cơ sở lý thuyết chung về máy xét nghiệm sinh hóa

8/11/2019 C S L Thuyt Chung V My Xt Nghim Sinh Ha

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]ay TA 1log= w\'nh 5%"t Mo%g%Rr,[ambRrtx

aCLA= w\'nh 5%"t Mo%g%Rr,

[ambRrt, MRRrx

1.;. $% &' quang i/n c


24/106

bin Fi .%ang thnh in gi 5 hin t!ng .%ang

in# :H v"y -hng -h- -hn t8ch thnh -hn

;%ng ;'ch ;2a tr&n nhng 5inh kin ny c?n gi 5 -h,

ng -h- o m% .%ang in#

1.+.1. Ri (ng -ang AinUm WYYe/ nh bc hc ]R(Rr 5m th8 nghim v6i

tCm k}m t8ch in m/ v ng -ht hin ra rng

chi% tia hQ .%ang thH tCm k}m =} b' b6t m i# Khi

thay bng tCm k}m t8ch in ;ng thH in t8ch

tr&n tCm k}m khng Fi# Uhng khi ch3n chEm tia hQ

.%ang bng mt tCm k8nh trong =%Ot c tc ;Ing hC-

thI cc tia t> ngo0i thH tCm k}m khng b' mCt in

t8ch m# $c th8 nghim v6i cc kim 5o0i khc cho kt

.% tng t2 ;Jn t6i kt 5%"n Khi chi% mt chEm

=ng th8ch h!- vo mt kim 5o0i thH 5m cho cc

R5Rctron + mt kim 5o0i b' b"t ra# \ ch8nh 5 hi$n t\

n! qan! i$n#

\A kho =t chi tit hin t!ng .%ang in/ ng1i

ta 5m th8 nghim nh =a%Dt bng zn c chn khng cao w - =%Ct

khong WS,mm]gx trong bng t hai bn c2c kim

5o0i bn c2c ;ng anOt wx v bn c2c m catOt wKx#

Mn c2c m 5m bng kim 5o0i cn nghi&m c7% hi%

7ng .%ang in# Ug%Qn in v in k !c m3c

_


25/106

nh hHnh v}# Min tr+ P A i4% chnh in -

ng%Qn t vo hai bn c2c / K#

Cnh 1.1*. Th n!hi$m hi$n tn! qan! i$n

$ho nh =ng t> ngo0i chi% vo bn c2c K/ chEm

=ng ny cC- nng 5!ng gi- cho cc R5Rctron b7t kh@i

b4 mt kim 5o0i# 6i tc ng c9a in tr1ng t

gia v K/ cc R5Rtron ny ch%yAn ng v4 -h8a

v ti- tIc i trong m0ch in t0o thnh mt ;?ng

in khng Fi/ c1ng ny !c o bng in k

G# \in - t vo K o bng vn k :#

da% khi 5m th8 nghim v6i cc tr1ng h!- khc

nha%/ ng1i ta thCy rng

, Khi chi% vo catOt mt chEm =ng n =3c thH

trong m0ch (%Ct hin ;?ng in/ y gi 5 ;?ng

.%ang in c chi4% t* anOt =ang catOt#

_


26/106

, Eng cc b6c =ng khc nha% chi% vo ng1i ta

thCy hin t!ng .%ang in ch =y ra khi cc b6c

=ng ny nh@ hn mt gi tr'S

no wgi 5 gi6i

h0n .%ang inx#

, Thay Fi hi% in th t vo K/ khi

tng thH ;?ng .%ang in cng tng/ nhng n

mt m7c no thH 0t gi tr' bo ho bh# Khi ;E

c tng thH cng khng tng#

1.+.2. Cc AMnh lt -ang Ain

T* cc kt .% th8 nghim + tr&n v4 hin t!ng

.%ang in/ cc nh bc hc nh dto5Rtov/ [Rnar;###

ti- tIc nghi&n c7% v -ht triAn v rt ra 'nh

5%"t gi 5 cc 'nh 5%"t .%ang in#

]Znh lt qan! i$n th nh:t ^ Znh lt v!i_i h2n qan! i$n`

G]'i v_i m@i 6im lo2i ;Nn! lm cat't c m3t b_c

sn! !i_i h2n WVc Znh !"i l !i_i h2n qan! i$n

ca 6im lo2i # hi$n tn! qan! i$n ch s=y ra 6hi

b_c sn! ca nh sn! 6ch thch nhI hoAc bn! !i_ih2n qan! i$n ^W`

:8 ;I gi6i h0n .%ang in c9a mt =O kim 5o0i

M0c _Snm/ Qng SSnm/ k}m Snm/ nhm Snm/

can(i Snm/ ka5i Snm/ (&i Snm# :H v"y/ trong

_


27/106

()t nghim cn -hi chn 5o0i c % th% .%ang c

gi6i h0n .%ang in 9 56n#

]Znh lt qan! i$n th hai ^ Znh lt v

;n! qan! i$n`

G]'i v_i m3t nh sn! thch h/# c(n! 3 ;n!

