. Trong c v t bo tim, hu ht nng lng
ny c s dng khi cc c hot ng.
C ba hnh thc khc nhau ca CK trong c th ca bn, chng c gi l isoenzymes:

CK-MM (c tm thy trong c xng v tri tim ca bn)
CK-MB (c tm thy phn ln trong tri tim ca bn)
CK-BB (c tm thy ch yu trong no ca bn).
Bnh thng CK c s lng nh trong mu, ch yu t cc c bp ca bn. CK trong no

ca bn hu nh khng bao gi vo mu.
Nng CK trong mu tng ln khi cc t bo c hoc tim b tn thng. Nng CK

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trong mu bt u tng khong 4 n 6 gi sau khi c cn au tim. N t n mc cao

nht sau khong 18 n 24 gi v tr li bnh thng trong vng 2 n 3 ngy. S lng
CK trong mu cng tng ln khi c xng b chn thng.
Ch nh
cc bnh nhn c th c mt cn au tim, cc xt nghim CK thng s c ch nh

khi h n phng cp cu v thc hin li mt ln na sau khong 4-6 gi, tng cng ba
ln. Nu bn b au c hay yu c, bc s c th yu cu th nghim CK xem cc c
khc c b tn thng hay khng.
Xt nghim ny c th c s dng :
Chn on cn au tim
nh gi nguyn nhn au ngc
Xc nh c bp c b tn thng
Pht hin vim da v polymyositis
Phn bit gia tng thn nhit c tnh v nhim trng sau phu thut.
Bnh lon dng c Duchenne (Muscular dystrophy)
ngha
Bnh thng: 25 180 U/L

CK cao ngay ln xt nghim u tin hoc ln th hai sau , ch cho bit c mt s
thit hi i vi tim hay cc c khc. N cng c th ch cho bit c bp ca bn hot
ng nng. Nu bc s nghi ng mt cn au tim v CK ca bn tng cao, Bc s thng
ch nh thm mt xt nghim c hiu khc l troponin xem c tim bn c b tn thng.
Mc CPK tng cao c th thy nhng bnh nhn c:
Tn thng no hoc t qu
Co git
M sng ca ngi nghin ru nng
Vim da hoc polymyositis (Vim a c)

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in git
au tim
Vim c tim (vim c tim)
Nhi mu phi
C bp teo
Bnh c
Nguyn nhn c th cho kt qu xt nghim dng tnh:

Suy gip
Cng gip
Vim mng ngoi tim sau mt cn au tim

Tiu c vn
Nhng ngi c khi lng c ln hn, c mc CK cao hn so vi nhng ngi binh

thng, v ngi M gc Phi c th c mc CK cao hn so vi cc dn tc khc. Tp th
dc rt nng (nh c t, cc mn th thao, hoc cc bui tp th dc di) cng c th tng
CK. Cc hnh thc khc, chng hn nh t mt t ng, mt tai nn xe hi, phu thut, hay
tim bp, lm tn thng c bp cng c th tng CK.
Nhiu loi thuc, bao gm c thuc h cholesterol (statin), c th gy tn thng c bp

v tng CK. Nu bn ang dng mt trong cc loi thuc ny, cho bc s bit nu bn gp
bt k au c hay yu. Ung qu nhiu ru tng nh CK.
17. Xt nghim CK-MB
CK-MB (Creatine Kinase Myoglobin) l mt trong ba hnh thc ring bit (isoenzymes)
ca enzyme creatine kinase (CK). CK-MB c tm thy ch yu c tim. CK MB tng
ln khi c tn thng cc t bo c tim.
CK-MB, cng vi CK tng s, c th nghim cho nhng ngi b au ngc chn

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on, cho d h c mt cn au tim. Khi CK tng s cao nguyn nhn c th do tn

thng c tim hoc c bp khc, CK-MB dng phn bit gia hai nguyn nhn ny.
CK-MB thng ch nh vi CK tng s ngi c au ngc xc nh xem cn au l
do mt cn au tim. N cng c th c ch nh mt con ngi c xt nghim CK cao
xc nh tn thng do c tim hay cc c khc.
CK-MB tng thng c th c pht hin nhng bnh nhn au tim khong 3-4 gi sau
khi khi pht au ngc. Nng CK-MB nh sau khong 18-24 gi v sau tr li bnh
thng trong vng 72 gi.
Mc d CK-MB l mt th nghim rt tt, nhng phn ln CK MB c thay th bi

troponin, l xt nghim c hiu hn cho cc tn thng c tim.
ngha
Bnh thng CK MB: < 25 U/L
Nu gi tr ca CK-MB l cao v t l % ca CK-MB / CK tng s (ch s tng i) ln

hn 5, c kh nng l tim b tn thng. Mt CK cao vi mt ch s tng i < 3 cho
thy rng c xng b tn thng.
Chn thng c xng nghim trng c th lm tng nng CK MB cao hn bnh

thng, nhng chn thng nh vy thng khng gy ra mt ch s tng i > 5.Tp
th dc nng cng c th lm tng c CK v CK-MB.
18. Xt nghim Myoglobin
Myoglobin l mt protein nh, lin kt vi oxy c tm thy trong tim v c xng. N

cung cp oxy cho cc t bo c bp, cho php cc t bo sn xut nng lng cn thit cho
s co c. Khi c tim hoc xng b tn thng, myoglobin c phng thch vo mu.
Nng tng c th o c trong vng vi gi sau chn thng.
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Myoglobin c lc ra khi mu qua thn v c bi tit vo nc tiu. S lng ln ca

myoglobin l c i vi thn. Nu s lng ng k ca myoglobin c phng thch vo
mu, c th xy ra sau khi chn thng nghim trng hoc tim v c xng b tn thng,
myoglobin d tha c th gy ra thit hi cho thn v cui cng dn n suy thn. o nng
myoglobin trong nc tiu gip pht hin tnh trng ny.
Myoglobin c th c s dng nh mt du n sinh hc tim, cng vi troponin, gip

chn on hoc loi tr mt cn au tim. Mc myoglobin bt u tng ln trong vng
2-3 gi sau khi c mt cn au tim hoc tn thng c bp khc, t mc cao nht trong
vng 8-12 gi, v thng ri tr li bnh thng trong vng mt ngy. S gia tng
myoglobin th pht hin sm hn so vi troponin, nhng n khng phi l c hiu i vi
tn thng tim v n s khng cao ko di nh troponin.
Mc d kt qu myoglobin m tnh c hiu qu c th loi tr mt cn au tim, nhng mt

kt qu dng tnh phi c xc nhn thm bi th nghim troponin.
i khi, mt xt nghim nc tiu c ch nh nh gi nng myoglobin trong

nhng ngi c thit hi ln cho cc c xng ca h (tiu c vn). Nng trong mu
ca myoglobin c th tng ln rt nhanh chng vi tn thng c nghim trng. Nng
myoglobin trong nc tiu phn nh mc ca chn thng c bp, myoglobin l c
i vi thn,nng myoglobin trong nc tiu phn nh nguy c tn thng thn.
Myoglobin khng c s dng rng ri chn on cn au tim v phn ln c
thay th bng troponin. Nu xt nghim myoglobin c sn, n c th c thc hin
nh gi ngi c au ngc nhng ngi b nghi ng c mt cn au tim. Cc mu mu
c rt ra xt nghim ln u v c lm li mi 2-3 gi cho n 12 gi cho nhng
ngi n phng cp cu vi mt nghi ng c cn au tim.
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Myoglobin nc tiu c th c ch nh khi c chn thng c xng rng, dn n s

sp nhanh chng ca c bp, v nghi ng tn thng n thn.
ngha
Bnh thng: 28 = 72 ng/mL
S gia tng myoglobin mu c ngha rng c s tn thng rt gn y i vi tim hay

m c xng. Th nghim b sung, chng hn nh troponin, l cn thit xc nh ni
nhng thit hi xy ra. Bi v myoglobin cng c tm thy trong c xng, nng
tng c th xy ra nhng ngi c tai nn, ng kinh, phu thut, hoc bnh c, chng
hn nh chng lon dng c bp.
Nu myoglobin khng tng trong vng 12 gi sau khi khi pht au ngc, nhi mu c tim
l rt kh.
Mc myoglobin thng rt thp hoc khng pht hin c trong nc tiu. Mc
cao ca myoglobin nc tiu cho thy tng nguy c tn thng thn v suy thn. Th
nghim b sung, chng hn nh BUN, creatinine, v phn tch nc tiu, c thc hin
theo di chc nng thn nhng bnh nhn ny.
Mc myoglobin tng c th xy ra sau khi tim bp tht hay tp th dc vt v. Bi v thn

loi b myoglobin trong mu, mc myoglobin c th cao nhng ngi c thn b h.
Ung ru nng v mt s loi thuc cng c th gy tn thng c bp v myoglobin
tng trong mu.
Mt xt nghim que th hemoglobin ca nc tiu cng c th l dng tnh nu c s

hin din ca myoglobin. Nu xt nghim que th nc tiu l dng tnh v myoglobin
nghi ng l nguyn nhn, n phi c th nghim li vi mt xt nghim c hiu hn
cho myoglobin.
19. Xt nghim Troponins

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Cc troponins l mt gia nh ca cc protein c tm thy trong c xng v c tim. C

ba loi khc nhau: Troponin C (TnC), Troponin T (TnT), v Troponin I (TnI). Ba protein
cng nhau iu ha co c.
Troponins I v T (cTnI v cTnT) l cc troponins ch c tm thy trong tri tim. Chng

thng hin din trong mu vi s lng rt nh khng th pht hin c. Khi c tn
thng cc t bo c tim, troponins I v T c phng thch vo mu. Tn thng c tim
cng nhiu, nng troponins trong mu cng cao. Cc th nghim troponin o lng
troponin I hoc T trong mu v c s dng gip xc nh nu mt c nhn b mt
cn au tim.
Khi mt ngi c mt cn au tim, mc ca troponins I v T c th tng cao trong mu

trong vng 3 hoc 4 gi sau khi b tn thng v c th vn cn tng cao trong 10-14 ngy.
Xt nghim troponin ch yu c ch nh nh gi nhng ngi b au ngc xem

h c mt cn au tim hoc tn thng khc tri tim ca h. Mt trong hai hoc c hai
th nghim troponin I hoc troponin T c th c thc hin, thng l mt phng th
nghim s thc hin mt trong hai xt nghim (TnT hoc TnI). Xt nghim troponin i
khi ch nh cng vi cc ch du sinh hc tim, nh CK-MB hoc myoglobin. Tuy nhin,
xt nghim troponins u tin c ch nh khi nghi ng c mt cn au tim, v n c
hiu vi chn thng c tim hn so vi cc xt nghim khc (v cc xt nghim ny cng
tng trong chn thng c xng) v vn cn cao trong mt thi gian di.
Cc th nghim troponin c s dng gip chn on mt cn au tim, pht hin
v nh gi tn thng c tim t nh n nng, v phn bit au ngc c th l do cc
nguyn nhn khc. Trong nhng kinh nghim nhng ngi au ngc c lin quan n tim,
kh chu, hoc cc triu chng khc v khng tm kim s chm sc y t trong mt ngy
hoc nhiu hn, th nghim troponin vn s l hu ch xc nh nu cc triu chng trn
do tn thng tim.
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Mt xt nghim troponin I hoc T thng s c ch nh u tin khi mt ngi b nghi

ng mt cn au tim i vo phng cp cu, tip theo l xt nghim troponin c thc
hin lp li trong nhiu gi. i khi n c ch nh cng vi cc xt nghim khc nh
CK, CK-MB, hoc myoglobin.
ngha
Bnh thng:
Troponin T < 0.05 ng/mL
Troponon I < 0,40 ng/mL
Bi v troponin l c hiu cho tim, thm ch cao nh c th cho bit mt s mc tn

thng cho tim. Khi mt ngi c mc troponin tng cao ng k v, c bit l tng
v / hoc gim cc kt qu t mt lot cc th nghim c thc hin trong nhiu gi sau
, ngi c kh nng c mt cn au tim hoc mt s hnh thc khc gy thit hi
n tim.
Khi au ngc v / hoc au tht ngc n nh c kt qu xt nghim troponin bnh thng
trong mt lot cc ln o lp li trong nhiu gi sau , th chc chn rng tim khng b
thng.
Nng Troponin c th duy tr mc cao trong 1-2 tun sau khi b mt cn au tim. Xt
nghim ny khng b nh hng bi tn thng ca cc c khc, do , tim, tai nn, v
cc loi thuc c th gy tn hi n c bp, khng nh hng n mc troponin tim.
Troponin c th tng sau khi tp th dc vt v trong trng hp ny khng c cc du
hiu v triu chng ca bnh tim, n thng khng c ngha bnh l.
Nng troponin tng, khng nn c s dng mt mnh chn on hoc loi tr mt
cn au tim. Mt k thut vt l (siu m tim), lch s lm sng, v in tm cng rt
quan trng nh l kt qu cc mc troponin t mt lot cc ln xt nghim lp li cao
n nh hoc thy s gia tng v / hoc gim trong nhiu gi. Rt him khi, nhng ngi
c mt cn au tim c nng troponin bnh thng, v mt s nhng ngi c nng
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troponin tng khng c tn thng tim r rng. Mc troponin cng c th c nng

cao vi cc iu kin cp tnh hoc mn tnh nh vim c tim (vim tim), suy tim sung
huyt, nhim khun nng, bnh thn, v mt s bnh mn tnh vim ca bp tht v da.
20. Xt nghim CRP
C-reactive protein (CRP) l mt cht phn ng giai on cp tnh, mt loi protein c

gan sn xut ra v c phng thch vo mu trong vng mt vi gi sau khi m b tn
thng, do b nhim trng, hoc nguyn nhn khc gy ra vim. Mc CRP tng ng
k, khi c chn thng, cn au tim, cc ri lon t min dch, v cc nhim trng nng
do vi khun nh nhim trng huyt. Mc CRP c th tng cao mt ngn ln p ng
vi mt tnh trng vim, v s gia tng ca CRP trong mu c th c trc cn au, st,
hoc ch s lm sng khc. Th nghim o lng CRP trong mu c gi tr trong vic pht
hin vim nhim cp tnh hoc theo di cn bng pht ca cc bnh mn tnh.
Xt nghim CRP khng dng chn on, nhng n cung cp thng tin bc s bit c
s hin din ca vim nhim. Cc bc s s dng thng tin ny kt hp vi cc yu t khc,
chng hn nh cc du hiu, triu chng khm lm sng v cc xt nghim khc xc
nh bnh nhn c mt tnh trng vim cp tnh hoc ang tri qua mt t bng pht ca
mt bnh vim mn tnh. Sau cc bc s c th thc hin thm cc th nghim khc
chn on v theo di iu tr.
C-reactive protein (CRP) l mt th nghim khng c hiu. N c bc s s dng

pht hin vim nhim nu c nghi ng tn thng m hoc nhim trng mt ni no
trong c th, nhng th nghim khng xc nh ni vim hay nhng nguyn nhn gy ra
vim nhim. CRP khng phi chn on nguyn nhn, nhng n c th c s dng
cng vi cc du hiu, triu chng v xt nghim khc nh gi tnh trng vim cp tnh
hoc mn tnh.
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CRP c th c s dng pht hin hoc theo di tnh trng vim ca mt c nhn b
nghi ng c mt tnh trng cp tnh nh:
Nhim trng nng nh nhim trng huyt hoc nhim trng nm

Bnh vim vng chu (PID)
Cc th nghim CRP l hu ch trong vic theo di s bng pht ca nhng ngi c bnh
vim mn tnh v / hoc nh gi hiu qu ca iu tr. Mt s v d bao gm:
Bnh vim rut

