Slide 1

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Slide 2

ĐL glucose máu - PP enzyme đo quang

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Slide 3

NGUYÊN LÝ
Glucose oxydase
Glucose + O2 → Gluconic acid + H2O2

POD
2H2O2 + 4 amino antipyrin + phenol → Phức hợp màu + 4 H20

* POD: Peroxydase
• Đậm độ phức hợp màu tạo thành tỷ lệ thuận với nồng độ glucose ban đầu. Đo
mật độ quang học ở bước sóng 546 nm, so với mẫu chuẩn.

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Slide 4

Ý NGHĨA LÂM SÀNG

• Glucosemáu: 3,9 – 6,4mmol/L lúc đói

• Điều hoà bởi hệ thống thần kinh , nội tiết.

• Glucose máu tăng (> 6,4mmol/L) : đái đường do tuỵ,

cường tuyến thượng thận, u tuyến yên, nhiễm độc tuyến
giáp, sốc chấn thương.

• Glucose máu giảm (< 3,9mmol/L): đói kéo dài, u thân

tuỵ, thiểu năng các tuyến nội tiết: vỏ thượng thận, tuyến
giáp, tuyến yên, tổn thương vùng dưới đồi; bệnh về gan (
xơ gan nặng,…); nhiễm độc các chất như asen, …

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Slide 5

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Slide 6

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Slide 7

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Slide 8

ĐỊNH LƯỢNG CHOLESTROL TP MÁU

Nguyên tắc
Cholesterol esterase
Cholesterol este hoá + H20 ↔ Cholesterol + RCOOH

Cholesterol oxydase
Cholesterol + O2 ↔ Cholesterol-3on + H2O2

POD
2H2O2 + 4 amino antipyrin + phenol → Phức hợp màu + 4 H20

POD: Peroxydase

Đậm độ phức hợp màu tạo thành tỷ lệ thuận với nồng độ Cholesterol ban đầu.
Đo mật độ quang học ở bước sóng 546 nm, so với mẫu chuẩn.

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Slide 9

Ý nghĩa lâm sàng:

• Hàm lượng Cholesterol máu được duy trì < 5,2mmol/L.

* Cholesterol tăng trong các bệnh:

• Cao thứ phát : đái đường

- thiểu năng tuyến giáp,

- viêm tuỵ cấp, viêm tuỵ mạn,

- hội chứng thận hư.

• Cao nguyên phát: bệnh bẩm sinh tăng lipoprotein.

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Slide 10

Cholesterol máu giảm:

+ Cường giáp

+ Hội chứng Cushing

+ Nhiễm trùng cấp

+ Thiếu máu

+ Bệnh bẩm sinh về chuyển hoá: thiếo vitamin A, hpặc B-lipoprptein.

+ Cholesterol<2mmol/L gặp trong suy giảm chức năng tế bào gan.

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Slide 11

ĐỊNH LƯỢNG TRIGLYCERID MÁU

Nguyên tắc

LPL
Triglycerid + H20 ↔ Glycerol + RCOOH

GK
Glycerol + ATP ↔ Glycero-3-phosphat + ADP

GPO
Glycero-3-phosphat + 02 ↔ dihydroxyaceton-phosphat + H2O2

POD
2H2O2 + 4 amino antipyrin + phenol → Phức hợp màu + 4 H20

Đậm độ phức hợp màu tạo thành tỷ lệ thuận với nồng độ Cholesterol
ban đầu. Đo mật độ quang học ở bước sóng 546 nm, so với mẫu chuẩn.

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Slide 12

Ý nghĩa lâm sàng:

Chỉ định xn triglyceride ht :
• Chẩn đoán sớm nguy cơ XVĐM và PL các dạng có lipid máu cao.
• TD hiệu quả chế độ ăn và thuốc làm giảm lipid máu

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Slide 13

Nồng độ Triglycerid máu tăng:

Nồng độ Triglycerid máu giảm:
• Tăng huyết áp -Không có β-lipoprotein huyết bẩm
• Đái tháo đường sinh
-Cường giáp.
• Viêm tuỵ cấp
-Suy dinh dưỡng.
• Xơ gan do rượu
-Do chế độ ăn: Tỷ lệ mỡ thấp.
• Tăng lipoprotein máu gia đình. -Hội chứng giảm hấp thu.
• Bệnh thận. -Nhồi máu não

• Hội chứng thận hư -Bệnh phổi tắc nghẽ mạn tính.