qan! i$n bdo ho te l$ thn v_i c(n! 3 ca chNm

sn! 6ch thchJ

\i4% ny !c nh=tanh gii th8ch 5 ;o =O

R5Rctron .%ang in b' b"t ra kh@i mt catt trong

mt n v' th1i gian t{ 5 v6i =O -htn n "-

vo mt catt trong th1i gian # Dt khc =O

-htn ny 50i t{ 5 v6i c1ng chEm =ng chi% t6i#

\y 5 mt t8nh chCt ht =7c .%an trng/ m nh1

A c thA ch t0o !c my o m% .%ang in#Tr&n y 5 hai 'nh 5%"t .%ang in c B

ngha 7ng ;Ing trong my =inh ho/ c?n 'nh 5%"t

th7 ta khng ()t t6i trong ti 5i% ny#

1.+.!. ":t s; linh &in -ang Ain

1.4.*.1. T7 bo qan! i$n

T7 bo qan! i$n Pflfnim ^gD\an! tr`

\y 5 5o0i t bo .%ang in n gin nhCt/

t bo .%ang in ny - 7ng tOt trong vEng

.%ang -hF nhHn thCy !c v khng cn ng%Qn

n%i# $c t bo .%ang in ny ho0t ng ;2a

_


28/106

thRo hi% 7ng .%ang in trong/ bng cch ch%yAn

Fi cc -htn nh =ng thnh cc in t> trong t

bo/ khi =} (%Ct hin mt in th .%a bn c2c

b+i =2 thay Fi cC% trc in t> trong 56- =R5ini%m#

\% ra c9a t bo t 5 v6i c1ng nh =ng#

T7 bo qan! i$n Pilic

T bo .%ang in ny cng t0o ra in - khi

-htn nh =ng "- vo b4 mt bn ;Jn# Uhng

nh0y c9a 5o0i t bo ny + trong vEng : k)m hn

trong vEng nhHn thCy c9a .%ang -hF#

Min qan! i$n

% iAm c9a -in .%ang in 5 gi thnh thC-

vo c nh0y cao trong vEng c2c t8m w:,5tra

:io5Rtx v nh =ng nhHn thCy !c# $C% trc c9a -in

_e

nh=ng

dR5Rni%m

\ =3t

Cnh 1.14. O: trXc ca t7 bo qan!i$n Pflfnim


29/106

.%ang in gQm mt bng th%{ tinh b&n trong trng

mt 56- v"t 5i% nh0y .%ang wRi hoc Ka5i q(itx#

Trong bng thFi y kh8 v mt anOt !c ;%y trH +

in - cao# `in .%ang in ho0t ng ;2a tr&n

hi% 7ng .%ang in ngoi# Khi -htn nh =ng

"- vo catOt .%ang =} gii -hng cc in t> v

cc in t> ny ch%yAn ng v4 -h8a anOt/ nh v"y

t8n hi% nh =ng !c ch%yAn Fi thnh t8n

hi% in#

]i% =%Ct ch%yAn Fi nh =ng thnh t8n hi%

in c9a -in .%ang in cao hn =o v6i cc t bo

.%ang in# $c -in .%ang in cho -h)- ho0t

ng v6i cc m7c nng 5!ng nh =ng thC- hn vH

th cc b 5c thng ;i thC- hn#

_Y

nh =ng

anOt

$atOt

Cnh 1.15. O: trXc ca /in qan! i$n


30/106

'n! nh0n qan! i$n

Ong nhn .%ang in ch8nh 5 =2 kt h!- c9a

mt -in .%ang in v mt b kh%ch 0i c h =O

kh%ch 0i cao# \ nh0y c thA i4% chnh !c

bng cch i4% chnh in - a vo Ong nhn

.%ang#Ong nhn .%ang in gQm mt catOt .%ang v

mt =O cc bn c2c int# Di 5n mt in t> "-

vo mt bn c2c int thH 50i c vi in t> -ht

ra# Kt .% ny =} !c nhn 5&n gC- nhi4% 5n =o v6i

t8n hi% gOc# :H v"y/ Ong nhn .%ang in ny c

nh0y rCt cao v vH th n !c => ;Ing nhi4%

trong cc my .%ang -hF k#

_Z

Cnh 1.19. O: trXc ca 'n! nh0n qan! i$n

nh =ng

% ra


31/106

1.4.*.%. Mhotoi't

`hotoiOt 5 mt 5o0i 5inh kin .%ang bn ;Jn/

ho0t ng c9a n ;2a tr&n _ hi% 7ng .%ang ;Jn v.%ang in trong# $C% trc v kB hi% c9a -hotoiOt

n gin !c trHnh by nh tr&n hHnh W#We a/b#

Cnh 1.18. aj c: trXc ca /hotoi't# bj 6 hi$#

c#;j cch mFc

6i tc ;Ing c9a nng 5!ng nh =ng/ trong mi4n

ch%yAn ti- -,n c9a chCt bn ;Jn nh0y .%ang c thA

(y ra =2 ion ho cc ng%y&n t> c9a chCt c bn v

c9a t0- chCt ;Jn n vic =inh ra cc c- in t>

v 5 trOng# $c in t> v 5 trOng ny t"- tr%ng +

hai % bn ;Jn# U% m0ch ngoi ta nOi hai % bn

;Jn thH =} c ;?ng in ch0y .%a gi 5 ;?ng .%ang

in / hai % -hotoiOt (%Ct hin hi% in th

#

S


32/106

$ hai cch m3c -hotoiOt cch m3c khng

;Eng ng%Qn n%i + m0ch ngoi nh hHnh W#We c/ v c

ng%Qn n%i + m0ch ngoi nh hHnh W#We ;# Khi m3c v6i

ng%Qn n%i mt chi4%/ in - t vo -hi thRo

chi4% -hn c2c ng!c#

\c trng von,am-R c9a -hotoiOt !c trHnh by

tr&n hHnh W#WY#

Cnh 1.1?. ](n! Ac trn! +on\[m/f ca

/hotoi't

Tr&n hHnh v} ta thCy/ c1ng nh =ng ri vo

m0nh thH ;?ng ng!c c9a -hotoiOt cng 56n/ c ngha

5 in tr+ ng!c c9a -hotoiOt cng gim khi chEm

=ng ri cng tng#

\c trng biA% ;iun =2 -hI th%c c9a ;?ng .%ang

in vo c1ng chi% =ng !c trHnh by tr&n

hHnh W#WZ#

W

_

W

Cnh 1.1S. PQ /h< th3c ca ;n! qan! i$n vo c(n!