Cc bnh vim khp
Bnh t min dch, chng hn nh lupus hay vim mch
CRP i khi c ch nh cng vi tc lng hng cu (ESR), cng l mt xt nghim

pht hin vim. Xt nghim CRP khng c hiu chn on mt cn bnh c th, n
phn nh mt du hiu chung ca mt tnh trng nhim trng v vim, CRP cnh bo cho
cc chuyn gia y t bit v tip tc lm cc th nghim khc chn on nguyn nhn v
theo di iu tr, y l iu cn thit. Ty thuc vo s nghi ng ca bc s v nguyn
nhn gy bnh, m mt s cc xt nghim khc c th c thc hin xc nh ngun
gc ca tnh trng vim.
ngha
Bnh thng: CRP / mu = < 5 mg/L
S lng CRP ngy cng cao trong mu cho thy s hin din ca vim nhng khng xc
nh v tr ca vim hoc nguyn nhn gy ra vim. Nu CRP cao bc s s nghi ng bnh
nhn c mt s nhim trng nghim trng do vi khun,. nhng ngi c bnh vim mn
tnh, mc CRP cao cho thy bnh ang bng pht hoc iu tr khng hiu qu.
Nu mc CRP ban u cao v sau gim,c ngha l tnh trng vim hoc nhim trng
gim v / hoc c p ng iu tr.
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Mc CRP c th c tng ln trong giai on cui ca thai k, s dng thuc trnh

thai hoc liu php hormone thay th (v d, estrogen). Mc ca CRP cao hn cng
c quan st thy nhng ngi bo ph.
Th nghim tc lng hng cu (ESR) cng s tng ln trong vim nhim, tuy nhin,
CRP tng sm hn v sau gim nhanh hn so vi ESR.
S khc bit gia CRP v cc xt nghim hs-CRP l g?
C hai xt nghim c bn ging nhau, o lng cht CRP trong mu. Tuy nhin, CRP
nhy cao (hs-CRP) l th nghim o s lng CRP rt nh trong mu v thng xuyn
c ch nh cho nhng ngi c v khe mnh nh gi nguy c tim tng cc vn
v tim. Thng thng th nghim hs- CRP c o trong khong 0,5-10 mg / L. Cc
th nghim CRP thng xuyn c ch nh cho nhng ngi c nguy c b nhim trng
hoc cc bnh vim mn tnh. CRP c o trong khong 10-1000 mg / L.
21. Xt nghim Ferritin
Xt nghim ny o lng ferritin trong mu. Ferritin l mt protein cha st l dng st

ch yu c lu tr bn trong cc t bo. Lng nh ferritin c lu hnh trong mu
phn nh s lng st tng s c lu tr trong c th.
nhng ngi khe mnh, khong 70% lng st hp th bi c th c gn kt vo
hemoglobin ca cc t bo mu ; 30% cn li, hu ht c lu gi di dng ferritin
hoc hemosiderin, l mt phc hp ca st vi protein, v cc cht khc. Ferritin v
hemosiderin khng ch tch t ch yu gan m cn c trong ty xng, l lch, v c
xng.
Khi lng st khng p ng nhu cu ca c th, cc kho st b cn kit v nng

ferritin gim. iu ny c th xy ra do cung cp khng lng st, hp thu khng y
, nhu cu st tng chng hn nh trong qu trnh mang thai, hoc nguyn nhn gy mt
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mu mn tnh. S suy gim ng k ca cc kho d tr st c th xy ra trc khi c bt

k du hiu thiu st pht trin.
St lu tr v mc ferritin tng khi cht st c hp th nhiu hn so vi nhu cu c

th. Hp thu st d tha mn tnh s dn n s tch t ca cc hp cht st trong cc m
v c quan v cui cng c th gy ra ri lon chc nng v tn thng cc m, c quan.
iu ny xy ra trong bnh nhim sc t st m, mt cn bnh di truyn, trong c th
hp th qu nhiu st, ngay c trong mt ch n ung bnh thng.
Gi tr tham kho bnh thng:
Nam: 30 400 ng/mL

N : 15 150 ng/mL
Ch nh
Tnh trng thiu mu thiu st: Cc th nghim ferritin c th c ch nh cng vi cc

xt nghim st khc, khi kt qu CBC bt thng cho thy rng mt ngi c hemoglobin
v hematocrit thp v hng cu nh v nht mu hn bnh thng (microcytic v
hypochromic), cho thy thiu mu thiu st thm ch mc d cc triu chng lm sng cha
xut hin.
Tnh trng tha st. Cc triu chng ca tnh trng qu ti st s khc nhau t ngi ny
sang ngi khc v c xu hng xu i theo thi gian. Cc triu chng l do st tch t
trong mu v cc m. Cc triu chng c th bao gm: au khp, mt mi, au bng.
xc nhn s hin din ca qu ti st, xt nghim v st khc (st, TIBC) v th nghim
di truyn i vi bnh nhim sc t st m di truyn c th c cho l tt.
ngha
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Mc ferritin thng c thm nh kt hp vi cc xt nghim st khc. Mt bng tm

tt v nhng thay i trong cc th nghim st nhn thy trong cc bnh khc nhau ca tnh
trng st c th hin trong bng di y.
%
BNH Iron TIBC/Transferin UIBC Tranferin Ferritin
Saturation
Thiu st Thp Cao Cao Thp Thp
Hemochromatosis Cao Thp Thp Cao Cao
Thp /
Bnh mn tnh Thp Thp Thp BT/Cao
BT
Thp /
Thiu mu tn huyt Cao BT / Thp Cao Cao
BT
Thiu mu BT / Thp /
BT / Thp Cao Cao
Sideroblastic Cao BT
Bnh
Ng c st Cao Bnh thng Thp Cao
thng
Ferritin thp nhng ngi c tnh trng thiu st v tng cao nhng ngi c bnh
nhim sc t st m v cc ri lon khc d tha d tr st v nhng ngi c truyn
nhiu mu.
Ferritin l mt cht phn ng giai on cp tnh v do c th c tng ln trong nhng

ngi b vim, bnh gan, nhim trng mn tnh, ri lon t min dch, v mt s loi ung
th. Ferritin khng thng c s dng pht hin hay theo di cc bnh trn.
22. Xt nghim St huyt thanh
Cc th nghim st huyt thanh (Serum Iron/ Serum Fe) o lng st trong phn cht lng
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ca mu. St l mt loi khong cht thit yu c hp th t thc n v vn chuyn khp

c th bi transferrin, mt loi protein c sn xut bi gan. St cn thit cho vic sn
xut cc t bo mu mu (hng cu) bnh thng. St l mt phn quan trng ca
hemoglobin, protein trong hng cu, cho php chng vn chuyn oxy i khp c th. St
cng c s dng trong sn xut mt s protein, bao gm myoglobin v mt s enzym.
Thng thng, khong 70% lng st hp th c kt hp vi cc hemoglobin trong hng
cu. Hu ht cc phn cn li c lu tr trong cc m nh ferritin hoc hemosiderin.
Nu st khng c cung cp trong ch n ung, dn n st trong mu c th gim,
m sau c th lm cn kit lng st c lu tr trong c th. Theo thi gian, nng
st trong mu thp v gim d tr st c th dn n thiu mu thiu st. Mt khc, s hp
th qu nhiu st c th dn n tch ly tng dn v gy thit hi cho cc c quan nh tim,
gan v tuyn ty.
Cc th nghim st huyt thanh o lng st vn chuyn trong c th - l st kt hp

vi transferrin. S lng st hin din trong mu s khc nhau trong sut c ngy v t
ngy ny sang ngy khc. V l do ny, st huyt thanh l gn nh lun lun c o cng
vi cc xt nghim st khc, chng hn nh kh nng gn st ti u (TIBC), t bo
ha transferrin c th c tnh ton. Transferrin bo ha phn nh s lng st c vn
chuyn trong mu. Vic s dng mt s cc th nghim st cung cp mt cch o lng
s thiu st v qu ti st ng tin cy hn ch o st huyt thanh.
St huyt thanh v kh nng gn st ti u (TIBC), hoc i khi UIBC (kh nng gn st

khng bo ha) hoc xt nghim transferrin, c sp xp vi nhau, v tnh ton bo
ha transferrin (st huyt thanh / Transferin) xc nh bao nhiu st ang c lu hnh
trong mu. Mt th nghim ferritin cng c th c ch nh nh gi d tr st hin
ti ca mt ngi.
Cc xt nghim ny c s dng cng nhau pht hin v gip chn on thiu st hoc
qu ti st. nhng ngi b thiu mu, cc xt nghim ny c th gip xc nh tnh trng
ny l do thiu st hoc cc nguyn nhn khc, chng hn nh bnh mn tnh. Xt nghim
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st cng ch nh nu nghi ng mt ngi c ng c st v sng lc bnh di truyn nhim

sc t st m, mt bnh di truyn lin quan n d tr st qu nhiu.
Gi tr tham kho bnh thng:

St (Fe): 60- 170 mcg/dl
TIBC: 240 - 450 g/dl
bo ho transferrin: 20-50%
Mc st huyt thanh thng c thm nh kt hp vi cc xt nghim st khc. Mt

bn tm tt v nhng thay i trong cc th nghim st nhn thy trong cc bnh khc nhau
ca tnh trng st c th hin trong bng di y.
%
Saturation
Thp /
BT
Thp /
BT
Thiu mu BT / Thp /
BT / Thp Cao Cao
Bnh
thng
Mt mc st thp vi mt transferrin hoc TIBC cao, thng l do thiu st. Trong cc

cn bnh mn tnh, c st v transferrin hoc TIBC thng thp. Thiu st thng l do
chy mu lu di hoc nng. Tuy nhin, n cng c th l do nhu cu st tng (trong thai
k), tng trng nhanh chng ( tr em), cung cp thiu nh n ung km, v cc vn
v km hp th (d dy hoc bnh ng rut).
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Mc cao ca st huyt thanh c th xy ra nh l kt qu ca truyn nhiu mu, tim

st vo c bp, dn n ng c, bnh gan hoc bnh thn. N cng c th l do bnh di
truyn, bnh nhim sc t st m.
23. Xt nghim TIBC, UIBC, Transferrin
Total Iron Binding Capacity; Unsaturated Iron Binding Capacity; Transferrin; Transferrin
Saturation
Transferrin l protein chnh trong mu lin kt vi st v vn chuyn st i khp c th. S

lng transferrin c sn gn kt v vn chuyn st c phn nh trong cc php o
tng cng sut (kh nng) gn kt st (TIBC), kh nng lin kt st khng bo ha (UIBC)
hoc transferrin bo ha.
Thng thng, st c hp th t thc n v vn chuyn khp c th bi transferrin,

transferrin c sn xut bi gan. Khong 70% st c vn chuyn n ty xng v kt
hp vi hemoglobin trong cc t bo mu . Phn cn li c lu tr trong cc m nh
ferritin hoc hemosiderin. S lng transferrin trong mu ph thuc vo chc nng gan v
tnh trng dinh dng ca mt ngi. Trong iu kin bnh thng, khong 1/3 transferin
bo ha vi st. iu ny c ngha rng khong 2/3 s lng ca st c lu tr trong cc
t chc m, c quan.
Cc th nghim transferrin, TIBC, UIBC v transferrin bo ha ch yu o lng nhng

dng tng t. Chng nh gi kh nng gn kt v vn chuyn st trong mu v l mt s
phn nh ca cc kho d tr st.
TIBC l php o tng lng st c kh nng gn kt vi cc protein trong mu.Tuy nhin

transferrin l protein chnh gn kt st, cc xt nghim TIBC l mt php o gin tip
transferrin, c gi tr tt.
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Cc th nghim UIBC xc nh kh nng d tr ca transferrin, tc l mt phn ca

transferrin cha c gn kt (cha c bo ha) vi st. UIBC c th c o trc tip
hoc tnh ton nh: TIBC - st = UIBC.
St huyt thanh o tng s lng st trong mu, gn nh tt c st trong huyt thanh u

gn kt vi transferrin. o st huyt thanh l cn thit tnh ton hoc TIBC hoc UIBC.
Transferrin bo ha l mt tnh ton (xem cu hi 2) bng cch s dng kt qu xt nghim

st v cc kt qu TIBC hoc UIBC, t l phn trm i din cho transferrin bo ha (gn
kt) vi st.
Tng kh nng gn kt st (TIBC) c s dng thng xuyn nht cng vi mt xt

nghim st huyt thanh nh gi nhng ngi b nghi ng c thiu st hoc qu ti st.
Hai xt nghim ny c s dng tnh ton bo ha transferrin, mt ch s nh gi
tnh trng st hu ch hn st huyt thanh hoc TIBC c nh gi ring r. nhng
ngi khe mnh, khong 20-40% transferrin c s dng vn chuyn st.
Thiu st, mc st thp, nhng TIBC c tng ln, do transferrin bo ha tr nn
rt thp. Trong trng thi qu ti st, chng hn nh bnh nhim sc t st m, mc st
s cao v TIBC s thp hoc bnh thng, gy ra bo ha transferrin tng. UIBC c th
c ch nh thay th cho TIBC.
Thi quen thng dng xt nghim transferrin (thay v TIBC hoc UIBC) nh gi tnh
trng dinh dng ca bnh nhn hoc chc nng gan. Bi v n c sn xut trong gan,
transferrin s thp nhng bnh nhn b bnh gan. Mc Transferrin cng gim khi
khng c protein trong ch n ung, do , th nghim ny c th c s dng
gim st dinh dng.
Ch nh
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Nghi ng thiu mu thiu st

Nghi ng tnh trng qu ti st
St v TIBC cng c ch nh trong cc trng hp nghi ng ng c st, ph bin nht

l tr em do v tnh dng thuc qu liu nh b sung vitamin c cha st.
Mt xt nghim transferrin c th c th nghim cng vi cc xt nghim khc nh
prealbumin khi bc s mun nh gi hoc gim st tnh trng dinh dng ca mt ngi.
Kt qu xt nghim c ngha l g?
St (Fe): 60- 170 g/dl

TIBC: 240 - 450 g/dl
bo ho transferrin: 20-40%
Cc kt qu xt nghim transferrin, TIBC, hoc UIBC thng c nh gi kt hp vi

cc xt nghim st khc. Mt bn tm tt v nhng thay i trong cc th nghim st nhn
thy trong cc bnh khc nhau ca tnh trng st c th hin trong bng di y.
%
Saturation
Thp /
BT
Thp /
BT
Thiu mu BT / Thp /
BT / Thp Cao Cao
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Bnh
thng
Mt TIBC, UIBC, hoc transferrin cao thng cho thy thiu st, nhng cc xt nghim
cng c tng ln trong thai k v vi vic s dng thuc trnh thai. Mt TIBC, UIBC,
hoc transferrin thp c th xy ra nu bn c bnh nhim sc t st m, mt s loi thiu
mu, trong st tch t, suy dinh dng, vim, bnh gan, hoc hi chng thn h, bnh
thn l nguyn nhn gy mt protein trong nc tiu.
Transferrin bo ha gim khi thiu st v tng ln khi lng st d tha nh trong trong
trng hp qu ti st hoc ng c st.
Nhng ngi mc bnh huyt tn c th lm tng nng st trong mu ca h bi v

hemoglobin c phng thch t cc t bo mu trong qu trnh tn huyt.
Truyn mu gn y c th nh hng n kt qu xt nghim. Truyn nhiu mu i khi
c th dn n tnh trng qu ti st.
24. Xt nghim Calcitonin
Calcitonin l mt hormone c sn xut bi cc t bo c bit trong tuyn gip c gi

l t bo - C. Calcitonin tham gia vo cc qu trnh iu ha nng canxi trong mu v
c ch s phn hy xng, mt cch chnh xc l c ch hot ng ca calcitonin trong c
th con ngi l khng r rng.
Hai nguyn nhn him gp lm tng sn xut s lng calcitonin qu mc l tng sn t

bo C v ung th tuyn gip th tu. Tng sn t bo C-l mt tnh trng lnh tnh c th
c hoc khng c th tin trin tr thnh ung th tuyn gip th tu. Ung th tuyn gip
th tu l c tnh - n c th lan trn ra ngoi tuyn gip v c th kh iu tr nu khng
c pht hin sm.
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Khong 75-80% cc trng hp ung th tuyn gip th tu l l t, xy ra nhng ngi