• Suy giáp

• Nhồi máu cơ tim

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Slide 14

CÁC T NGHI M ENZYM

AST và ALT
 Nguyên tắc đo AST:
Aspartate + α-CetoGlutarate   Oxaloacetate + Glutamate
AST

Oxaloacetate + NADH + H+ 

MDH
 Malate + NAD+

 Nguyên tắc đo ALT:

Alanin + α-CetoGlutarate   Pyruvate + Glutamate
ALT

Pyruvate + NADH + H+ 

 Lactate + NAD+
LDH

Đo độ giảm mật độ quang của NADH ở 340 nm

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Slide 15

 Ý nghĩa lâm sàng:

Nam: 10-50 U/L; Nữ: 10-35 U/L

• - Tổn thương tế b o gan do:

• + Viêm gan virus cấp
• + Viêm gan cấp
• + Nhiễm độc rượu cấp
• + Ngộ độc thuốc: ngộ độc paracetamol…
• + Ngộ độc hóa chất hác: halothan, CCl4…

• - Tổn thương bệnh ly hác tại gan:

• + Tắc mật

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Slide 16

ĐỊNH LƯỢNG URE MÁU

• Giúp chẩn đoán tình trạng suy thận nhất
là khi phân tích kết hợp với tỉ lệ nồng độ
urê niệu/ nồng độ urê máu.

• Để đánh giá mức cung cấp protein của

một chế độ ăn.

• XN nồng độ urê niệu: để đánh giá khẩu

phần protein cung cấp qua chế độ ăn.

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Slide 17

• TĂNG URÊ MÁU 4. Suy thận:

1. Chế độ ăn gi u protein.
2. Tăng dị hóa protein
- Sốt.
- Bỏng.
- Nhịn đói.
- Bệnh lý u tân sinh.
3. Xuất huyết đường tiêu hóa.
- Nguồn gốc tại thận:
· Tổn thương cầu thận
· Tổn thương ống thận.
- Nguồn gốc sau thận:
· Sỏi.
· Xơ hóa sau phúc mạc.
· U b ng quang hay tử cung.
· U biểu mô tuyến (adenoma), TLT
5. Các nguyên nhân khác:
- Ngộ độc thủy ngân.
- Nhiễm trùng nặng.

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Slide 18

GIẢM URE MÁU

1.Đang tuổi phát triển.

2. Có thai.

3. Hòa loãng máu:

4. Hội chứng tiết ADH hông thích hợp.

5. Suy gan:

7. Chế độ ăn hông cung cấp đủ protein.

8. Hội chứng giảm hấp thu.

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Slide 19

ĐỊNH LƯỢNG CREATININ MÁU

NGUYÊN LÝ
Creatinin l sản phẩm của QT thoái hóa creatin phosphate và
creatin ở cơ.
Creatinin được đ o thải chủ yếu qua thận.
Creatinin máu được ĐL theo phương pháp Jaffe (đo điểm đầu v
cuối).
Alkaline pH
Creatinin + acid pycric ------------------> phức hợp v ng cam

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Slide 20

NHẬN ĐỊNH KẾT QUẢ

Bình thường: Nam: 62- 106 μmol/L
Nữ: 44 – 88 μmol/L Trẻ em: 15 – 77 μmol/L
Tăng trong:
- Suy thận v các bệnh về thận
- Ngộ độc thủy ngân
- Lupus ban đỏ
- Bệnh bạch cầu
- Bệnh tim mạch: tăng huyết áp vô căn, nhồi máu cơ tim …
Giảm trong: có thai, sản giật …

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Slide 21

ĐỊNH LƯỢNG ACID URIC

NGUYÊN LÝ
Acid Uric l sản phẩm chuyển hóa cuối cùng của base có nitơ nhân
purin.
Acid Uric máu được định lượng theo phương pháp enzyme so m u.
Uricase
Uric Acid + 2H2O + O2 -----------------> Allatoin + CO2 + H2O2
Peroxidase

2 H2O2 + H+ + TOOSa + 4-aminophenazone --------------------> hợp chất

m u đỏ + 4H2O
Sản phẩm m u được đo ở bước sóng 546nm.

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Slide 22

Bình thường: + Nam: 202 – 416 mmol/l, Nữ: 143 – 399 mmol/l

Acid uric máu tăng trong:

+ Bệnh Goutte

+ Suy thận

+ Nhiễm độc chì, thuỷ ngân

Acid uric máu giảm trong:

+ Bệnh Willson

+ Cơn liệt chu ỳ

+ Xanthin niệu

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Slide 23

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Slide 24

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Slide 25

2.2. CÁC T NGHI M HU T THANH

a. Bilirubin: Phương pháp định lượng

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Slide 26

2.2. CÁC T NGHI M HU T THANH

a. Bilirubin:
hoảng tham chi u:

- Ngư i l n:
+ Bil-TP < 17.0 µmol/L
+ Bil-TT < 4.3 µmol/L
+ Bil-GT < 14.0 µmol/L
- Trẻ em: ng da sinh lý.

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