33/106

d2 -hI th%c ny !c biA% ;iun bng cng th7c

lK#

Trong K!c gi 5 nh0y t8ch -hn c9a-hotoiOt/ Kl X# d2 -hI th%c c9a nh0y vo b6c=ng nh =ng !c gi 5 c trng -hF c9a-hotoiOt.:6i cc b6c =ng khc nha% thH nh0y

c9a -hotoiOtcng khc nha%# \ nh0y c?n !c hiA%5 hi% =%Ct 5!ng t> c9a -hotoiOt/ ]i% =%Ct 5!ng t>!c 'nh ngha 5 =O c- in t> , 5 trOng !c =inhra 7ng v6i mi -hoton t6i#

]i% =%Ct 5!ng t> !c t8nh thRo cng th7c1

=

h

P

q

I optp

Trong / -5 ;?ng .%ang in t0o ra t* vic hC-thI nh =ng c cng =%Ct `o-tt0i b6c =ng wtng 7ngv6i nng 5!ng -hoton hvx# Dt trong cc hng =O nh h,+ng t6i hi% =%Ct 5!ng t> 5 hng =O hC- thI # :H 5mt hm -hI th%c rCt 56n vo b6c =ng m ;i b6c=ng 5 y% tO .%y 'nh gi6i h0n ;?ng .%ang in#\ ;i b6c =ng c3t c!c t0o ra b+i rng vEng

cCm/ v8 ;I b6c =ng c3t khong W#Ym v6i GRmani vc< W#Wm v6i =i5ic# :6i cc b6c =ng ;i hn c/ gi tr'

_


34/106

c9a .% nh@ A (%Ct hin =2 hC- thI trong# :6i ccb6c =ng ng3n thH gi tr' c9a rCt 56n wWScm,Wx/ vvH v"y vic -ht (0 ch9 y% b+i cc hC- thI gn b4

mt/ ni th1i gian ti h!- rCt ng3n# o / cc h0t;Jn c thA ti h!- tr6c khi chng b' t"- tr%ng t0i 56-ti- gi- -,n#

]Hnh W#_S 5 gin Q iAn hHnh c9a hi% =%Ct5!ng t> thRo b6c =ng c9a mt =O iOt .%ang tOc cao# Ta thCy rng/ trong vEng c2c t8m v vEng khkin/ cc iOt .%ang bn ;Jn kim 5o0i c hi% =%Ct 5,

!ng t> cao/ trong vEng c"n hQng ngo0i/ cc iOt .%ang

=i5ic wc -h9 56- chOng -hn (0x c thA 0t hi% =%Ctt6i WSS t0i vEng b6c =ng S#Y,S#Zm# T0i vEng c b6c=ng W#S,W#m/ cc iOt .%ang GRmani v iOt.%ang nhm ,: w5o0i Gan=x cho hi% =%Ct cao# :6icc b6c =ng ;i hn/ cc iOt .%ang c thA !c 5m50nh wkhong eeKx A tng hi% =%Ct .%ang t>#

Cnh 1.%W. Ci$ s:t ln! tB /h< th3c b_c sn!

ca cc b3 th qan!


35/106

o c cC% t0o n gin/ nh0y cao v k8ch th,

6c nh@ n&n -hotoiOt !c ;Eng nhi4% trong my =inh

ho hin nay/ c bit 5 cc my ()t nghim (ch

tay#

1.4.*.*. Mhototrankito

`hototranito cng 5 mt ;Ing cI .%ang bn

;Jn/ n 5 -hn t> nh0y .%ang c cC% trc nh mt

tranito/ ho0t ng nh mt -hotoiOt nhng c khnng kh%ch 0i ;?ng .%ang in#

nh =ng c thA ri vo M/ $/ hoc c mi4n

t%j v' tr8 c9a c>a =F .%ang# Tng t2 nh tranito/

-hototranito cng c hai 5o0i th%"n -,n,- v ng!c n,-,

n# $C% trc v k8 hi% c9a -hototranito !c trHnhby tr&n hHnh W#_W#

Cnh 1.%1. O: trXc v 6 hi$ ca

/hototrankito


36/106

$ thA m3c -hototranito trong cc = Q o

.%ang nh cc tranito thng th1ng whHnh W#__ ;x

hoc c thA m3c tr+ ti v6i cc c2c M/ M$ hoc $

c?n A trOng mt chn w hHnh W#__# a/b/cx

Cnh 1.%%. P - mFc /hototrankito

] cc 1ng c trng von,am-R c9a

-hototranito!c trHnh by tr&n hHnh W#_#

T

$

cwmx

S

W

_

Cnh 1.%*. ](n! Ac trn! von\am/f ca/hototrankito


37/106

T ;?ng tOi khi c1ng nh =ng lS

Trong = Q ch%ng/ cl#T h =O kh%ch 0i ;?ng c9a -hototranito

:6i c t8nh nh0y cao/ -hototranitogn nh

!c ;Eng trong tCt c cc my cn c % th%

.%ang/ v ;n thay th -hotoiOt#

2. T=nh n>ng )c 6ng c


38/106

)t nghim =inh ho !c th2c hin v6i nhi4% 5o0i

mJ% bnh -hm nh m%/ n6c tiA%/ -hn/ ;'ch no

t%{/ cc 5o0i ;'ch khc#

)t nghim =inh ho m% 5 cc ()t nghim !c

;Eng -hF bin nhCt hin nay t0i cc bnh vin/ c =+

y t# $ho -h)- (c 'nh 'nh t8nh cc chCt ho hc

trong m%# :H m% !c ;Jn kh3- c thA/ c 5i&n

.%an m"t thit v6i tCt c cc c .%an trong c thA/

vH v"y cng ch'% nh h+ng c9a tCt c cc c .%an

ny# :4 -hng ;in v"t 5B/ m% 5 mt tF ch7c 5@ng

5% ng trong h t%n hon nhng 5%n c =2 trao

Fi m"t thit v6i cc chCt ;'ch gian bo/ 5m nhim

vI v"n ch%yAn cc ng%y&n 5i% ;inh ;