khng c mt tin s gia nh c bnh. Khong 20-25% cc trng hp c lin quan n
t bin di truyn gen RET dn n nhiu tn sinh ni tit loi 2 (multiple endocrine
neoplasia* type 2 (MEN 2)). MEN 2 l mt hi chng lin quan vi mt s bnh c lin
quan, bao gm c ung th tuyn gip th tu v pheochromocytomas. S bin i gen RET
c tnh tri. Ch c mt bn sao ca t bin gen t mt ngi cha hoc m - l bt buc
phi c, nguy c pht trin ung th tuyn gip th tu tng ln rt nhiu. Hu ht cc trng
hp ung th tuyn gip th tu l t pht trin ngi ang tui 40 hoc 50, v t l
nhim cao hn ph n. Cc hnh thc di truyn nh hng n c hai gii nh nhau v
c th xy ra tui sm hn.
Cc th nghim calcitonin ch yu c s dng gip chn on tng sn t bo C v

ung th tuyn gip th tu, nh gi hiu qu iu tr v theo di nhng ngi b nh
hng ti pht. N cng c ch nh tm sot ung th tuyn gip th tu cho cc thnh
vin trong gia nh ca ngi b nhiu tn sinh ni tit loi 2
Xt nghim kch thch nhy hn hn so vi php o calcitonin mt mnh. iu ny lin

quan n vic thu thp mt mu c bn, sau tim tnh mch canxi hoc pentagastrin
kch thch sn xut calcitonin. Mt s mu mu c thu thp trong vi pht tip theo sau
o lng hiu qu ca s kch thch. Nhng ngi b tng sn sm cc t bo C v /
hoc ung th tuyn gip th tu thng s c gia tng rt ng k trong mc ca
calcitonin trong thi gian th nghim ny.
ngha XN
Bnh thng: < 10 pg/mL
Mt mc thp calcitonin c ngha l khng chc rng cc triu chng ny l do tng sn

t bo C hoc ung th tuyn gip th tu.
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Mt nng cao ca calcitonin c ngha l s lng ang c sn xut qu mc. Mc

cao ng k ca calcitonin l mt ch s tt v tng sn t bo C hoc ung th tuyn gip
th tu, tuy nhin, bc s s s dng cc th thut khc, chng hn nh sinh thit tuyn
gip, scan, v siu m, thit lp chn on.
iu tr thnh cng bnh ung th tuyn gip th tu, c th l lin quan n vic ct b cc
tuyn gip v mt s m bnh thng xung quanh, mc calcitonin thng s gim xung
mc rt thp. Nu sau theo thi gian cc gi tr vn mc thp, c kh nng l iu tr
c hiu qu. Trong mt s trng hp, mc calcitonin s gim nhng vn cn cao va phi
sau khi iu tr. iu ny c ngha rng mt s m sn xut calcitonin vn cn. Bc s s
theo di calcitonin v xem c tng theo thi gian. Nu nng calcitonin bt u tng ln,
n c kh nng l ung th tuyn gip th tu ti pht.
Vi ung th tuyn gip th tu v tng sn t bo C, cc xt nghim tuyn gip khc, chng

hn nh T4, T3, TSH, bnh thng trong khi mc calcitonin c tng cao.
Mc Calcitonin c th tng trong ung th v, phi v tuyn ty, insulinomas, v cc khi
u tuyn ty him gp c gi l VIPomas (lin kt vi sn xut hormone vasoactive
intestinal peptide (VIP)). Nng ca calcitonin c th c tng ln vi cc loi thuc
nh glucagon, epinephrine, v thuc trnh thai, v tr s sinh v ph n trong thi k
mang thai thng cao hn.
25. Xt nghim Thyroglobulin
Thyroglobulin l mt protein c sn xut bi tuyn gip. Tuyn gip gip iu chnh tc

s dng nng lng ca c th. N l mt c quan nh hnh con bm nm phng so
vi kh qun c hng v cu to ch yu l nhng cu trc rt nh hnh qu bng, gi l
nang. Cc t bo trong nang sn xut v lu tr Thyroglobulin, khi cn thit n b ph ph
v v to ra cc hoc mn tuyn gip T4 (thyroxine) v T3 (triiodothyronine). Vic sn
xut cc kch thch t v phng thch cc hormone vo dng mu c kch thch bi cc
hormone tuyn yn TSH (hormone kch thch tuyn gip). Khng c phn no khc ca c
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th sn xut thyroglobulin, nhng n c sn xut nhiu bi ung th tuyn gip, ngay c

khi cn gii hn trong tuyn gip hoc di cn sang cc b phn khc ca c th.
Cc th nghim thyroglobulin ch yu c s dng nh l mt du n ca khi u, nh

gi hiu qu iu tr v theo di ti pht ung th tuyn gip. Khng phi tt c ung th
tuyn gip u sn xut thyroglobulin, nhng loi ph bin nht l ung th nh v nang
tuyn gip, tng sn xut Tg v dn n lm tng mc thyroglobulin trong mu.
Thyroglobulin c th c ch nh, cng vi mt xt nghim TSH trc khi iu tr ung
th tuyn gip, xc nh xem ung th sn xut thyroglobulin. Nu c, xt nghim TSH
c th c ch nh sau trong khong thi gian sau khi iu tr gim st ung th ti
pht. Mt lot mc thyroglobulin c th c xt nghim trong mt khong thi gian
(serial mu) xem xt s thay i nng . S thay i ny thng cung cp nhiu thng
tin hn mt gi tr duy nht.
Mt th nghim khng th thyroglobulin (TgAb) thng c ch nh cng vi cc th

nghim thyroglobulin. Khng th thyroglobulin l cc protein c sn xut bi h thng
min dch ca c th tn cng thyroglobulin. Nhng khng th ny c th pht trin bt c
lc no. Khi n c mt, n c th lin kt vi bt k thyroglobulin hin din trong mu v
nh hng n vic gii thch ca cc kt qu xt nghim thyroglobulin. Mt khi n
pht trin, n s khng mt i v t thi im tr i n s nh hng n tnh hu ch
ca cc th nghim thyroglobulin.
Th nghim thyroglobulin thnh thong cng ch nh gip xc nh nguyn nhn gy

ra cng gip v theo di hiu qu iu tr cho cc nguyn nhn nh bnh Graves. Him
khi n c ch nh gip xc nh nguyn nhn gy ra suy gip bm sinh tr.
Khi no c ch nh?
Mt xt nghim thyroglobulin c th c ch nh trc khi phu thut ct b tuyn gip

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b bnh ung th. N cng c th c ch nh sau khi hon thnh iu tr gip xc nh

xem c bt k m bnh thng v / hoc ung th tuyn gip c th b b st. N thng
c ch nh xt nghim mt cch thng xuyn sau phu thut m bo rng khi u
khng ti pht hoc di cn.
Mt xt nghim thyroglobulin cng c th ch nh khi mt ngi c triu chng cng

gip v / hoc mt tuyn gip phnh ln v bc s nghi ng ngi bnh c th b ri lon
tuyn gip nh vim tuyn gip hoc bnh Graves. N c th c ch nh trong khong
thi gian khi mt ngi no ang c iu tr vi thuc chng tuyn gip (i vi cc
nguyn nhn nh bnh Graves), xc nh hiu qu iu tr.
Him khi n c ch nh, khi mt tr s sinh c cc triu chng lin quan n suy gip.
Bnh thng: Thyroglobulin: 2 50 ng/mL
Bnh thng c mt lng nh ca thyroglobulin trong mu nhng ngi c chc nng

tuyn gip bnh thng. Nu nng thyroglobulin ban u tng cao mt ngi mc
bnh ung th tuyn gip, sau thyroglobulin c th c kh nng c s dng nh l mt
du n ca khi u. Mc thyroglobulin khng cn pht hin c hoc rt thp sau khi
phu thut ct b tuyn gip (tuyn gip) v / hoc sau khi iu tr i-t phng x tip theo.
Nu mc vn cn pht hin, c th l bnh thng hoc m ung th tuyn gip cn st
li trong c th ngi, cho thy s cn thit phi iu tr thm.
Da trn cc kt qu xt nghim thyroglobulin, c th theo di vi mt my qut cht

phng x iodine v / hoc phng php iu tr iode phng x xc nh v / hoc ph
hy bt k m tuyn gip bnh thng hoc ung th tuyn gip cn li. Mc
thyroglobulin sau c kim tra mt ln na trong mt vi tun hoc vi thng xc
minh rng vic iu tr c tc dng.
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Nu mc thyroglobulin thp trong mt vi tun hoc vi thng sau phu thut v sau
bt u tng li theo thi gian, ung th c th ti pht.
Nu mt ngi pht trin cc khng th thyroglobulin, cc kt qu xt nghim

thyroglobulin sau c th sai, tng ln hay gim ty thuc vo phng php th nghim
c s dng. Kt qu phi c gii thch mt cch thn trng. S hin din ca cc
khng th lm gim hoc loi b tnh hu ch ca cc xt nghim thyroglobulin, nh l mt
du n ca khi u.
Mc gim ca thyroglobulin trong nhng ngi iu tr bnh Graves cho thy c mt p

ng iu tr.
Nhng ngi b bnh bu c, vim tuyn gip, hoc cng gip c th c mc

thyroglobulin cao, mc d th nghim thng khng c ch nh vi nhng nguyn nhn
ny.
iu g khc cn bit?
Nng thyroglobulin tng khng c dng chn on xc nh ung th tuyn gip.

Ung th phi c chn on bng cch nhn vo cc t bo mu c ly (sinh thit) di
knh hin vi. Bn thn mt kt qu nng thyroglobulin khng bao hm mt tin lng
xu. Trong vic theo di ung th ti pht, nng thay i theo thi gian quan trng hn
l kt qu ca mt ln th nghim thyroglobulin.
iu quan trng l khi lm xt nghim thyroglobulin nhiu ln ni tip phi c thc hin
ti mt phng th nghim nht nh bi v phng php th nghim c th to ra kt qu
khc nhau trong cc phng th nghim khc nhau.
26. Xt nghim Thyroid Antibodies
T khng th tuyn gip (Thyroid autoantibodies) l khng th pht sinh khi h thng min
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dch ca mt ngi nhm ln mc tiu cc thnh phn ca tuyn gip hoc protein tuyn
gip, dn n tnh trng vim tuyn gip mn tnh, tn thng m, v / hoc s ri lon
chc nng tuyn gip. Cc xt nghim ny pht hin s hin din v o lng s lng t
khng th tuyn gip c hiu.
Tuyn gip l mt tuyn c hnh con bm nh nm phng so vi kh qun c hng. N

to ra cc hormon chnh thyroxine (T4) v triiodothyronine (T3), l rt quan trng trong
vic gip iu chnh tc s dng nng lng - qu trnh trao i cht ca chng
ta. C th c mt h thng thng tin phn hi, s dng hormone kch thch tuyn gip
(TSH) gip sn xut hormone tuyn gip ln lt theo nhp kch thch hay c ch
duy tr mt s lng cc kch thch t tuyn gip trong mu n nh. Khi khng th tuyn
gip can thip vo qu trnh ny, c th dn n cc bnh mn tnh v cc ri lon t min
lin quan vi suy gip hoc cng gip, chng hn nh bnh Graves hoc vim tuyn gip
Hashimoto.
Mt hoc nhiu trong cc xt nghim sau y c th c thc hin gip thit lp mt

chn on v / hoc theo di mt ri lon tuyn gip t min:
Khng th Thyroperoxidase (TPO- Ab) mt du n ca bnh tuyn gip t min; n c
th c pht hin trong bnh Graves hoc vim tuyn gip Hashimotos.
Khng th Thyroglobulin (TGAb) cng l mt du n, thyroglobulin l nhng mc tiu

ca khng th ny, mt hnh thc tch ly ca cc hormon tuyn gip.
Khng th khng th th hormone kch thch tuyn gip (TSHRAb) bao gm hai loi t
khng th lin kt vi th th TSH trong tuyn gip:
Globulin min dch kch thch tuyn gip (Thyroid stimulating immunoglobulin (TSI))
lin kt vi cc th th v thc y s sn xut hormon tuyn gip, dn n tng nng tuyn
gip.
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Globulin min dch c ch rng buc tuyn gip (Thyroid binding inhibitory
immunoglobulin (TBII)) khi TSH lin kt vi th th, ngn chn sn xut hormon tuyn
gip v dn n suy gip.
TBII khng kim tra thng xuyn, nhng TSI thng c s dng gip chn on
bnh Graves (Basedow).
Xt nghim khng th tuyn gip ch yu l gip chn on bnh tuyn gip t min
dch v phn bit vi cc hnh thc khc ca ri lon chc nng tuyn gip. N c th
c thc hin gip iu tra nguyn nhn gy ra bu c hoc cc du hiu v triu
chng khc lin quan n nng hormone tuyn gip thp hay cao. Th nghim c th
c thc hin nh mt theo di khi cc kt qu xt nghim tuyn gip khc (nh T3, T4,
v / hoc TSH) ch ra ri lon chc nng tuyn gip.
Mt hoc nhiu xt nghim khng th tuyn gip cng c th c ch nh nu mt ngi

c mt nguyn nhn c bit n t min dch, khng lin quan n tuyn gip, nh lupus
ban h thng, vim khp dng thp, hoc thiu mu c tnh, pht trin cc triu chng
cho thy c s tham gia ca tuyn gip. S tham gia ny c th xy ra bt c lc no trong
qu trnh ca cc iu kin khc.
Theo di iu tr ung th tuyn gip, xt nghim khng th thyroglobulin c s dng

xc nh nu cc khng th c kh nng gy tr ngi vi cc th nghim o lng mc
thyroglobulin.
Bng sau y tm tt khi xt nghim t khng th tuyn gip c th c thc hin.

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C trong iu cn bt
Thyroid Antibody Vit tt Khi no ch nh
bnh khc
Khi mt ngi c cc triu gn lin
chng gi bnh tuyn gip, vi sinh sn
khi mt bc s ang xem xt kh khn,
Hashimoto bt u iu tr mt bnh nhn chng hn
Thyroid peroxidase thyroiditis; bng thuc c lin quan n nh sy thai,
TPOAb
antibody Graves nguy c pht trin suy gip tin sn git,
disease khi khng th peroxidase sinh non, v
tuyn gip c mt, chng hn tht bi th
nh lithium, amiodarone, tinh trong ng
interferon alpha, interleukin-2 nghim
Bt c khi no mt th
nghim thyroglobulin c
thc hin, xem c khng
Thyroid
th hin din v c kh nng
Thyroglobulin cancer;
TgAb can thip vo kt qu xt
antibody Hashimoto
nghim (v d, khong cch
thyroiditis
khng thay i sau khi iu tr
ung th tuyn gip), khi cc
triu chng ca suy gip
Thyroid stimulating
Khi mt ngi c triu chng
hormone receptor TRAb,
Graves cng gip, theo di hiu qu
antibody, Thyroid TSHR
disease ca liu php chng tuyn
Stimulating Ab, TSI
gip
Immunoglobulin
Nu mt ngi ph n mang thai c bnh tuyn gip t min dch bit (chng hn nh
vim tuyn gip Hashimoto hoc bnh Graves) hoc c mt ri lon t min khc v nghi
ng c s tham gia ca tuyn gip, th mt hoc nhiu cc khng th tuyn gip c th
c ch nh sm trong thai k v sau mt ln na lc gn kt thc thai k. Cc xt
nghim ny c s dng gip bc s xc nh xem em b c th c nguy c b ri lon
chc nng tuyn gip v cc khng th tuyn gip c th i qua nhau thai v gy ra suy gip
hoc cng gip trong thai nhi hoc tr s sinh.
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Xt nghim khng th tuyn gip cng c th c ch nh khi mt ngi c mt ri lon

t min khc c cc triu chng ca ri lon chc nng tuyn gip v / hoc khi ngi y
c kh khn v kh nng sinh sn m bc s nghi ng c th c lin quan vi t khng th.
ngha
Bnh thng:
TPO Ab: < 34 U/mL
TG Ab : < 34 U/mL
TRAb : 1,0 U/L
Kt qu xt nghim m tnh c ngha l t khng th khng hin din trong mu ti thi