39/106

(c 'nh =O 5!ng/ chCt 5!ng/ k8ch th6c### c9a cc t

bo =} 5 -hn ()t nghim cng th7c m% !c 4

c"- + mt ti 5i% khc#

)t nghim =inh ho n6c tiA% cng 5 mt ()t

nghim th1ng thCy trong cc bnh vin# T%y nhi&n/

ngy nay v6i tin b khoa hc kL th%"t/ ng1i ta

th2c hin -hng -h- =inh ho kh ;Eng .%R th> A

(c 'nh 'nh t8nh hoc bn 'nh 5!ng v6i cc my

()t nghim n6c tiA% hoc t2 =o =nh tr&n bng m%

ch%n cho kt .% nhanh/ c thA th2c hin t0i gia

Hnh ;u ;ng# `hn ny !c trHnh by chi tit

trong -hn ti 5i% my ()t nghim n6c tiA%/ cc b0n

.%an tm c thA c tham kho# :6i nhng chCt

m .%R th> khng gii .%yt !c thH cn -hi ;Engt6i ()t nghim =inh ho + -h?ng th8 nghim/ tCt

nhi&n n% khng c my ()t nghim n6c tiA% thH

b0n vJn c thA ;Eng my ()t nghim =inh ho A

(c 'nh cc chCt trong n6c tiA% mt cch 'nh 5,

!ng/ v i khi n% nghi ng1 kt .% c9a my n6c

tiA%/ b0n c thA kh~ng 'nh 50i nh1 ()t nghim

=inh ho t0i -h?ng th8 nghim#

)t nghim =inh ho -hn c gi tr' chn on

cc bnh 1ng ti&% ho# Uhng hin nay ()t nghim

ny 8t !c ;Eng vH 5B ;o v =inh/ ng1i ta ch th2c

Y


40/106

hin v6i -hn n% ()t nghim v4 t bo/ vi kh%n

hoc kB =inh trEng#

'ch no t%{ 5 56- ;'ch bao .%anh no v t%{

bo v cho h thn kinh tr%ng ng tr6c cc bin

Fi v4 - 52c v cc chCn ng# 'ch no t%{ !c

-hn cch v6i m% b+i mt mng ngn khng cho cc

t bo m% v -hn 56n -rotRin h%yt tng vo ;'ch

no t%{/ trong khi cc -hn t> nh@ tan trong n6c nh

g5%co thH thCm .%a mng# 'ch no t%{ ti- c"n

m"t thit v6i no v t%{ n&n nhng tFn thng c9a

hai c .%an ny 4% c nh h+ng t6i ;'ch# Ughi&n

c7% ;'ch no t%{ c thA chn on mt =O bnh

thn kinh v thRo ;i tin triAn c9a bnh#

$c 5o0i ;'ch khc nh ;'ch m"t/ ;'ch mng-hFi/ ;'ch mng bIng### gi- chn on kh ch8nh

(c cc bnh 5i&n .%an tr2c ti- n cc c .%an

ny#

2.2. M) & )hAng & )0ng ,y -) nghi/, &inh

h0$c my ()t nghim =inh ho hin nay c thA

5m !c rCt nhi4% thng =O/ i4% ny -hI th%c vo

vic ng1i ta nghi&n c7% ra cc ho chCt tng 7ng cho

t*ng thng =O# Trong -h0m vi ti 5i%/ ch (in n&% ra

mt =O cc thng =O trong my ()t nghim =inh ho

m% th1ng g- trong ()t nghim t0i cc bnh vin

Z


41/106

v c B ngha trong chn on cc bnh -hF bin

hin nay# \A tHm hiA% chi tit cc thng =O =inh ho

m% khc/ b0n c tham kho thRo ti 5i% ch%y&n

ngnh y v4 ()t nghim# Khi 5m ()t nghim cn

ch cc kt .% ()t nghim ch 5 khch .%an/ cn

-hn t8ch bin ch7ng cc kt .%/ trnh { 50i vo

my/ nhHn kt .% -hin ;in m ;Jn n kt

5%"n khng ch8nh (c# Di thng =O o !c -hn

nh nhi4% kt .% bnh 5B khc nha%/ cI thA

2.2.1. CBGatinin SCUV$rRatinin 5 =n -hm ch%yAn ho c9a $rRatin,

-ho=-hat/ mt ;0ng ;2 tr nng 5!ng ;Eng cho vic

co c# $rRatinin khng !c c => ;Ing/ vo m% rQi

!c th"n o thi ra ngoi .%a n6c tiA%#

MHnh th1ng/ nQng crRatinin trong h%yt

thanh 5 ,WS %mo5X5 wS/, W/_ mgX;5x

Tng trong

, TFn thng hoc ;"- nt c ;in rng/ vi&m

c###, $c bnh v4 th"n vi&m th"n cC- v mn t8nh/

nhium c th%{ ngn/ b8 i ;o t3c 1ng tit

ni%/ =a% khi c3t b@ th"n#

Gim trong

, d%y gan ;o gim tFng h!- crRatinin/ ng%y&n

5i% t0o n&n crRatin,-ho=-hat#

S


42/106

$rRatinin 5 thnh -hn 0m Fn 'nh nhCt

trong m%/ khng -hI th%c vo ch n %Ong

hoc nhng thay Fi =inh 5B kh3c m ch -hI

th%c vo kh nng o thi c9a th"n n&n hin nay

!c => ;Ing nhi4% A thRo ;i ch7c nng th"n/

.%an trng hn %r

2.2.2. WBotGin to3n )h*n SWXVMHnh th1ng/ -rotRin ton -hn c trong WSSm5

h%yt thanh 5 e/W,Y/ g/ thRo hng =O =inh hc c9a

ng1i :it Uam/ bao gQm /,/g a5b%min v _/,

/ g5ob%min#

Tng trong cc tr1ng h!- mCt n6c 5i&n tIc w nn/ a

chyx/ khi =Ot k)o ;i/ a % t%{#

Gim ;o

, ]C- th% khng 9 -rotRin thi% ;


43/106

2.2.!. YBr& 5 =n -hm thoi ging .%an trng c9a

-rotRin/ !c tFng h!- + gan v !c o thi ch9

y% .%a th"n#

MHnh th1ng/ nQng %r& trong h%yt thanh 5

_/,/e mmo5X5 wW, S mgX;5x#

Tng ;o

, Tng c%ng cC- ch n gi% 0m/ tng

ch%yAn ho 0m trong c thA w=Ot nhium kh%n###x, Gim o thi

Tr6c th"n i 8t w bnh tim/ ( ganx/ mCt n6c

w a chy/ nn nhi4%x

T0i th"n bnh c% th"n/ Ong th"n cC- v mn

t8nhda% th"n t3c 1ng ;Jn n6c tiA% nh trong %ng

th hoc % 5nh t%yn ti4n 5it/ =@i 1ng tit ni%#

Gim ;o

, $h n nghzo 0m

, d%y gan 5m gim tFng h!- %r

2.2.+. CholGstGBol SCRXVMHnh th1ng/ nQng cho5R=tRro5 trong h%yt

thanh 5 /Z,/Z mmo5X5 wWS,WZS mgX;5x

$ho5R=tRro5 tng =a% khi n nhi4% m


44/106

Tng

, Mnh ( va ng m0ch

, Th"n h/ cho5R=tRro5 m% c thA tng WS mmo5X5

, d%y gi-

, :ng ;a ;o t3c m"t/ =@i m"t

, $h7ng bing n ;o thn kinh

, nh h+ng c9a mt =O 5o0i th%Oc#

Gim

, ThiA% ;


45/106

mt =O bnh thn kinh nh vi&m mng no/ ng

kinh/ mCt tr8 =6m/ =a% khi c3t ;0 ;y/ nhium c

cQn Rthy5ic###

2.2.#. 7iliBPilMi5ir%bi5 5 =n -hm thoi ging c9a ch%yAn ho

h%yt =3c tO# $ hai 5o0i bi5ir%bi5

, Mi5ir%bi5 gin ti- hHnh thnh trong h thOng vng

m/ 5 5o0i bi5ir%bi5 cha !c .%a gan A vo cc ,

1ng ;Jn m"t/ khng tan trong n6c n&n khng bi tit

.%a th"n# Mi5ir%bi5 ny c?n gi 5 thnh -hn ch9

y% c9a bi5ir%bi5 ton -hn/ nQng bHnh th1ng

trong h%yt thanh 5 W_ %mo5X5 wS/e mgX;5x#

, Mi5ir%bi5 tr2c ti- hHnh thnh trong gan t* bi5ir%bi5

gin ti-/ bHnh th1ng ch c rCt 8t/ %mo5X5 wS/

mgX;5x

$ hai 5o0i bi5ir%bi5 tr&n kt h!- thnh bi5ir%bi5

ton -hn nQng tr%ng bHnh trong h%yt thanh

5 We %mo5X5 wWmgX;5x

Mi5ir%bi5 ton -hn tng trong cc tr1ng h!- ctan m% w =Ot r)t/ =a% tr%y4n m%x/ khi hC- thI mt

F tI m% 56n/ tFn thng nh% m gan/ th%Oc gy

c cho t bo gan#

Mi5ir%bi5 tr2c ti- tng ;o

, o 7 m"t trong gan vi&m gan ;o vir%= hay ;o

nhium c/ ( gan m"t###


46/106

, o t3c 1ng ;Jn m"t ngoi gan =@i m"t/ h0ch

to chzn )- 1ng ;Jn m"t#

2.2.0. ZmylasGUg%Qn gOc amy5a=R + tIy v t%yn n6c bt/

amy5a=R 5 mRn tham gia .% trHnh ch%yAn ho

cacbon hirat#

MHnh th1ng/ nQng amy5a=a trong h%yt

thanh 5 S,WYS X5

Tng cao trong bnh vi&m tIy cC- t8nh/ nQng

trong m% c thA tng 5&n t6i ,e 5n trong nhng

ngy %/ tng v*a -hi trong vium tIy mn t8nh/

%ng th tIy/ 5o)t ;0 ;y t trng th9ng vo tIy/ vi&m

ti m"t/ .%ai b'/ vi&m t%yn n6c bt#

2.2.@. CBGatinin&inasG SCV$?n c t&n 5 crRatin -ho=-hokina=R w$`Kx# $K 5

mRn (c tc -hn 7ng

$rRatinT` crRatin -ho=-hat`

$ Qng mRn $K,DD c + cc c/ $K,DM c ch9

y% + tim, 5o0i ny th1ng !c ;Eng hn c/ $K,MM cch9 y% + no# MHnh th1ng/ ho0t t8nh $K trong

h%yt tng ch9 y% 5 $K,DD# Tr' =O $K tr%ng bHnh

trong h%yt thanh 5 WZ X[/ tr' =O c9a $K,DM 5

_, tr' =O $K#


47/106

, $K tng khi 5ao ng g3ng =7c/ trong cc bnh v4

c nh vi&m c/ chCn thng c/ nhQi m% c tim

, $K,DM tng trong nhQi m% c tim#

2.2.4. $actat dGhydBogGnasG S $[RV[] 5 mRn cn thit cho =2 ch%yAn ho g5%co

(c tc -hn 7ng

[actat U -yryvat U]_

Tr' =O tr%ng bHnh trong h%yt thanh 5 WSS,_S X5

Thay Fi bnh 5B

, UhQi m% c tim nQng trong m% rCt cao/

gC- t* e,WS 5n tng t* _ n gi1 =a% khi kh+i

-ht bnh v tr+ 50i bHnh th1ng =a% WS,W ngy/

nQng tng =ong =ong v6i m7c tFn thng#

, $c bnh v4 gan tng v*a trong vi&m gan ;o

vir%= cC- t8nh/ ( gan/ ;i cn %ng th + gan/ tng nh

trong cc bnh 1ng m"t#

2.2.1\. Whos)hatG[ mRn A th9y -hn cc R=tR -hot-horic/ rCt

cn A ch%yAn ho -hot-ho/ trong 5m =ng th1ng;Eng _ 5o0i ()t nghim -ho=-hatR a(it v -ho=-hatR