im xt nghim v c th ch ra rng cc triu chng l do mt nguyn nhn khc hn l
t min dch. Tuy nhin, c mt t l phn trm nht nh ca nhng ngi c bnh tuyn
gip t min khng c t khng th. Nu c nghi ng rng cc t khng th c th pht
trin theo thi gian, c th xy ra vi mt s ri lon t min dch, th nghim c th c
thc hin lp li mt ngy sau .
Mc cc khng th tuyn gip tng nh n trung bnh c th c tm thy trong mt

lot cc ri lon tuyn gip v t min dch, chng hn nh ung th tuyn gip, Bnh tiu
ng loi 1, vim khp dng thp, thiu mu c tnh, v cc bnh collagen mch mu t
min. Nng tng ln ng k thng nht trong bnh l tuyn gip t min nh vim
tuyn gip Hashimoto v bnh Graves.
Ni chung, s hin din ca cc khng th tuyn gip cho thy rng c s tham gia ca
tuyn gip t min v mc cao hn, th nhiu kh nng l chn oc chnh xc. Mc
gia tng c th c ngha hn so vi mc n nh, n cho thy s gia tng hot ng t
min dch. Tt c cc khng th, nu c mt ngi ph n mang thai, c th tng nguy
c suy gip hoc cng gip trong thai nhi hoc tr s sinh.
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nhy v c hiu ca xt nghim khng th tuyn gip ang c ci thin nhng

vn cn khng tt nh bc s mong mun. Tt c cc xt nghim khng th tuyn gip
thay i theo thi gian. y l mt phn ca l do m cc xt nghim c rt nhiu ci
tn khc nhau. Ngoi ra cn c nhiu phng php khc bit v cng c gi tr bnh thng
tham kho dao ng khc nhau. Nu ai ang c thc hin th nghim nhiu ln ni
tip cho cc mc ch gim st, cch tt nht l th nghim phi c thc hin bi cng
mt phng th nghim, bng cch s dng phng php tng t.
27. Xt nghim Aldosterone v Renin
Aldosterone l mt hormone kch thch s hp th natri (mui) v bi tit kali qua thn. N
ng mt vai tr quan trng trong vic duy tr nng natri, kali trong mu, trong vic
kim sot khi lng mu v huyt p mc bnh thng. Aldosterone c sn xut bi
v thng thn, phn bn ngoi ca tuyn thng thn nm trn cng ca mi thn. S
sn xut aldosteron bnh thng c iu ho bi hai loi protein khc l Renin v
Angiotensin. Renin s c sn xut t thn khi c gim huyt p, gim nng natri, hay
tng nng kali. Renin ct protein trong mu l Angiotensinogen to thnh Angiotensin
I, sau n c chuyn i bi mt enzyme th hai bin thnh Angiotensin II.
Angiotensin II gy ra co cc mch mu v kch thch sn xut Aldosterone. Hiu qu tng
th l tng huyt p v gi natri v kali mc bnh thng.
Mt lot cc nguyn nhn c th dn n sn xut tha (hyperaldosteronism) hoc khng

u (hypoaldosteronism) aldosteron. V Renin v Aldosterone lin quan cht ch, nn c hai
cht thng c th nghim cng nhau xc nh nguyn nhn ca mt Aldosterone
bt thng.
Xt nghim Aldosterone v renin c s dng nh gi mt lng Aldosterone thch

hp ang c sn xut v phn bit gia nguyn nhn tim tng d tha hoc thiu
ht. Aldosterone c th o c trong mu hoc trong mu nc tiu 24 gi, Renin lun
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lun o lng trong mu. Cc xt nghim ny hu ch nht trong vic sng lc bnh tng
aldosteron nguyn pht, cn c gi l hi chng Conn, gy ra cao huyt p. Nu xt
nghim sng lc dng tnh, sn xut Aldosterone c th c tip tc nh gi thng qua
vic s dng cc th nghim kch thch v c ch.
C hai nng Aldosterone v Renin cao nht vo bui sng v thay i trong sut c
ngy, b nh hng bi t th ca mt ngi, bi s cng thng, v mt lot cc loi thuc
theo toa.
Khi no c ch nh?
Aldosterone v Renin huyt tng thng c ch nh cng vi nhau khi bnh nhn c
huyt p cao v kali thp. Thm ch nu kali l bnh thng, xt nghim c th c thc
hin nu thuc c th khng kim sot huyt p cao hoc nu tng huyt p pht trin
tui tr. Aldosteronism nguyn pht l mt th cao huyt p c kh nng cha c, do
, pht hin n l quan trng x l n ng cch. Mc aldosterone i khi c ch
nh, cng vi cc xt nghim khc, khi bc s nghi ng bnh nhn c suy thng thn.
Huyt thanh
Ch n T th Gi tr tham chiu
Nm 1 16 ng/ dL
Mui bnh thng ng 4 31 ng /dL
t mui Nm (2 5) x gi tr nm
Nc tiu
n mui bnh thng 6.0 25 mcg/ 24 gi
n t mui 17 44 g/ 24 gi
n nhiu mui 0.0 6.0 mcg / 24 gi
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Bng di y cho thy nhng thay i renin, aldosterone, v cortisol xy ra vi cc ri

lon khc nhau.
Bnh Aldosterone Cortisol Renin

Tng aldosterone nguyn pht
Cao Bnh thng Thp
(Conn syndrome)
Tng aldosteron th pht Cao Bnh thng Cao
Suy tuyn thng thn (Addison's disease) Thp Thp Cao
Tng Aldosteron nguyn pht l do s sn xut qu mc Aldosterone bi tuyn thng

thn, thng l do mt khi u lnh tnh ca mt trong hai tuyn. Mc aldosterone cao
lm tng ti hp thu natri (mui) v mt kali qua thn, dn n s mt cn bng in gii.
Tng Aldosteronism nguyn pht i khi c gi l hi chng Conn. Cc triu chng

thng khng in hnh, mc d yu c c th xy ra nu nng kali rt thp. S hin
din ca h kali mu trong mt ngi b cao huyt p cho thy s cn thit phi tm kim
tng Aldosteron.
Ph bin hn l tng Aldosteron th pht, c th xy ra nh l kt qu ca bt c iu g

lm gim lu lng mu n thn, gim huyt p, hoc lm gim nng natri. Nguyn
nhn quan trng nht l hp cc mch mu cung cp mu cho thn, gi l hp ng mch
thn. iu ny gy ra huyt p cao do Renin v Aldosterone cao,c th c cha khi
bng phu thut hoc nong ng mch thn. i khi, nu ch c mt thn b nh hng,
xc nh, mt ng thng c lun qua hng v mu c thu thp trc tip t cc tnh
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mch thot thn (nng renin tnh mch thn), nu gi tr l cao hn ng k mt bn,
iu ny ch ra ni thu hp ca ng mch. Tng t nh vy, i khi mu c th c ly
t c hai tnh mch thng thn xc nh xem c s khc bit s lng aldosterone (v
i khi cortisol) c sn xut bi mi tuyn thng thn. Tng Aldosteron th cp cng
c th c nhn thy vi suy tim sung huyt, x gan, bnh thn, v nhim c mu ca
thai k.
Aldosterone thp (hypoaldosteronism) thng xy ra nh l mt phn ca suy thng thn,

n gy ra p lc mu thp, mt nc, gim hp th natri v gim bi tit kali. tr s sinh
vi tng sn thng thn bm sinh, tr s sinh thiu mt loi enzyme cn thit sn xut
cortisol, trong mt s trng hp, iu ny cng lm gim sn xut aldosterone. y l
mt nguyn nhn him gp ca aldosterone thp.
Lng mui trong ch n ung v thuc, chng hn nh thuc gim au khng steroid,
thuc li tiu, thuc chn beta, steroid, enzyme chuyn i Angiotensin (ACE) cht c
ch, v thuc trnh thai c th nh hng n kt qu th nghim. Mt s cc loi thuc
ny c s dng iu tr cao huyt p. Bc s ca bn s cho bn bit bn nn thay i
lng natri (mui) trong ch n ung ca bn, vic bn s dng thuc li tiu hoc cc
loi thuc khc, hoc thi quen tp th dc ca bn trc khi th nghim aldosterone.
Mc Aldosterone tr nn rt thp vi nhng bnh nng, do , th nghim khng nn c
thc hin vo nhng thi im khi mt ngi ang bnh nng. Cng thng v tp th dc
vt v, c th lm tng tm thi nng Aldosteron.
28. Xt nghim Cortisol
Cortisol l hormone ng vai tr quan trng trong s chuyn ha cht protein, cht bo v
carbohydrate. N nh hng n lng ng trong mu, gip duy tr huyt p, v gip
iu chnh h thng min dch. Hu ht cortisol trong mu gn kt vi mt protein, ch mt
phn nh dng "t do" v c hot tnh sinh hc. Cortisol t do (free Cortisol) c bi
tit vo nc tiu v hin din trong nc bt. Xt nghim ny o lng cortisol trong
mu, nc tiu, hoc nc bt.
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Mc cortisol trong mu thng tng v gim theo mt nhp iu " thay i ngy m".
nh vo sng sm, sau gim trong sut c ngy, t mc thp nht khong na m.
Nhp iu ny c th thay i khi mt ngi lm vic thay i gi lm vic bt thng
(chng hn nh ca m) v ng vo nhng thi im khc nhau trong ngy, v nhp iu
c th b ph v khi mt cn bnh hoc nguyn nhn hoc c ch hoc kch thch s sn
xut cortisol.
Cortisol c sn xut v tit ra bi cc tuyn thng thn, hai c quan hnh tam gic nm
trn u ca thn. Sn xut ni tit t ny c iu ha bi vng di i trong no v
tuyn yn, mt c quan nh b nm di no. Khi mc cortisol mu xung thp, vng
di i gii phng corticotropin releasing hormone (CRH), kch thch tuyn yn sn xut
ACTH (hormon kch thch v thng thn). ACTH kch thch tuyn thng thn sn
xut v phng thch cortisol. sn xut lng cortisol thch hp, vng di i v c
tuyn yn v tuyn thng thn phi hot ng chnh xc.
Nhm cc du hiu v triu chng c nhn thy khi nng cortisol cao bt thng c
gi l hi chng Cushing. Gia tng sn xut cortisol c th do:
Khi u trong tuyn yn tng sn xut ACTH

Tng sn xut bi tuyn thng thn, do mt khi u hoc do s tng trng qu mc
ca m thng thn (tng sn)
Gim sn xut cortisol c th do:
Tuyn yn hot ng km hoc mt khi u tuyn yn lm c ch sn xut ACTH, iu

ny c gi l suy thng thn th cp.
Tuyn thng thn hot ng km hoc b suy thng thn hn ch sn xut cortisol,
iu ny c gi l suy thng thn nguyn pht v cn c gi l bnh Addison.

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Mt xt nghim cortisol c th c ch nh sng lc v gip chn on hi chng

Cushing, mt nhm cc du hiu v triu chng lin quan vi d tha cortisol. Xt nghim
cortisol mu nh gi c hai cortisol gn kt protein v t do, trong khi th nghim nc
tiu ch nh gi cortisol t do, iu ny phi c s tng quan vi mc cortisol t do
trong mu. i khi cortisol nc bt cng ch nh gip pht hin hi chng Cushing.
Cortisol mu cng c s dng gip chn on suy thng thn v bnh Addison, cc
nguyn nhn lm tuyn thng thn hot ng khng chnh xc.
Nng cortisol mu v / hoc nc bt c thu thp ti cc thi im khc nhau, chng

hn nh ti 8 gi sng v 4 gi chiu, c th c s dng nh gi nng cortisol v
s thay i trong ngy. Thng thng, mc cortisol trong mu tng ln v thay i theo
mt nhp iu " bin i ngy m", t nh im vo bui sng sm sau gim trong
sut c ngy v t mc thp nht khong na m. Mt mu nc tiu 24-gi cortisol s
khng hin th s thay i ngy m, n o tng s lng cortisol t do bi tit trong 24
gi.
Nu nng cortisol bt thng c pht hin, bc s s lm xt nghim b sung gip

xc nhn nhng pht hin v gip xc nh nguyn nhn ca n:
c ch Dexamethasone
Nu mt ngi c mt mc cortisol cao, bc s c th thc hin mt th nghim c ch

dexamethasone gip xc nh xem nguyn nhn c lin quan n sn xut ACTH d
tha bi tuyn yn. Xt nghim ny lin quan n vic nh lng cortisol mt mu mu
c bn, sau cho ngi bnh ung dexamethasone (mt glucocorticoid tng hp) v o
lng mc cortisol trong cc mu mu c ly theo thi gian qui nh. Dexamethasone
ngn chn sn xut ACTH nn gim sn xut cortisol nu ngun d tha lin quan n
tuyn yn. Mt php o thc hin trong m c th c s dng gip tm sot hi
chng Cushing. Hn na th nghim cn gip khng nh ca s pht hin bnh ban u.
C th dng nhng liu thuc thp hoc liu cao mi 6 gi hoc 2 hoc 4 ngy trc khi
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thu gom mu hoc nc tiu. Ring mu nc tiu 24-gi c thu thp trc v trong
sut thi gian th nghim, nh lng nng Cortisol trong cc mu mu v nc tiu
thu thp v nh gi.
ACTH kch thch
Nu nhng pht hin ca xt ln nghim mu v / hoc cc xt nghim nc tiu ban u

cho thy khng sn xut cortisol, mt bc s c th yu cu mt th nghim kch thch
ACTH. Xt nghim ny lin quan n vic o nng cortisol trong mu ca mt ngi
trc v sau khi tim ACTH tng hp. Nu cc tuyn thng thn hot ng bnh thng,
mc cortisol s tng ln sau s kch thch ACTH. Nu tuyn b suy hoc hot ng khng
chnh xc, s khng p ng vi khch thch ACTH. Mt th nghim kch thch ACTH c
th lm li thi gian di hn (1-3 ngy) c th c thc hin gip phn bit gia suy
thng thn v tuyn yn.
Bnh thng:
Sng (8 gi): 6,6 19,4 mg/L
Chiu (16 gi): 2,3 - 12,3 mg/L
Thng thng, mc cortisol rt thp trc khi i ng v mc cao nht sau khi thc dy,
mc d nhp iu ny s thay i nu mt ngi lm vic thay i gi lm vic bt thng
(chng hn nh ca m) v ng vo nhng thi im khc nhau trong ngy.
Nng cortisol tng hoc bnh thng vo bui sng, mt mc khng st gim vo
bui chiu v bui ti gi cho bit c mt sn xut cortisol qu mc v hi chng Cushing.
Nu cortisol d tha b c ch trong mt th nghim c ch dexamethasone, s cho thy
cortisol d tha l do tng sn xut ACTH ca tuyn yn. Nu n khng b c ch sau th
nghim, cortisol gia tng c th l do mt khi u tng sn sut ACTH bn ngoi tuyn yn,
do mt vn ca tuyn thng thn, hoc do dng thuc nh corticosteroids iu tr
cho mt ngi no b bnh hen suyn.
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Nu c s thiu ht cortisol v ngi c kim tra c p ng vi mt th nghim kch

thch ACTH, th nguyn nhn c th l do tuyn yn khng sn xut khng ACTH. Nu
ngi khng p ng vi cc th nghim kch thch ACTH, th nguyn nhn c nhiu
kh nng l ca tuyn thng thn. Nu cc tuyn thng thn hot ng km do ri lon
chc nng tuyn yn v / hoc khng sn xut ACTH, c gi l suy thng thn th
pht. Nu sn xut cortisol gim l do tn thng tuyn thng thn, c gi l suy
thng thn nguyn pht hoc bnh Addison.
Mt khi s bt thng c xc nh v c lin quan vi tuyn yn, tuyn thng thn,

hoc nguyn nhn khc, bc s c th s dng th nghim khc nh CT (chp ct lp vi
tnh) hoc MRI (cng hng t hnh nh) qut xc nh v tr ngun gc ca s d tha
(chng hn nh mt khi u tuyn yn, tuyn thng thn, hoc u khc) v nh gi mc
tn thng ca cc tuyn.
Nng, lnh, nhim trng, chn thng, tp th dc, bo ph, v bnh suy nhc c th nh
hng n nng cortisol. Mang thai, cng thng v th cht v tnh cm, v bnh tt c
th lm tng lng cortisol. Mc cortisol cng c th tng nh l mt kt qu ca cng
gip hoc bo ph. Mt s loi thuc cng c th tng nng , c bit l thuc nga thai
dng ung (thuc trnh thai), hydrocortisone (dng tng hp cortisol), v spironolactone.
Ngi ln c mc cortisol cao hn mt cht so vi tr em.
Suy gip c th lm gim mc cortisol. Loi thuc c th lm gim mc bao gm mt

s hormone steroid.
Cortisol nc bt th nghim ang c s dng thng xuyn hn gip chn on hi

chng Cushing v cc ri lon lin quan n cng thng nhng vn i hi chuyn mn
chuyn ngnh thc hin.
29. Xt nghim Catecholamines