ki4m

`hot-hat a(it w $`x


48/106

$ nhi4% trong cc tF ch7c/ c .%an nh t%yn ti4n

5it/ hQng c%/ tiA% c%/ 5ch/ (ng###Tr' =O tr%ng

bHnh trong h%yt thanh 5 / X5

$` tng trong cc bnh %ng th t%yn ti4n 5it/

c bit khi c ;i cn vo (ng#

`hot-hat ki4m w [`x

]o0t ng trong mi tr1ng -] Z,WS/ ng%Qn gOc ch9

y% + (ng/ mt -hn + gan/ th"n/ 5ch/ ni&m m0c

r%t### Tr' =O bHnh th1ng trong h%yt thanh 5 S,

W_S X5#

Thay Fi bnh 5B

, Tng trong bnh c?i (ng/ nh%yun (ng/ %ng

th (ng###

, Gim trong bnh 5ao -hFi/ ch7ng 5En t%yny&n/ thi% hIt vitamin $/ thi% m%###

2.2.11. TBanBamin[ mRn gi- cho =2 v"n ch%yAn nhng nhm

amin/ t0o n&n mOi 5i&n h gia nhng =2 ch%yAn ho

-rotRin v g5%(it# $ _ 5o0i !c ch B trong 5m =nghin nay nhCt 5

G5%tamo,s(a5o Tranramin w GsT x/ c nhi4% +

tim/ gan rQi n cc c/ th"n/ -hFi# DRn ny c?n

!c gi 5 a=-artat amino tran=Rra=R/ trong 5m

=ng th1ng gi t3t 5 dT#

e


49/106

G5%tamo,`yr%vic Tranramin w G`Tx/ c nhi4%

trong gan# DRn ny c?n !c gi 5 a5anin amino

tran=Rra=R gi t3t 5 [T

Trong h%yt thanh/ _ 5o0i mRn ny c th&m ch

d + % v vit t3t 5 dGsT v dG`T#

Tr' =O tr%ng bHnh trong h%yt thanh 5

, dGsT X5

, dG`T X5

dGsT tng trong nhQi m% c tim cC- t8nh/

vi&m c tim/ vi&m mng ngoi tim/ =%y tim/ trong

nhQi m% c tim cC- t8nh dGsT tng rCt cao#

dG`T tng trong cc bnh v4 gan m"t nh vi&m

gan cC- t8nh v mn t8nh/ ( gan/ %ng th gan/ vi&m

1ng m"t### Trong vi&m gan ;o vir%= cC- t8nh/ dG`Ttng rCt cao/ c khi gC- WS,S 5n hoc hn#

2.2.12. TBiglycGBidGs S WZWVMHnh th1ng nQng trong h%yt thanh 5

_mmo5X5 w We mgX;5x

Tng trong bnh ( va ng m0ch/ c?n tngtrong bnh b)o -hH/ nghin r!%/ i tho 1ng/ =%y

gan/ vi&m tIy/ =%y th"n/ nhium kh%n##

2.2.1!. Zxit Bic S ZYV(it %ric 5 =n -hm thoi ging c9a n%c5R-rotit#

MHnh th1ng nQng trong h%yt thanh 5 _SY,_e

Y


50/106

%mo5X5 thRo hng =O =inh hc ng1i :it Uam/ + n

thC- hn nam mt cht#

Tng trong bnh gt/ trong =Ot cao/ b@ng rng/

mt =O bng v4 th"n nh vi&m th"n,bA th"n/ th"n 7

n6c/ 5ao th"n###

Gim trong mt =O bnh c tFn thng t bo

gan/ mt =O tr1ng h!- tFn thng Ong th"n#

2.7. $% &' h0 &inh 6Cng )0ng ,y &inh h0Uh bit/ ()t nghim =inh ho => ;Ing -hng

-h- o m% .%ang in/ A o hC- thI c9a

cc chCt trong bnh -hm/ ng1i ta khng thA o

tr2c ti- cc chCt vH bn thn cc chCt

trong ;%ng ;'ch 5 trong =%Ot# Dt khc/ trong cc

;%ng ;'ch ()t nghim c rCt nhi4% cc chCt khc

nha% n&n cng kh khn trong vic o 0c v t8nh

ton# :H v"y/ A 5m vic v6i mt 5o0i chCt cn

nghi&n c7% trong ;%ng ;'ch ()t nghim/ ng1i ta =>

;Ing -hng -h- nh ;C% m%# Mng cch => ;Ing

t8ch chCt ho hc c9a cc chCt cn nghi&n c7%/ ng1ita => ;Ing chCt cho tc ;Ing v6i mt chCt hay

mt =O chCt no / trong .% trHnh -hn 7ng/ chCt

=} t0o ra mt =n -hm hC- thI nh =ng + mt b,

6c =ng no 5 m0nh nhCt# d2 hC- thI m0nh hay

y% =} t{ 5 v6i nQng c9a chCt trong ;%ng

;'ch# T* ta c thA t8nh ton ;u ;ng A c !c

Z


51/106


52/106

w G[]x t0o thnh G5%tamatR v U/ -hn 7ng

U]XU t0o ra =2 thay Fi t%yn t8nh v4 =2 hC-

thI + b6c =ng Snm/ n t{ 5 v6i nQng %r& trong

;%ng ;'ch#

`hng trHnh -hn 7ng

OHA!Gluta"ateLA!HteOxo#lutaraH

COHOHUre

GL!H

Urease

2

4

22

222222

2

++ ++

+ +

+

+

2.!.+. CholGstGBol SCRXV

`hn 7ng t0o m% c9a cho5R=tRro5 thRo cc -hn 7ng=a%

OHRqeoantipyrinAPhenolOH

OHCholestenOlCholestero

Axit$eolCholesteroOHlesteCholestero

Peroxidase

lOxidaseCholestero

lEsteraseCholesteri

222

222

2

4min42

134

+ ++

+ +

+ +

P. 5 ;%ng ;'ch @/ !c o + b6c =ng Z_ n

Snm

2.!.6. DlcosG SD$YV`hn 7ng t0o m% c9a g5%co=R nh =a%

2222

22

cos

2

4min42

cos

OHRqeoantipyrinAPhenolOH

OHGluconicAxitOeGlu

Peroxidase

eOxidaseGlu

+ ++

+ +

P. 5 ;%ng ;'ch @/ !c o + b6c =ng Z_ n

Snm/ tOt nhCt 5 + SSnm#

2.!.#. 7iliBPil to3n )h*n(8t d%5anic -hn 7ng v6i natri nitrit A t0o

a(8t ;iaotiR; =%5ani5ic# (8t ny -hn 7ng v6i

bi5ir%bi5 ton -hn v6i chCt (c tc ;imRthy5=%5o(i;R

W


53/106

t0o thnh aobi5ir%bi5/ ;%ng ;'ch ny o + b6c =ng

S n S nm/ tOt nhCt + nm#

2.!.0. ZmylasGTrong -hn 7ng/ amy5a=R ng vai tr? (c tc#

TOc -hn 7ng -hI th%c vo nQng amy5a=R c

trong ;%ng ;'ch/ =n -hm t0o ra hC- thI m0nh + b6c

=ng SS,_Snm/ tOt nhCt t0i Snm#

`hng trHnh -hn 7ng

++ + pPGGEthylideneOHpPGEthylidene a"ylase 2252575 2

%Ethyli;fnf\4

%*\/MEthyli;fnf\

*4\/M

GpPOHpPGpPGpPG idaseGlu

1451443222 cos

2 + +++

Trong G g5%co=R

-U` -,nitro-hRno5

2.!.@. CBGatinin&inasG SCV`hng trHnh -hn 7ng c9a $rRatinR -ho=-hatR

nh =a%

++ ++ +

++++

HA!PHPhosphateGluconateA!PPG

A!PPhosphateeGlueGlu!ATPATPCreatineA!PPhosphatCreatine

P!HG

HK

CK

66

6coscos

6

]K hR(okina=R

T` ;Rno=inR tri,`ho=-hatR

G,,`] G5%co=R,,`ho=-hatR ;Rhy;rogRn=R

U` Uicotinami;R a;RninR ;Rn%c5Roti;R -ho=-hatR

_


54/106

`hn 7ng cho U`] v G,,` c tOc tng =2 hC-

thI + ;i b6c =ng Snm w,nmx cho ta

ho0t ng c9a $K trong mJ%#

2.!.4. $actat dGhydBogGnasG S $[RV\o =2 ho0t ng c9a [] thRo -hn 7ng =a%

++ ++ + HA!HPyru%ateA!LactateL L!H

\o [] ;2a vo tOc -hn 7ng tr&n/ [] ng vai

tr? (c tc/ -hn nh .%a =2 hC- thI + b6c =ng ,

nm#

2.!.1\. Whos)hatG(8t -ho=-hatR w$`x

d2 c mt c9a a(8t -ho=-hatR trong h%yt

thanh =} -hn h%{ ,na-hthy5 -ho=-hatR thnh ,

na-htho5 v -ho=-hatR v c# ,na-htho5 ti- tIc

-hn h%{ ;6i (c tc a=t rR; TP cho ;%ng ;'ch m%

vng "m ;n 5&n# \o =2 thay Fi c9a ;%ng ;'ch

ny t0i b6c =ng Snm cho ta ho0t t8nh c9a a(8t

ny#

`ho=-hatR ki4m w [`x

[` c trong ;%ng ;'ch th%{ -hn -,

Uitro-hRny5-ho=-hatR w`U``x/ trong .% trHnh gii

-hng -,nitro-hRno5 v -ho=-hatR/ =2 tng hC- thI +

b6c =ng Snm =} cho chng ta bit ho0t ng c9a

[` trong ;%ng ;'ch#


55/106

`hng trHnh -hn 7ng th%{ -hn nh =a%

PlitrophenopOHPPPALP

+ +2

2.!.11. TBanBamindT wGsTx

`hng trHnh -hn 7ng

A!&alateLA!HteOxaloaceta

Gluta"ateLteOxaloacetaateKeto#lutarAspartateL

&!H

AST

+ +

++

D] 5 Da5atR ;Rhyo/ dT ng vai tr? (c

tc -hn 7ng t0o o(a5oacRtatR/ -hn 7ngo(a5oacRtatR t0o U hC- thI + b6c =ng S cho ta

=2 ho0t ng c9a dT#

[T wGsTx

[T ng vai tr? (c tc cho -hn 7ng t0o

-yr%vatR

Gluta"ateLPyru%ateateKeto#lutarAlanineL ALT + +

`hn 7ng c9a -yr%vatR t0o U hC- thI + b6c =ng

Snm cho ta ho0t ng c9a [T trong ;%ng ;'ch

A!LactateLA!HPyru%ate L!H + +

[] [actatR ;Rhro#

2.!.12. TBiglycGBidGs S WZWVTrig5ycRri;R= trong ;%ng ;'ch b' th%{ -hn ;6i

(c tc 5i-o-rotRin 5i-a=R w[`[x thnh G5ycRro5 v a(it

b)o# G5ycRro5 tc ;Ing v6i T` v6i (c tc G5ycRro5

Kina=R wGKx t0o ra g5ycRro5,,`ho=-hatR G,,`/ G,,`


56/106

b' o(i ho/ ;%ng ;'ch c m% @ nh hC- thI tOt +

b6c =ng S wZS,Snmx#

`hng trHnh -hn 7ng

OHRqolChlorophenpeoantipyrinAOH

OHphosphateceton!ehydroxiaOPG

A!PPGATPGlycerol

Axit'eoGlycerolOHdesTri#lyceri

PO!