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Catecholamine l mt nhm cc hormone tng t nhau c sn xut bi ty thng

thn, phn bn trong ca tuyn thng thn. Tuyn thng thn nh, hnh tam gic nm
trn u ca mi thn. Catecholamine gm ba cht chnh l dopamine, epinephrine
(adrenaline) v norepinephrine. Th nghim Catecholamine o s lng cc kch thch t
trong mu v / hoc nc tiu.
p ng vi tnh trng cng thng v th cht hay tnh cm Catecholamine c phng

thch vo mu. Hormon gip truyn xung ng thn kinh trong no, lm tng glucose v
gii phng axit bo to ra nng lng, lm gin ph qun, v lm gin ng t.
Norepinephrine lm co tht mch mu, tng huyt p, v epinephrine gia tng nhp tim v
s trao i cht. Sau khi hon thnh cc tc ng, cc kch thch t c chuyn ha thnh
cc hp cht khng hot ng. Dopamine tr thnh homovanillic acid (HVA),
norepinephrine ph v thnh normetanephrine v acid vanilmadelic (VMA), v
epinephrine tr thnh metanephrine v VMA. C hai kch thch t v cc cht chuyn ha
ca chng c bi tit trong nc tiu.
Bnh thng, catecholamine v cc cht chuyn ha ca n c mt trong c th mt lng

nh, dao ng tng ch thy r trong v ngay sau khi c tnh trng cng thng. Tuy nhin
Pheochromocytomas v cc khi u thn kinh ni tit khc sn xut s lng ln
catecholamine, kt qu l nng cc kch thch t v cc cht chuyn ha ca chng tng
ln rt nhiu trong mu v nc tiu. iu ny c th lm cho kinh nguyt ko di hoc
t tng huyt p, c th dn n nhc u nng. Cc triu chng khc ca catecholamine
gy ra bao gm nh trng ngc, v m hi, bun nn, lo lng, v nga ran chi.
Pheochromocytomas l rt him v khong 90% nguyn nhn l do bu ca cc tuyn
thng thn.Ch c mt vi pheochromocytomas l ung th, cn hu ht l lnh tnh v
khng lan trn ra ngoi v tr ban u ca n. Tuy nhin nu khng iu tr, bu c th
tip tc pht trin v cc triu chng c th xu i. Qua thi gian, cc catecholamine d
tha gy ra tng huyt p, c th dn n tn thng thn, bnh tim, v tng nguy c t
qu hoc au tim.
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Xt nghim Catecholamine nc tiu v mu c th c s dng gip pht hin s

hin din ca pheochromocytomas. iu quan trng l chn on v iu tr cc khi u
him bi v chng gy ra mt dng cao huyt p c kh nng cha c. Trong hu ht cc
trng hp, cc khi u c th c phu thut ct b v / hoc x l lm gim sn xut
s lng catecholamine v gim bt hoc loi b cc triu chng lin quan v cc bin
chng.
Th nghim catecholamine mu o s lng kch thch t hin din trong mu ti thi im

thu thp mu, trong khi cc xt nghim nc tiu o s bi tit trong khong thi gian 24-
gi.
Th nghim catecholamine ch yu c s dng gip pht hin hoc loi tr nhng

ngi c triu chng pheochromocytomas. N cng c th c ch nh khi
pheochromocytoma c ly ra gim st s ti pht. Xt nghim mu l hu ch nht
khi ngi c tng huyt p ko di hoc hin ang tri qua mt tnh trng tng huyt p
nh k. Bi v cc hormon khng lu di trong mu, chng c c th s dng, chuyn
ha, v / hoc bi tit,nn cc bin php xt nghim catecholamin nc tiu l o tng s
lng catecholamine phng thch trong 24 gi c s dng. Trong thi gian ny mc
hormone c th dao ng ng k, xt nghim nc tiu c th pht hin sn xut d tha
m cc th nghim mu b mt. Xt nghim mu v nc tiu c th c ch nh vi
nhau hoc ring r tm s lng qu mc ca c hai catecholamine v cc cht chuyn
ha ca chng.
Nhng th nghim ny cng b nh hng bi cc loi thuc, thc phm, v s cng thng,
xt nghim dng tnh gi c th xy ra. V l do ny, th nghim catecholamine khng
c khuyn co nh l mt th nghim tm sot cho cng chng. Cc bc s thng
xt mt kt qu dng tnh bng cch nh gi p lc ca mt ngi, khi thay i lm vic
hoc gim thiu bt k nh hng, v sau lp li cc xt nghim xc nhn pht hin
ban u.
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Thnh thong, cc xt nghim c th c ch nh cho mt ngi khng c triu chng

nhng nu c mt khi u thng thn hoc thn kinh ni tit c pht hin trong qu trnh
qut (CT) c tin hnh cho mc ch khc hoc nu ngi c mt lch s c nhn hoc
gia nh c pheochromocytoma.
Hm lng bnh thng ca catecholamine trong huyt tng v trong nc tiu/ 24 gi
Adrenaline Noradrenaline Dopamine

Huyt tng < 70 pg/mL < 400 pg/mL < 30 pg/mL
< 20 mcg/ 24 gi < 90 mcg/ 24 gi < 400 mcg/ 24 gi
Nc tiu/ 24 gi
(110 nmol/ 24 gi) (535 nmol/ 24 gi) (2600 nmol/ 24 gi)
Th nghim catecholamine l nhy cm vi nhiu nh hng bn ngoi v

pheochromocytomas l rt him, bc s c th nhn thy nhiu kt qu dng tnh gi hn
dng tnh tht. Nu mt ngi c triu chng, c s lng catecholamine tng trong mu
v / hoc nc tiu, tip tc ch nh thm xt nghim iu tra. Cn bnh nghim trng
v cng thng c th gy ra tng tm thi mc catecholamine va phi. Cc bc s phi
nh gi ton b tnh trng th cht ca h, trng thi cm xc, thuc men, v ch n
ung. Khi cht gy tr ngi v / hoc nguyn nhn c tm thy v gii quyt, bc s cng
thng xuyn kim tra li xc nh xem cc catecholamine c cn tng ln. Bc s cng
c th yu cu kim tra metanephrine mu v / hoc nc tiu gip xc nhn s pht
hin ca mnh v kim tra hnh nh, chng hn nh mt MRI, gip xc nh v tr khi
u.
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Nu mc catecholamine tng cao mt ngi c mt pheochromocytoma t trc,

mc tng c kh nng l hoc iu tr khng hiu qu hoc do tng nh k ca khi u.
Nu nng catecholamin bnh thng trong huyt tng v nc tiu, cng khng chc
rng ngi khng c mt pheochromocytoma.Tuy nhin Pheochromocytomas khng
nht thit phi sn xut catecholamine vi mt tc khng thay i,. Nu ngi gn y
khng c cao huyt p, th nng catecholamin trong mu v nc tiu ca h c th l
bnh thng hoc gn mc bnh thng ngay c khi h c pheochromocytoma.
Trong khi th nghim catecholamine trong huyt tng v nc tiu c th gip pht hin
v chn on pheochromocytomas, n khng th ch cho bc s ni c khi u, cho d c
nhiu hn mt, hoc c hoc khng c khi u l lnh tnh (mc d hu ht). S lng
catecholamine sn xut khng nht thit phi tng ng vi kch thc ca khi u. y l
mt c tnh sinh l ca cc m khi u. Tuy nhin tng s lng catecholamine sn xut
s c xu hng tng bng vi tng kch thc khi u.
Nhiu loi thuc c th can thip vo th nghim catecholamine. Tuy nhin, iu quan
trng l ni chuyn vi bc s trc khi ngng bt c loi thuc no theo ch nh. ng s
lm vic vi ngi ang c th nghim xc nh cc cht v thuc iu tr c kh
nng gy tr ngi v xc nh trong s c th c nhng thuc khng gy nh hng
v phi c tip tc th nghim. Mt s cc cht c th gy nhiu th nghim
catecholamine bao gm: acetaminophen, aminophylline, cht kch thch, c ch s thm
n, c ph, tr, v cc hnh thc khc ca caffeine, chloral hydrate, clonidin,
dexamethasone, thuc li tiu, epinephrine, ethanol (ru), insulin, imipramin, lithium,
methyldopa (Aldomet), c ch MAO (monoamine oxidase), nh mi nicotine,
nitroglycerine, propafenone (Rythmol), reserpin, salicylat, theophylline, tetracycline,
thuc chng trm cm, thuc gin mch. Cc tc dng ca cc thuc ny lm kt qu
catecholamin s khc nhau t ngi ny sang ngi khc v thng khng th d on
c.
Trong khi 90% pheochromocytomas c tm thy trong cc tuyn thng thn, hu ht

trong s 10% cn li thng c tm thy trong khoang bng. T chc Y t Th gii s
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dng "paraganglioma ngoi thng thn" m t khi u sn xut catecholamine khng

nm tuyn thng thn.
30. Xt nghim Thyrotropin
Tn chnh: Thyroid-stimulating Hormone
Xt nghim ny o lng hormone kch thch tuyn gip (TSH) trong mu. TSH c sn
xut bi tuyn yn, mt c quan nh nm di no v ng sau cc hc xoang. S sn xut
TSH c iu ha theo c ch h thng thng tin phn hi ca c th duy tr s lng
n nh ca kch thch t tuyn gip thyroxine (T4) v triiodothyronine (T3) trong mu.
Hormon tuyn gip gip kim sot tc s dng nng lng ca c th.
Khi nng hormone gip gim trong mu, vng di i tit ra hormone thyrotropin
(TRH). TRH kch thch tuyn yn gii phng TSH. TSH ln lt kch thch tuyn gip sn
xut T4 v T3 v phng thch T3,T4 vo mu, tuyn gip l tuyn nh hnh con bm nm
c mt trc kh qun. Khi c ba b phn ny c hot ng bnh thng, tuyn gip
sn xut T3,T4 theo kiu bt v tt duy tr lin tc mc hormone tuyn gip n nh
trong mu.
Nu c ri lon chc nng tuyn yn, c th cho kt qu l s lng TSH tng hoc gim.
Khi nng TSH tng ln, tuyn gip s tng sn xut v tng s lng T4 v T3 trong
mu v ngi b nh hng c th gp cc triu chng lin quan vi cng gip, chng
hn nh nhp tim nhanh, gim cn, cng thng, run tay, mt b kch thch, v kh ng.
Nu sn xut hormone tuyn gip gim (hypothyroidism), ngi bnh c th gp cc triu

chng nh tng cn, da kh, to bn, khng chu lnh, v mt mi. Ngoi ra ri lon chc
nng tuyn yn, cng gip hoc suy gip c th xy ra nu c mt vn vng di i
(TRH khng hoc qu nhiu). Nng hormone tuyn gip cng c th c thay i
bi mt lot cc bnh tuyn gip, bt k s lng TSH hin ti trong mu nh th no.

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Th nghim TSH thng l th nghim c la chn nh gi chc nng tuyn gip

v / hoc cc triu chng cng gip hoc suy gip. N thng xuyn c ch nh cng
vi hoc trc khi xt nghim T4. Xt nghim tuyn gip khc c th c ch nh bao
gm xt nghim T3 v cc khng th tuyn gip (nu c nghi ng lin quan n bnh tuyn
gip t min).
Th nghim TSH c s dng :

Chn on ri lon tuyn gip mt ngi c triu chng
Tm sot s sinh cho mt b c tuyn gip km hot
Theo di iu tr bng hormone tuyn gip thay th nhng ngi suy gip
Chn on v theo di cc vn v sinh n
Tr gip nh gi chc nng ca tuyn yn (i khi)
Tm sot ngi ln c cc triu chng ri lon tuyn gip, mc d kin cc chuyn
gia khc nhau v li ch ca vic sng lc v tui bt u sng lc.
Kt qu th nghim c ngha l g?
Gi tr tham chiu: TSH: 0,27 4,2 mU/L
Kt qu TSH cao thng c ngha l tuyn gip hot ng km (nhc gip),khng p

ng y vi s kch thch ca TSH,nguyn nhn do mt s loi ri lon chc nng tuyn
gip cp tnh hoc mn tnh. Him khi c kt qu TSH cao, nguyn nhn c th c vn
lin quan vi tuyn yn, chng hn nh mt khi u sn xut ra lng TSH khng kim sot
c. Mt gi tr TSH cao cng c th xy ra khi mt ai c mt ri lon tuyn gip,
nhng ngi ny tuyn gip khng sn xut hay sn xut qu t hormone tuyn gip.
Mt kt qu TSH thp c ngha tuyn gip hot ng qu mc (cng gip) hoc dng
qu nhiu thuc ni tit t tuyn gip cho nhng ngi ang c iu tr tuyn gip km
hot (hoc ct b). Him khi c mt kt qu TSH thp m nguyn nhn do tuyn yn,c
th do ngn chn s sn xut TSH.
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Cho d cao hay thp, TSH bt thng cho thy s d tha hoc thiu ht lng hormone
tuyn gip cho c th, nhng n khng cho bit l do ti sao. Mt kt qu xt nghim TSH
bt thng, thng c thc hin thm cc xt nghim b sung iu tra nguyn nhn
ca s gia tng hoc gim.
ngha cc xt nghim
TSH T3 T4 Gii thch
Cao Bnh thng Bnh thng Suy gip nh (Di lm sng)
Cao Thp Thp hoc BT Suy gip
Thp Bnh thng Bnh thng Cng nng tuyn gip thng nh (Di lm sng)
Thp Cao hoc BT Cao hoc BT Cng nng tuyn gip
Him gp,suy gip th cp
Thp Thp hoc BT Thp hoc BT
(tuyn yn)
Nhiu loi thuc - bao gm c aspirin v liu php thay th hormone tuyn gip - c th
nh hng n kt qu th nghim chc nng tuyn gip v s dng xt nghim cn c
tho lun vi bc s trc khi th nghim.
Khi bc s iu chnh liu lng hormone tuyn gip thay th ca mt ngi, iu quan
trng l phi ch i t nht 1-2 thng kim tra TSH li mt ln na trc khi iu chnh
liu mi, mi c th nh gi hiu lc y ca liu mi.
Cng thng qu mc v bnh cp tnh cng c th nh hng n kt qu xt nghim TSH,

v kt qu c th thp trong ba thng u ca thai k.
31. Xt nghim T3, T4

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Xt nghim ny o lng s lng thyroxine, hoc T4 trong mu. T4 l mt trong hai kch
thch t ch yu c sn xut bi tuyn gip,mt cht khc l triiodothyronine, hoc T3.
Tuyn gip l mt tuyn c hnh con bm nh nm ngay di qu to ca Adam. Tuyn
ny ng mt vai tr quan trng trong vic kim sot qu trnh trao i cht, t l s dng
nng lng ca c th.
C th c mt h thng thng tin phn hi c th kch thch hay c ch sn xut hormone

tuyn gip (c ch m v tt). Khi mc T4 trong mu gim, vng di i gii phng
ni tit t thyrotropin (TRH), TRH kch thch tuyn yn gii phng hormon kch thch
tuyn gip (TSH), TSH kch thch tuyn gip bi tit ra T4. Khi nng T4 trong mu
tng, TSH b c ch gim sn xut.
T4 chim khong 90% ca kch thch t tuyn gip. Khi c th i hi hormon tuyn gip,
T4 lu tr trong ti tuyn c phng thch vo mu lu thng. Trong mu T4 lu hnh
di 2 dng ,T4 t do (khng b rng buc, Free T4) hoc gn vi protein (ch yu
thyroxine-binding globulin). Nng T4 t do ch khong 0,1% tng s T4. T4 c
chuyn thnh T3 trong gan hoc cc m khc. Cng nh T4, T3 trong mu cng di 2
dng, dng t do (Free T3) v dng gn vi Protein (ch yu l Globulin) dng kt hp
protein cng c nh gi cao, nhng dng Free T3 v Free T4 mi c hot tnh sinh hc.
Trong mu lu thng Free T3 hot ng mnh gp 4-5 ln hot ng ca Free T4.
Nu tuyn gip khng sn xut T4, do ri lon chc nng tuyn gip hoc thiu TSH,
ngi bnh c cc triu chng ca suy gip nh tng cn, da kh, khng chu lnh, kinh
nguyt khng u, v mt mi. Nu tuyn gip sn xut qu nhiu T4, t l cc chc nng
c th ca ngi s tng v gy ra cc triu chng cng gip nh nhp tim tng, lo
lng, gim cn, kh ng,tay run ry, v bng quanh mt, kh mt, mt b kch thch.
Cc nguyn nhn ph bin nht ca ri lon chc nng tuyn gip t min lin quan n
bnh gy ra cng gip Graves v bnh gy ra suy gip vim tuyn gip Hashimoto. C
hai cng gip v suy gip cng c th c gy ra bi vim tuyn gip, ung th tuyn
gip, v sn xut qu nhiu hoc thiu TSH. nh gi hiu qu ca nhng iu kin gy
nh hng trn sn xut hormone tuyn gip c th c pht hin v theo di bng cch
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o T4 tng s (bao gm phn gn protein v t do) hoc T4 t do (hnh thc khng gn

protein).
T4 ton phn v T4 t do l hai xt nghim ring bit, n c th gip bc s nh gi chc

nng tuyn gip. Cc xt nghim T4 ton phn c s dng trong nhiu nm gip
chn on cng gip v suy gip. N l mt th nghim hu ch, nhng c th b nh
hng bi s lng protein lin kt vi hormone ny c trong mu. Cc th nghim Free
T4 l mt th nghim mi khng b nh hng bi mc protein. T khi nhn bit Free
T4 l dng hot ng ca thyroxine, th nghim Free T4 c nhiu bc s s dng v cho
rng n phn nh chc nng ni tit t tuyn gip chnh xc hn, v trong nhiu trng
hp, bc s ch nh xt nghim Free T4 thay th cho cc xt nghim T4 ton phn.Xt
nghim thyroxine thng c ch nh cng vi hoc sau mt th nghim TSH. iu ny
gip bc s xc nh c h thng phn hi ca cc hoc mn tuyn gip c p ng tng
thch hay khng, v kt qu ca cc xt nghim gip phn bit cc nguyn nhn khc nhau
gy ra cng gip v suy gip. i khi mt th nghim T3 cng s c ch nh cung
cp thm cc thng tin cho bc s chn on.
Mt th nghim T4 v TSH c th c ch nh gip nh gi mt ngi b bu c

v h tr trong chn on v sinh n. Nu bc s nghi ng mt ngi no c th c mt
triu chng lin quan n tuyn gip t min, cc khng th tuyn gip c th c ch
nh, sau hoc cng vi xt nghim T4. nhng ngi c ri lon chc nng tuyn gip,
T4 v / hoc xt nghim TSH c th c ch nh theo di chc nng tuyn gip.
Kt qu th nghim c ngha l g?
Gi tr bnh thng:
T4 = 4.0 12,0 mcg/dL
Free T4 = 0.93 1,71 ng/dL

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Ni chung, T4 ton phn hoc free T4 tng c th ch ra mt tuyn gip hot ng qu mc

(cng gip), v free T4, hoc T4 ton phn thp c th ch ra mt tuyn gip km hot
(suy gip). Kt qu th nghim mt mnh T4 hay fT4 cha chn on nhng s nhc
nh bc s thc hin b sung thm th nghim iu tra nguyn nhn ca s d tha hoc
thiu ht T4. C hai trng hp gim v tng kt qu T4 c lin quan vi mt lot cc iu
kin tm thi v mn tnh ca tuyn gip. Kt qu T4 thp kt hp vi mt mc TSH
thp hoc kt qu T4 cao cng vi mt TSH cao c th ch ra mt bnh l ca tuyn yn.
ngha cc xt nghim
TSH T3 T4 Gii thch
Cao Bnh thng Bnh thng Suy gip nh (Di lm sng)
Cao Thp Thp hoc BT Suy gip
Thp Bnh thng Bnh thng Cng nng tuyn gip thng nh (Di lm sng)
Thp Cao hoc BT Cao hoc BT Cng nng tuyn gip
Him gp,suy gip th cp
Thp Thp hoc BT Thp hoc BT
(tuyn yn)
32. Xt nghim LH
Luteinizing hormone (LH) c sn xut bi tuyn yn trong no. Kim sot s sn xut
LH l mt h thng phc tp lin quan n hormon c sn xut bi cc tuyn sinh dc
(bung trng hoc tinh hon), tuyn yn v vng di i.
Chu k kinh nguyt ca ph n c chia thnh: giai on nang trng v giai on hong
th, c im ca hormone kch thch nang (FSH) v LH l tng gia chu k. Mc cao
ca LH (FSH) ti gia chu k gy nn rng trng. LH cng kch thch bung trng sn
xut steroid, ch yu l estradiol. Estradiol v steroid khc gip tuyn yn iu chnh vic
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sn xut LH. Ti thi im mn kinh, bung trng ngng hot ng v nng LH tng.
nam gii, LH kch thch mt loi t bo nht nh (t bo Leydig) trong tinh hon sn
xut testosterone. Nng LH tng i n nh nam gii sau tui dy th. Mt mc
testosterone tng cung cp thng tin phn hi ngc n tuyn yn v vng di i, do
lm gim bi tit LH.
tr s sinh v tr em, mc LH tng ngay sau khi sinh v sau gim xung mc rt
thp ( cc b trai 6 thng v 1-2 tui n). Vo khong 6-8 tui, LH tng ln mt ln
na, trc khi bt u tui dy th v s pht trin ca cc c tnh sinh dc th pht.
LH thng c s dng kt hp vi cc xt nghim khc (FSH, estradiol, testosterone v

progesterone) trong WORKUP v sinh c nam gii v ph n. Mc LH cng rt hu
ch trong vic iu tra kinh nguyt khng u v h tr trong vic chn on cc ri
lon tuyn yn hoc cc bnh lin quan n bung trng hoc tinh hon.
Khi xt nghim c bn nc tiu c hon thnh, tip tc th nghim nc tiu c th
c s dng pht hin s tng LH, cho bit rng s rng trng s xy ra trong 1-2 ngy
ti.
tr em, FSH v LH c s dng chn on dy th chm v sm.
i khi o hormone gii phng gonadotropin (GnRH) lin quan n LH phn bit gia
ri lon nguyn pht hay th pht lin quan n vng di i, tuyn yn, tuyn sinh dc.
GnRH l hormone c sn xut bi vng di i kch thch tuyn yn phng thch LH
v FSH. i vi th nghim ny, mt mu mu ban u c rt ra v sau bnh nhn
c tim thuc GnRH. Mu mu sau tim c rt ra theo thi gian quy nh v inh
lng mc LH trc v sau tim thuc. Th nghim ny c th gip phn bit gia
bnh ca bung trng hoc tinh hon (nguyn pht) v ri lon ca tuyn yn hoc vng
di i (th pht). N cng rt hu ch trong vic nh gi tr dy th sm hoc chm tr.
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Ch nh
ph n v nam gii, xt nghim LH (FSH) c ch nh nh mt phn ca WORKUP

v sinh, nghi ng tuyn yn c vn , hoc ri lon sinh dc khi mt ngi ph n ang
gp kh khn khi mang thai hoc khi nghi ng ri lon tuyn yn, bung trng, hoc tuyn
sinh dc.
Xt nghim ny c th c ch nh cng vi mt xt nghim FSH khi mt ph n c chu

k kinh nguyt khng u, c bit l vo lc bt u ca thi k mn kinh.
LH v FSH c th c ch nh khi mt cu b hay c gi khng c biu hin bc
vo tui dy th tui thch hp (hoc qu mun hoc qu sm).
Thi gian bt u ca tui dy th bt thng c th l mt du hiu ca mt vn nghim

trng lin quan n vng di i, tuyn yn, tuyn sinh dc (bung trng hoc tinh hon),
hoc cc h thng khc. Cc o lng ca LH v FSH c th phn bit gia cc triu chng
lnh tnh v bnh thc s. Sau khi cc triu chng c xc minh l kt qu ca bnh tht
s, th nghim thm na c th c thc hin phn bit nguyn nhn c bn.
Bnh thng:
Nam: 1,7 8,6 mU/L
N:
Giai on nang trng: 2,4 12,6 mU/L

Giai on rng trng: 14,0 95,6 mU/L
Giai on th vng : 1,0 11,4 mU/L
Sau mn kinh : 7,7 58,5 mU/L
Ph n
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ph n, mc LH v FSH c th gip phn bit gia thiu nng bung trng nguyn
pht (thiu nng do bn thn bung trng hoc thiu pht trin bung trng) v thiu nng
bung trng th pht (thiu nng bung trng do ri lon ca mt trong hai tuyn yn hoc
vng di i). Mc tng ca LH v FSH c nhn thy trong suy bung trng nguyn
pht. Mt s nguyn nhn ca thiu nng bung trng ch yu c lit k di y.
Pht trin khuyt tt:
Bung trng khng pht trin (bung trng bt sn)

Nhim sc th bt thng, chng hn nh hi chng Turner, hi chng Kalllmann
Khim khuyt trong sn xut steroid do bung trng, chng hn nh thiu 17 alpha
hydroxylase
Do thiu nng bung trng sm

Mn tnh khng rng trng (anovulation) do:
Hi chng bung trng a nang (PCOS)

Bnh thng thn
Bnh tuyn gip
Khi u bung trng
Trong qu trnh mn kinh, bung trng ca ngi ph n chm dt hot ng, do LH

s tng.
Cc mc thp ca LH v FSH c nhn thy trong thiu nng bung trng th cp v ch

ra mt vn vi tuyn yn hoc vng di i.
Nam gii
nam gii, LH mc cao c th ch cho bit thiu nng tinh hon nguyn pht. iu
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ny c th l do cc khuyt tt pht trin trong s pht trin tinh hon hoc chn thng
tinh hon, nh c m t di y.
Pht trin khuyt tt:
Tuyn sinh dc khng pht trin (bt sn tuyn sinh dc)

Nhim sc th bt thng, chng hn nh hi chng Klinefelters
Tinh hon thiu nng do:

Nhim virus (quai b)
Chn thng
Bc x
Ha tr
Bnh t min dch
Khi u t bo mm
LH p ng vi GnRH c th gip phn bit gia ri lon chc nng nguyn pht (thiu
nng bung trng hoc tinh hon) v ri lon th pht (mt vn lin quan n tuyn yn
hoc vng di i). Mt khi cc mc c bn ca LH c nh lng, sau tim
mt liu GnRH. Mc LH tng ln sau tim ch ra rng tuyn yn p ng vi GnRH v
ch im cho bit mt chng ri lon lin quan n bung trng hoc tinh hon. Mc LH
gim cho thy tuyn yn khng p ng vi GnRH v ch cho thy mt cn bnh lin quan
n tuyn yn hoc vng di i.
Tr nh
tr nh, mc LH v FSH cao v c s pht trin cc c tnh sinh dc th pht tui

rt tr, l mt du hiu ca dy th sm. iu ny l ph bin b gi nhiu hn b trai.
Pht trin sm ny c th c nhiu nguyn nhn khc nhau cn phi c chn on v
iu tr. Mt s nguyn nhn bao gm:
Tn thng h thng thn kinh trung ng
Khi u tit hormone

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Khi u hoc u nang bung trng

Khi u tinh hon
Mc LH v FSH bnh thng tr em tin dy th,trng by mt s du hiu thay i ca

tui dy th, c th cho thy mt hnh thc lnh tnh ca dy th sm khng c nguyn nhn
c th hoc xc ng, hoc ch c th l mt bin i bnh thng ca tui dy th.
Chm tui dy th, mc LH v FSH c th l bnh thng hoc thp hn nhng g
c d kin cho mt thanh nin trong tui ny. Th nghim LH p ng vi GnRH,
cng thm cc th nghim khc c th gip chn on l do tui dy th chm. Mt s
trong nhng nguyn nhn chm dy th c th bao gm:
Tuyn sinh dc (bung trng hoc tinh hon) thiu
Thiu hormone
Hi chng Turner (nhim sc th bt thng cc b gi)
Hi chng Klinefelter (nhim sc th bt thng cc b trai)
Vim nhim mn tnh
Ung th
Ri lon n ung (chn n tm thn)
Mt s thuc c th gy ra LH tng, chng hn nh thuc chng co git, clomiphene, v

naloxone, trong khi nhng thuc khc gy ra LH gim, nh digoxin, thuc trnh thai, v
cc phng php iu tr hormone.
33. Xt nghim Testosterone
Testosterone l mt hormone steroid (androgen) c sn xut bi m ni tit c bit (cc

t bo Leydig) tinh hon nam. Sn xut Testosterone c kch thch v kim sot bi
hc mn Luteinizing (LH), c sn xut trong tuyn yn. iu ha bi tit Testosterone
theo mt c ch thng tin phn hi ngc: nh testosterone tng, LH gim, ngc li khi
LH tng lm testosterone gim. Nng testosterone ban ngy, t nh im vo bui
sng sm (khong 4:00 n 8:00 gi sng), vi mc thp nht vo bui ti (khong 4:00
n 8:00 pm). Nng cng tng sau khi tp th dc, nhng gim theo tui tc. Khong
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hai phn ba testosterone lu thng trong mu gn cht vi protein c th l Globulin,c

gi l Sex Steroid Binding Globulin (SSBG) hoc Sex Hormone Binding Globulin (SHBG)
v hi t hn mt phn ba lin kt lng lo vi albumin. Mt phn nh (khong 1-4%) lu
thng di dng testosterone t do (Free testosterone).
nam gii, testosterone kch thch pht trin cc c im gii tnh th cp, bao gm pht
trin dng vt, s pht trin ca lng trn c th, c bp pht trin, v mt ging ni trm
hn. N hin din vi s lng ln nam gii trong tui dy th v nam gii trng
thnh iu ha ham mun tnh dc v duy tr khi lng c bp. Testosterone cng c
sn xut bi tuyn thng thn c nam v n, v bung trng cng sn xut vi s lng
nh n. ph n, testosterone c chuyn thnh estradiol, hormone sinh dc chnh
ph n.
Xt nghim Testosterone c s dng chn on mt s tnh trng nam gii, ph n,

v tr em trai. Nhng tnh trng ny bao gm:
Tui dy th chm tr hoc sm cc b trai
Gim ham mun tnh dc nam gii v ph n
Ri lon chc nng cng dng nam gii
V sinh nam gii v ph n
Khi u tinh hon nam gii
Ri lon vng di i hoc tuyn yn
Rm lng v nam ha cc b gi v ph n.
nam gii, xt nghim testosterone thng c ch nh cng vi xt nghim FSH v

LH, nu tui dy th b tr hon hoc chm pht trin. Mc d tui bt u dy th ca
tng c nhn c s khc nhau, thng thng l 10 tui, khi u c pht trin v kch thch
t v sinh l ca tui dy th nam gii. Mt s triu chng ca tui dy th chm c th
bao gm:
Chm pht trin khi lng c
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Ging ni khng trm hoc thiu tng trng ca lng trn c th

Chm hoc tr hon s pht trin ca tinh hon v dng vt
S chm tr c th xy ra nu tinh hon khng sn xut testosterone hoc nu tuyn yn

khng sn xut LH. Xt nghim ny cng c th c ch nh nu mt chng trai tr
dng nh c tri qua tui dy th t rt sm vi cc c im gii tnh th cp r rng.
Nguyn nhn ca dy th sm cc b trai, do testosterone tng ln, bao gm cc khi u
khc nhau v tng sn thng thn bm sinh.
nam gii, xt nghim c th c ch nh khi nghi ng v sinh hoc nu bnh nhn c

gim tnh dc hoc ri lon chc nng cng dng, tt c u c th l kt qu ca nng
testosterone thp. Mt s triu chng khc bao gm thiu ru v lng trn c th, gim
khi lng c, v pht trin ca cc m v (gynecomastia).
ph n, xt nghim testosterone c th c thc hin nu bnh nhn c bt thng hoc

khng c chu k kinh nguyt (v kinh), gp kh khn trong vic mang thai, hoc xut hin
cc tnh nng nam tnh, chng hn nh lng trn khun mt v c th, chng hi u, v
mt ging ni trm. Mc testosterone c th tng ln v cc khi u pht trin trong
bung trng hoc tuyn thng thn hoc do cc nguyn nhn khc chng hn nh hi
chng bung trng a nang (polycystic ovarian syndrome (PCOS)).
Bnh thng:
Nam: 2.8 8.0 ng/mL
N : 0.06 0.82 mg/mL
Trai < 17 tui: 0.28 11 ng/mL
Gii hn bnh thng i vi nng testosterone nam gii l rng ln v khc nhau
theo tng giai on trng thnh v tui tc. Mc bnh thng testosterone tt theo tui
ngi n ng. Mc gim (thiu nng sinh dc) nam gii c th l do:
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Bnh vng di i hoc tuyn yn

Bnh di truyn c th gy ra gim sn xut testosterone nam gii tr (Klinefelter,
Kallman, v hi chng Prader-Willi) hoc suy tinh hon v v sinh (nh trong chng lon
dng trng lc c, mt dng ca chng lon dng c)
Suy gim sn xut testosterone v tinh hon b tn thng nh nghin ru, thng tch,
hoc cc bnh do virus nh quai b.
Mc testosterone tng nam gii c th do:

Khi u tinh hon
Khi u thng thn tng sn xut testosterone
S dng ni tit t androgen (cn gi l anabolic steroid)

Dy th sm khng r nguyn nhn tr em trai
Cng gip
Tng sn thng thn bm sinh (congenital adrenal hyperplasia)
ph n, mc testosterone bnh thng thp. Mc testosterone tng c th do:
Hi chng bung trng a nang (PCOS)
Khi u bung trng hay tuyn thng thn
Tng sn v thng thn bm sinh.
Nghin ru v bnh gan nam gii c th lm gim nng testosterone. Loi thuc,
bao gm cc ni tit t androgen v steroid, cng c th lm gim nng testosterone.
Ung th tuyn tin lit p ng ni tit t androgen, ngi n ng dng nhiu liu php
thuc cao iu tr ung th tuyn tin lit th mc testosterone thp hn.
Cc loi thuc nh thuc chng co git, barbiturate, v clomiphene c th gy ra mc
testosterone tng ln. Ph n dng liu php estrogen c th lm tng mc testosterone.
34. Xt nghim Estrogens
Estrogen l mt nhm steroid iu ha chu k kinh nguyt v chc nng nh l cc

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hormone gii tnh n chnh. Cc dng ph bin nht ca estrogen c th nghim l

estrone (E1), estradiol (17-beta estradiol, E2), v estriol (E3). Estrogen o c trong mu
hoc nc tiu l Estrogen tng.
Estrogen chu trch nhim v s pht trin ca c quan sinh dc n v cc c im gii

tnh th cp v c gn lin vi chu k kinh nguyt v mang thai. Chng c coi l
hormone gii tnh chnh ph n v hin din vi s lng nh nam gii. E1 v E2 l
hai estrogen chnh ph n khng mang thai, trong khi E3 l hormon chnh trong thi k
mang thai.
Estrone (E1) c ngun gc t s chuyn ha cc cht bo (Cholesterol) trong tuyn thng

thn. Estrone c th c chuyn i thnh estradiol hoc estriol khi cn thit. Estrone hin
din vi s lng nh tr em trc khi n tui dy th v sau tng nh tui dy th
cho c nam v n. Mc ny khng thay i nam gii trng thnh, nhng n s tng
v dao ng ph n theo chu k kinh nguyt. Sau khi mn kinh, n chim lng ln ca
estrogen tng, trong khi E2 v E3 gim bt rt nhiu.
Estradiol (E2) l dng chim u th trong Estrogen tng v c sn xut ch yu trong

bung trng v s lng b sung c sn xut bi tuyn thng thn ph n v trong
tinh hon v tuyn thng thn nam gii. Trong chu k kinh nguyt ph n, mc E2
thay i khc nhau trong sut thng, ln v xung ty thuc nng FSH (hormone kch
thch nang), LH (luteinizing hormone), v progesterone, cc nang trng trong bung trng
c kch thch, mt qu trng c phng thch, v t cung chun b tim nng cho s
mang thai. Mc E2 thp nht l lc bt u chu k kinh nguyt v tng ln mc cao
nht l trc khi phng thch mt qu trng t bung trng (rng trng). Mc E.2 bnh
thng thch hp cho s chun b rng trng, th tinh ca trng (th thai), v mang thai,
ngoi ra E.2 lm cu trc xng tng thm chc chn v iu ha mc cholesterol.
Estriol (E3) l estrogen ch yu trong thi k mang thai, vi s lng tng i ln c

sn xut bi nhau thai pht trin. Mc estriol bt u tng trong tun th tm ca thai
k v tip tc tng ln cho n trc khi sinh mt thi gian ngn. Estriol lu hnh trong
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mu ngi m nhanh chng c thi ra khi c th. Mi ln o, nng estriol phn nh

c ca nhng g ang xy ra vi nhau thai v thai nhi, nhng nng estriol cng c s
thay i t nhin hng ngy.
Xt nghim estrogen c th c s dng cho mt lot cc l do:
Mc estrone c th tng nhng bnh nhn c hi chng bung trng a nang v lc

ni mc t cung. Cc xt nghim c th c s dng h tr trong vic chn on mt
khi u bung trng, hi chng Turner, v suy tuyn yn. nam gii, n c th gip trong
vic chn on nguyn nhn ca n ha tuyn v hoc trong vic pht hin cc khi u sn
xut estrogen.
Mc Estradiol c s dng trong vic nh gi chc nng bung trng. Mc

estradiol tng trong cc trng hp tui dy th sm tr em gi v n ha tuyn v nam
gii. S dng chnh ca n c s dng trong chn on phn bit ca v kinh - v d,
xc nh xem nguyn nhn l thi k mn kinh, mang thai, hay mt vn bnh l khc.
Trong k thut h tr sinh sn (ART), trong nhng ngy trc khi th tinh trong ng
nghim,cc php o ni tip c s dng theo di s pht trin nang trong bung trng.
Estradiol i khi cng c dng theo di iu tr hormone thay th tui mn kinh.
Mt bc s i khi c th ra lnh mt xt nghim estrogen tng. Xt nghim ny o estrone
v estradiol vi nhau nhng khng o lng c estriol.
Estriol i khi c th c ch nh theo tng k gim st mt thai k c nguy c cao.

Khi n c s dng theo cch ny, cc th nghim c o trong mu mu c rt ra
trong cng mt ngy.Mt th nghim estriol khng lin kt (estriol unconjugated (uE.3))
l estriol khng gn vi protein, l mt trong cc xt nghim ca b tm sot gm ba hoc
bn th nghim. Hm lng c lin quan vi cc ri lon di truyn khc nhau bao gm c
hi chng Down, khim khuyt ng thn kinh, v nhng bt thng tuyn thng thn.
uE.3 c ch nh trong thi gian mang thai, cng vi alpha-fetoprotein (AFP), chorionic
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gonadotropin ngi (hCG), v xt nghim inhibin-A, nh gi nguy c mang mt bo thai

c bt thng nht nh.
Khi no c ch nh?
Mt bc s c th yu cu mt xt nghim estrone hoc estradiol, cng vi cc xt nghim

khc, khi mt ngi ph n c cc triu chng nh nng vng chu, chy mu m o bt
thng, chu k kinh nguyt bt thng, v sinh, v khi cc c quan sinh dc ca b gi
c pht trin trc hoc mun hn so vi tui dy th bnh thng. Mt bc s cng c
th yu cu estrone v / hoc estradiol khi mt ngi ph n c cn nng bng, m hi
m, mt ng, v / hoc v kinh, triu chng ca thi k mn kinh. Khi mt ph n s
dng liu php hormon thay th, nh k bc s c th yu cu o mc estrone theo
di iu tr.
Khi mt ph n ang gp vn v kh nng sinh sn, bc s c th s dng cc php o
estradiol trong qu trnh ca chu k kinh nguyt theo di s pht trin nang trc khi
thc hin k thut th tinh ng nghim (mt s t bin estradiol theo thi gian). Estradiol
cng c th ch nh kim tra khi mt ngi n ng cho thy du hiu ca s n tnh,
chng hn nh n ha tuyn v, c th l do mt khi u sn xut estrogen.
Trong thi gian mang thai, bc s c th ch nh xt nghim estriol ni tip tm mt xu
hng, tng hay gim mc estriol theo thi gian. Estriol Unconjugated thng c o
lng tun 15 n tun th 20 ca thai k nh l mt phn ca b tm sot ba hoc bn
xt nghim.
Mc tng hoc gim ca estrogen c nhn thy trong nhiu iu kin trao i cht.Xt
nghim c s dng trong vic gii thch estrone, estradiol, v kt qu estriol, bi v nng
ca cc xt nghim mi ngy mi khc nhau trong sut chu k kinh nguyt. Mt bc s
theo di kch thch t ca ngi ph n s c xem xt theo xu hng tng hoc gim
theo thi gian lin quan vi chu k kinh nguyt hay mang thai,ch khng phi l nh gi
gi tr ring r. Kt qu th nghim khng phi chn on ca mt nguyn nhn c th,
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nhng cung cp cho cc bc s thng tin b sung v nguyn nhn tim nng ca cc triu
chng hoc tnh trng ca mt ngi. Di y l nhng nguyn nhn m ngi ta c th
thy s gia tng hoc gim nng estrogen.
Mc tng ca estrogen c nhn thy trong:

Chu k kinh nguyt bnh thng
Tui dy th sm
Gynecomastia (v pht trin bt thng n ng)
Khi u bung trng, tinh hon, hoc tuyn thng thn
Cng gip
X gan
Mc gim ca estrogen c nhn thy trong:

Hi chng Turner
Suy tuyn yn
Thiu nng sinh dc
Khng mang thai (estriol)

Ri lon n ung chn n tm thn
Sau khi mn kinh (estradiol)
PCOS (hi chng bung trng a nang, hi chng Stein-Levanthal)
Tp th dc bn b cc k
Kt qu xt nghim trong mu v nc tiu khng c thay th cho nhau. Bc s s chn

loi estrogen trong mu hoc nc kim tra da trn nhng g bc s ang tm kim.
Ngoi s thay i hng ngy v chu k, cc bnh nh cao huyt p, thiu mu, v suy gan
v chc nng thn c th nh hng n mc estrogen trong c th.
Mt s loi thuc, chng hn nh glucocorticosteroid, ampicillin, cc loi thuc c cha
estrogen, phenothiazin, v tetracycline c th lm tng mc estrogen trong mu. Glucose
trong nc tiu v nhim trng ng tiu c th lm tng nng trong nc tiu. Cc
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loi thuc c th lm gim nng bao gm thuc kch thch rng trng v thuc nga
thai ung.
35. Xt nghim Progesterone
Xt nghim o lng mc progesterone trong mu. Progesterone l mt hormone

steroid c vai tr chnh l gip c th ca mt ngi ph n chun b mang thai, tc
dng ca Progesterone thng kt hp vi mt s kch thch t n khc.
Trn nn tng hng thng, hormone estrogen c tc dng lm pht trin nim mc ca t
cung, ni mc t cung v t hon chnh, trong khi s t bin nng luteinizing hormone
(LH) dn n vic phng thch mt qu trng t mt trong hai bung trng. U th vng
c hnh thnh trong bung trng ti cc ni m trng c pht trin v bt u sn
xut progesterone. Progesterone cng c b sung vi mt lng nh c sn xut bi
tuyn thng thn, s tng trng ni mc t cung dng li v t cung sn sng cho vic
cy ghp c th c ca mt qu trng th tinh.
Nu s th tinh khng xy ra, cc th vng thoi ha, mc progesterone gim, v chy
mu kinh nguyt bt u. Nu trng th tinh c cy vo t cung, th vng tip tc sn
xut progesterone. Sau vi tun, nhau thai thay th th vng sn xut progesterone v l
ngun chnh. Progesterone c sn xut ra mt lng tng i ln trong sut phn cn
li ca mt thai k bnh thng.
Xt nghim s dng nh th no?
Mc progesterone khc nhau trong sut chu k kinh nguyt, o mt lot nhiu ln c
th c s dng gip nhn ra v qun l mt s nguyn nhn v sinh. Progesterone c
th c o xc nh c hay khng rng trng mt ngi ph n, xc nh khi rng
trng xy ra, v theo di s thnh cng ca s rng trng.
Trong giai on u ca thai k, o lng mc progesterone c th c s dng, cng
vi th nghim chorionic gonadotropin ngi (hCG), gip chn on c hoc khng c
thai ngoi t cung. Nng progesterone cng c th c thc hin theo di mt
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thai k c nguy c cao, gip nh gi sc khe nhau thai v thai nhi.Mc gim c
nhn thy trong thai ngoi t cung v sy thai.
Nu mt ph n c tim progesterone u k mang thai ca mnh h tr, mc
progesterone ca thai ph c th c theo di mt cch thng xuyn gip xc nh
hiu qu ca iu tr.
Xt nghim progesterone c th c ch nh, cng vi cc xt nghim khc nh FSH,
LH, hCG, xt nghim tuyn gip, xt nghim ng mu, v cng thc mu ton b(CBC),
gip xc nh nguyn nhn gy ra chy mu t cung bt thng ph n khng mang
thai.
Khi no c ch nh?
Nng progesterone c o:
L mt phn ca mt nh gi v sinh khi mt ph n gp kh khn mang thai v
bc s mun xc minh rng c ang rng trng bnh thng. Xt nghim ny c th c

o mt vi ln trong chu k kinh nguyt ca ngi ph n nh gi s thay i v nng
progesterone.
xc nh khi no rng trng, xy ra v sau iu tr bng thuc gy rng trng
Khi cc triu chng nh au bng tng cn, gi thai ngoi t cung hoc da sy thai
theo di hiu qu iu tr khi ngi ph n yu cu tim progesterone gip duy
tr mang thai.
nh k trong sut mt thi k mang thai nu c nguy c cao, theo di sc khe nhau
thai v thai nhi

Khi mt ngi ph n khng mang thai c xut huyt t cung bt thng.
Bnh thng:
Nam: 0,2 1,4 ng/mL
N :
Giai on nang trng: 0,2 1,5 ng/mL

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Giai on rng trng: 0,8 3,0 ng/mL

Giai on th vng : 1,7 27 ng/mL
Gii thch kt qu xt nghim progesterone ph thuc vo l do th nghim v i hi

hiu bit v mt ngi ph n trong chu k kinh nguyt hoc c mang thai. Nng
progesterone thng bt u tng cao khi mt qu trng c phng thch t bung trng,
s gia tng ko di trong vi ngy, v sau hoc l tip tc tng giai on u ca thai
k hay gim bt u chu k kinh nguyt.
Trn mt nn tng hng thng, nu mc progesterone khng tng v gim, mt ph n
c th khng rng trng hoc c chu k kinh nguyt. Nu nng khng tng bnh thng
trong giai on u ca qu trnh mang thai, thai k c th l ngoi t cung v / hoc c
th khng mang thai. Nu cc php o ni tip khng hin th mc progesterone tng
theo thi gian, c th c vn v kh nng tn ti ca nhau thai v thai nhi.
Hm lng progesterone tng ln cng c nhn thy thnh thong vi:
Mt s u nang bung trng
Mang thai khng kh thi c gi l mang thai trng.
Mt dng him ca ung th bung trng
Sn xut qu mc progesterone bi cc tuyn thng thn
Tng sn thng thn bm sinh (CAH)
Mc progesterone thp c th c kt hp vi:

Nhim c thai nghn vo cui thai k
Gim chc nng ca bung trng
Thiu kinh nguyt (v kinh)
Mc progesterone t nhin, trong thi gian mang thai tng cao hn so vi nhng ngi
trong ch c mt thai nhi, c th c lin quan n a thai (anh em sinh i, sinh ba, vv).
Ung b sung estrogen v progesterone c th nh hng n kt qu.
36. Xt nghim Prolactin
Prolactin l mt hormone c sn xut bi thy trc ca tuyn yn, mt c quan c kch

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thc nh c tm thy sn no tht ba, trong h yn ca thn xng bm.Bi tit

prolactin c iu ha v c ch bi cc cht dopamine trong no. Bnh thng nng
Prolactin trong mu thp nam gii v ph n khng mang thai, vai tr chnh ca prolactin
l kch thnh bi tit sa (sn xut sa m).
Mc prolactin thng cao trong sut thai k v sau khi sinh con. Trong thi gian mang
thai, cc hormone prolactin, estrogen, v progesterone kch thch pht trin sa m. Sau
khi sinh con, prolactin gip kch thch v duy tr ngun cung cp sa m. Nu mt ngi
ph n khng cho con b, mc prolactin s sm gim tr li mc trc khi mang thai.
Nu cho con b, tr s sinh b ng mt vai tr quan trng trong vic phng thch prolactin.
C mt c ch phn hi gia cc em b thng xuyn b m v s lng prolactin tit ra
bi tuyn yn cng nh s lng sa sn xut.
Mt nguyn nhn ph bin ca mc prolactin cao l mt prolactinoma, mt khi u sn

xut prolactin ca tuyn yn. Prolactinomas l loi khi u ph bin nht ca tuyn yn v
thng l lnh tnh. Khi u thng pht trin ph n nhng cng c tm thy nam
gii.Cc triu chng c th gy ra l do nhng tc ng qu mc ngoi mun ca
prolactin, chng hn nh sn xut sa ngi ph n khng mang thai (v him khi, ngi
n ng) v t kch thc v v tr ca khi u.
Nu thy trc tuyn yn v / hoc khi u ln ng k, n c th chn p ln cc dy thn

kinh th gic, gy au u v ri lon th gic, v n c th gy cc triu chng ca cc
hormon khc do tuyn yn sn xut ra. ph n, prolactinomas c th gy v sinh v chu
k kinh nguyt bt thng, nam gii, nhng khi u ny c th gy ra mt dn chc nng
tnh dc v ham mun tnh dc. Nu khng c cha tr, prolactinomas cui cng c th
gy hi cho cc m xung quanh.
Mc prolactin c s dng, cng vi cc xt nghim hormone khc, gip:

Xc nh nguyn nhn gy ra galactorrhea (tit sa)
Xc nh nguyn nhn gy ra au u v ri lon th gic

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Chn on v sinh v ri lon chc nng cng dng nam gii

Chn on v sinh ph n
Chn on prolactinomas
nh gi chc nng thy trc tuyn yn (cng vi cc hoc mn khc)
Theo di iu tr ca prolactinomas v pht hin ti pht
Khi no c ch nh?
Mc prolactin c th c ch nh khi mt ngi c triu chng ca mt prolactinoma,

chng hn nh au u khng r nguyn nhn, suy gim th lc, v / hoc galactorrhea.
Th nghim c th c ch nh cng vi cc xt nghim khc, khi mt ngi ph n
ang b v sinh hoc chu k kinh nguyt khng u hoc khi mt ngi n ng c cc
triu chng nh gim ham mun tnh dc, galactorrhea, hoc v sinh. Mc prolactin cng
thng c xt nhim nam gii nu mc testosterone thp.
Khi mt ngi c mt prolactinoma, mc prolactin c th c ch nh theo nh k
theo di s tin trin ca khi u v p ng ca khi u vi iu tr. Prolactin cng c th
thng c s dng trong mt khong thi gian gim st cho ti pht prolactinoma.
Xt nghim prolactin c th c ch nh cng vi xt nghim hormone khc nh
hormone tng trng, khi bc s nghi ng rng mt ngi c suy tuyn yn ton b. nng
prolactin i khi c th c theo di khi mt ngi c mt nguyn nhn hoc l dng
thuc c th nh hng n sn xut dopamine.
Bnh thng:
Nam: 4,04 15,2 ng/mL
N : 4,79 23,5 ng/mL
n ng v ph n khng mang thai thng ch c lng nh prolactin trong mu. Tuy

nhin mc Prolactin cn phi c nh gi da trn thi gian trong ngy m chng
c thu thp. Cc mc s khc nhau trong khong thi gian 24-gi, tng trong khi ng
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v t nh im vo bui sng. L tng nht, mu mu thng c rt ra xt nghim

ngay sau khi thc dy, tt nht l sau khi c ngh ngi yn lng trong 30 pht, mc
d vy bc s c th c l do ring ca mnh ch nh lm xt nghim thi im khc.
Mc cao ca prolactin (prolactin) l bnh thng trong thi gian mang thai v sau khi
sinh con, khi ngi m cho con b. Mc cao cng gp:
Chn n tm thn
Thuc: Estrogen, thuc chng trm cm, thuc phin, cht kch thch, thuc cao huyt
p (reserpin, verapamil, methyldopa) v mt s loi thuc c s dng iu tr tro

ngc d dy thc qun (cimetidine)
Bnh vng h i
Suy gip
Bnh thn
Kch thch nm v (tng trung bnh)
Cc khi u tuyn yn v cc bnh khc
Hi chng a nang bung trng
Prolactinomas
Mc prolactin di mc bnh thng thng khng cn iu tr, nhng c th l du

hiu ca suy tuyn yn ton b. Mc thp cng c th c gy ra bi cc loi thuc
nh dopamine, levodopa, v cc dn xut ergot alkaloid.
p lc t bnh tt, chn thng, v thm ch c ni s hi ca vic c thc hin xt nghim

mu c th gy ra tng prolactin va phi.
Prolactinomas thng l nh. Cng vi xt nghim o mc prolactin, bc s c th lm
thm MRI (cng hng t hnh nh) ca b no xc nh v tr v xc nh kch thc
ca khi u cng nh kch thc ca tuyn yn.
37. Xt nghim hCG
Human chorionic gonadotropin (hCG) l mt hormone c sn xut trong nhau thai ca

ngi ph n mang thai. Xt nghim th thai l mt xt nghim c hiu v c th pht
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hin hCG trong mu hoc nc tiu xc nhn mang thai. Hormone ny c th c pht
hin khong 10 ngy sau khi mt kinh nguyt, khi trng th tinh c cy vo t cung
ca ngi ph n.HCG c th c pht hin rt sm c th ch mt tun sau khi th thai.
Trong nhng tun u ca thai k, chc nng ca hong th rt quan trng trong vic duy
tr sn xut hCG. Sn xut hCG tng u n trong tam c nguyt u tin (8-10 tun) ca
mt thai k bnh thng, t nh khong tun th 10 sau chu k kinh nguyt cui cng.
Mc sau gim t t trong thi gian cn li ca thai k, hCG khng cn pht hin
trong vng vi tun sau khi sinh.
HCG cng c sn xut bi mt s cc khi u t bo mm v mc tng c nhn thy
trong bnh trophoblastic thai.
Xt nghim hCG nh tnh pht hin s hin din ca hCG v thng c s dng xc
nhn c thai.
Xt nghim hCG nh lng, thng c gi l beta hCG, o lng hCG trong mu. N
c th c ch nh gip chn on thai ngoi t cung, gip chn on v theo di
mang thai c th b tht bi, v / hoc gim st mt ngi ph n sau khi sy thai.
Mt xt nghim nh lng hCG cng c th c ch nh gip chn on bnh
trophoblastic thai hoc khi u t bo mm tinh hon hoc bung trng. N c th c ch
nh u n theo di hiu qu iu tr cho nhng bnh l ny v pht hin khi u ti
pht.
Th nghim hCG nh lng trong nc tiu hoc mu c ch nh sm nht l 10 ngy

sau khi mt kinh nguyt, khi mt ph n mong mun xc nhn c hay khng c thai (mt
s phng php c th pht hin hCG sm hn, mt tun sau khi th thai).
Xt nghim nh lng hCG mu c th c ch nh xt nghim li trong vng vi ngy
loi tr thai ngoi t cung hoc gim st mt ngi ph n sau khi sy thai.
Xt nghim nh lng hCG cng c th ch nh khi mt bc s nghi ng rng mt ngi
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c th c bnh trophoblastic thai hoc mt khi u t bo mm. N c th c ch nh

nh k theo di hiu qu iu tr v pht hin khi u ti pht.
HCG nh tnh/ nc tiu = m tnh
HCG nh lng / mu = < 6 mU/mL
Ph n khng mang thai, nng hCG thng khng th pht hin c. Trong giai on
u ca thai k, nng hCG trong mu tng gp i mi 2-3 ngy. Thai ngoi t cung,
thng c mt thi gian nhn i hCG di hn. Nhng ngi c thai yu cng c mt thi
gian nhn i hCG di hn hoc thm ch c th nng hCG gim. nng hCG s gim
xung nhanh chng sau khi sy thai. Nu hCG khng gim xung mc khng th pht hin
c, c th ch cho bit m sn xut hCG cn st, cn phi c loi b.
Trong qu trnh iu tr bnh trophoblastic thai k hoc mt khi u t bo mm, mt mc
hCG gim thng ch ra rng c p ng iu tr, trong khi mc gia tng c th ch
ra rng n khng p ng vi iu tr. Khi mc hCG tng ln sau khi iu tr c th cho
thy bnh ti pht.
Xt nghim hCG thc hin qu sm trong thai k, trc khi c mt mc hCG tng ng
k, c th cho kt qu m tnh gi, ngc li mu hoc protein trong nc tiu c th gy
ra kt qu dng tnh gi. Xt nghim hCG nc tiu c th cho mt kt qu m tnh gi
khi nc tiu rt long. Ph n khng nn ung mt lng ln cc cht lng trc khi ly
mu nc tiu xt nghim th thai.
Mt s loi thuc nh thuc li tiu v promethazine (thuc khng histamin) cng c th

gy ra kt qu nc tiu m tnh gi. Cc loi thuc khc nh chng co git, thuc chng
parkinson, ng v thuc an thn c th gy ra kt qu dng tnh gi.
C nhng bo co kt qu hCG huyt thanh dng tnh gi do mt s hp cht khc nhau

(khng phi thuc) c th gy tr ngi vi cc th nghim. Chng bao gm mt s loi
khng th c th xut hin trong mt s c nhn v cc mnh v ca phn t hCG. Ni
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chung, nu kt qu c vn , kt qu xt nghim c th c khng nh bng cch th

nghim li vi mt phng php khc.

Xet Nghiem Sinh Hoa Mau

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CNG TY TNHH SAO VIT NAM | Red Star Vietnam Co., Ltd.

17 Phm Hng, Cu Giy, H Ni, Vit Nam

2. Xt nghim Creatinin 22. Xt nghim St huyt thanh

3. Xt nghim ALT & AST 23. Xt nghim TIBC, UIBC, Transferrin

4. Xt nghim GGT 24. Xt nghim Calcitonin

5. Xt nghim Bilirubin 25. Xt nghim Thyroglobulin

6. Xt nghim Albumin 26. Xt nghim Thyroid Antibodies

7. Xt nghim Protein ton phn 27. Xt nghim Aldosterone v Renin

8. Xt nghim RF 28. Xt nghim Cortisol

9. Xt nghim Anti CCP 29. Xt nghim Catecholamines

10. Xt nghim khng th khng nhn 30. Xt nghim Thyrotropin

11. Khng th khng DNA 31. Xt nghim T3, T4

12. Xt nghim Acid Uric 32. Xt nghim LH

13. Xt nghim Amylase 33. Xt nghim Testosterone

14. Xt nghim Lipase 34. Xt nghim Estrogens

15. Xt nghim Phosphatase kim 35. Xt nghim Progesterone

16. Xt nghim CK/ CPK 36. Xt nghim Prolactin

17. Xt nghim CK-MB 37. Xt nghim hCG

18. Xt nghim Myoglobin

19. Xt nghim Troponins

20. Xt nghim CRP

Urea, cn c gi l carbamide, l mt hp cht c sn xut bi qu trnh trnh chuyn

Mc ur v creatinin c s dng nh gi chc nng thn v theo di bnh nhn suy

Theo di iu tr bnh thn

Nng Ure nc tiu: 250 500 mmol/24h.

Xt nghim ny o lng creatinine trong mu hoc nc tiu ca bn. Creatinine l mt

Xt nghim mu creatinine c s dng cng vi xt nghim Urea, cn c gi BUN

Mt s kt hp ca nng creatinine mu v nc tiu c th c s dng tnh ton

Nc tiu: 8 - 12 mmol/24h (8000 - 12000 mmol/l).

Xt nghim creatinin tin cy hn xt nghim Ure v n t chu nh hng bi ch n, n

Tng creatinin (v Ure) ni ln s thiu nng thn, gim lc ca cu thn v gim bi

thanh lc Creatin theo cng thc Cockroft v Gault

Bnh thng: thanh lc ca creatinin = 70 - 120 ml/pht

Bnh l: thanh lc creatinin gim

nng thn, n phn nh tn thng cu thn.

Vim b thn - thn mn; vim b thn - thn ti pht.

Nhim Ure huyt (Ccre gim mnh).

Thiu nng tim.

Cao huyt p c tnh.

Dng mu qua thn gim, gim p lc lc cu thn.

3. Xt nghim ALT & AST

ALT v AST l hai loi enzyme c tm thy ch yu cc t bo ca gan v thn, mt

Mt s nguyn nhn gy ra tn hi cho cc t bo gan, dn n s gia tng nng ALT

Nhng ngi nghin ru nng

C nhn c gia nh c tin s bnh gan

Ngi dng thuc m thuc c th lm ri lon chc nng gan

Ngi tha cn, hoc c bnh tiu ng

Theo di iu tr ngi b bnh gan.

GGT (Gamma-glutamyl Transpeptidase) l mt loi enzyme c tm thy nhiu c

GGT tng hu ht cc bnh gy ra tn thng gan cp tnh hoc ng dn mt, nhng n

Khi ung mt lng ru nh cng c th lm tng GGT. Tng cao hn c tm thy

GGT c th c s dng bit tnh trng lm dng ru mn tnh ca mt ngi (GGT

Xt nghim GGT c th c ch nh khi mt ai c mt mc ALP cao. Th nghim

GGT c th c ch nh khi nhng ngi c tin s lm dng ru hon tt iu tr

Mc GGT cao c th cho thy mt nguyn nhn no gy tn hi gan nhng khng

Bilirubin l mt sc t mu vng cam, mt sn phm cht thi c sn xut ch yu bi

Bilirubin khng kt hp cao c th l c qu nhiu Bilirubin ang c sn xut, thng

Tnh trng hp ng mt bm sinh him gp (khong 1 trong 10.000 ca sinh), nhng e

C bng chng ca bnh vng da

Bilirubin ton phn tng ch yu l bilirubin gin tip c th l mt kt qu ca:

Hi chng Gilbert, do thiu cc enzyme gn cc phn t Glucuronic vi bilirubin

Xt nghim o lng nng ca Albumin trong mu. Albumin l mt protein c nhiu

S khc bit gia Albumin, Prealbumin, v microalbumin l g?

Albumin v microalbumin l nhng phn t tng t, trong khi prealbumin, mc d tn