GPO

GK

LPL

222

222

2

4min42

3

3

+ ++

+ +

++

++

Trong

G`s G5ycRro5,,`ho=-hatR o(i;a=R

`s `Rro(i;a=R#

2.!.1!. Zxit YBicrica=R ch%yAn a(it %ric c trong ;%ng ;'ch

thnh a55antoin/ carbon ;io(i;R $s_ v hy;rogRn

-Rro(i;R ]_s_# 6i (c tc c9a `s/ `hRno5

;RrivativR/ /,ich5oro,_,]i;ro(y,bRnRnR=%5onica(8t w]Mdx v ,minoanti-yrinR/ ]_s_ cho mt

;%ng ;'ch m% @ nh c thA o + b6c =ng

_Snm/ vic tng hC- thI tng 7ng v6i nQng %ric

c trong ;%ng ;'ch#

`hng trHnh -hn 7ng

OHRq!H$SeoantipyrinAOH

OHCOeAllantoninOOHUric

PO!

Uricase

222

22222

4min42

2

+ ++

++ ++

7. My -) nghi/, &inh h0Ugy nay/ v6i =2 -ht triAn m0nh m} c9a khoa

hc kL th%"t tr&n tCt c cc 5nh v2c/ trong cc

-h?ng ()t nghim/ con ng1i khng -hi t2 5m


57/106

cc ()t nghim na m ;2a vo cc my ()t

nghim# $on ng1i ch -hi 5m mt =O cng vic

nh -ha/ 9 ho chCt nh trong cc my .%ang k/ hoc

ch -ha/ my =} t2 9 v t8nh ton kt .% trong cc

my =inh ho bn t2 ng/ hoc ch 5 thao tc v"n

hnh my c?n cc cng vic ht mJ%/ -ha mJ% v 9

mJ% v t8nh ton ;o my 5m hon ton trong cc

my =inh ho t2 ng# :H v"y/ my =inh ho tr+

thnh mt cng cI 3c 52c trong cc -h?ng ()t

nghim/ gi- cho cng vic ()t nghim tr+ n&n

n gin/ ng1i 5m ()t nghim khng c?n -hi nh6

t*ng ho chCt/ cch -ha ch### $ng vic ch n

gin 5 cho tCt c mJ% vo cc khay ch7a mJ%/ chn

5o0i ()t nghim v nhCn nt cho my t2 o 0c/t8nh ton/ v hiAn th' kt .% c?n h c thA i 5m

cc cng vic khc nh 5Cy mJ% m%/ th2c hin cc

5o0i ()t nghim khc# :H v"y thay bng c -h?ng

()t nghim/ ch cn mt kL th%"t vi&n v6i cc my

()t nghim 5 9#

`hn ny (in gi6i thi% ng%y&n 5B cC% t0o c9a

mt my =inh ho# U3m !c ng%y&n 5B ny/ b0n c

thA hiA% !c ho0t ng c9a mt my =inh ho bCt

kj t* n gin n -h7c t0-/ t* ;u ;ng -hn

t8ch ho0t ng c9a chng#


58/106

7.1. D% E * nguy5n l( h0F) ng c


59/106

c trng c9a ()t nghim / v n =} hC- thI

m0nh nhCt mt ;i b6c =ng tng 7ng/ vH v"y khi o

=2 hC- thI ta ch ;Eng mt b6c =ng c bn# :6i

nhi4% ()t nghim ta =} ;Eng nhi4% b6c =ng khc

nha% v ng%Qn =ng tr3ng =} cC- y 9 cc b6c

=ng ny cho tCt c cc ()t nghim#

Trong th2c t ng1i ta c thA ;u ;ng t0o ra

ng%Qn =ng tr3ng# ]Hnh W#_ minh ha % ra c9a

mt zn t%ng=tRn# $hng ta thCy rng nng 5!ng

gim v4 -h8a tia c2c t8m gn nhng n vJn 9 m0nh

A cC- nng 5!ng cho b -ht hin .%ang + b6c =ng

gn Snm# \A tng c1ng nh =ng n ;i vEng

c2c t8m/ ng1i ta => ;Ing mt zn ha5ogRn t%ng=tRn#

\zn ny gQm mt ;y tc t%ng=tRn t trong v@th0ch anh ch7a ha5ogRn nh iOt ch~ng h0n#

Y

SSS SS SS eS

S

S

WSS

Cnh 1.%4. ] ra ca m3t pn Tn!stfn

M6c =ng wnmx

\%ra


60/106

\zn th%{ ngn 5 mt v8 ;I iAn hHnh c9a zn

-hng in .%a 56- kh8/ n t0o ra =2 -ht (0 m0nh

trong .%ang -hF m% (anh v ;i c2c t8m#

Uh!c iAm ch8nh c9a zn th%{ ngn 5 n ch c

thA !c => ;Ing + cc b6c =ng c trng# \A kh3c

-hIc nh!c iAm ny/ ng1i ta => ;Ing mt zn

tRri mc ;E gi thnh cao v t%Fi th tng Oi

ng3n# \zn tRri -ht ra nh =ng c b6c =ng t6i

WZSnm/ ;i b6c =ng -hE h!- v6i h% ht ()t nghim

Z

\% ra

Cnh 1.%5. ] ra ca m3t pn the n!0n

M6c =ngwnmx


61/106

hin nay#

!.1.2. 7: lFc P^c s_ng

M 5c b6c =ng ;Eng A chn 5Cy mt b6c =ng

y&% c% cho t*ng ()t nghim# d+ ; ng1i ta ;Eng

ng%Qn =ng tr3ng v cc b 5c m khng ;Eng cc

5inh kin -ht ra cc b6c =ng cO 'nh 5 ;o ;Eng b

5c c thA ;u ;ng th&m cc b 5c thRo y&% c% ()t

nghim t7c 5 c t8nh m+ Oi v6i ()t nghim hn 5;Eng 5inh kin -ht ra b6c =ng cO 'nh# Trong cc

my ()t nghim =inh ho hin nay/ b 5c th1ng 5

mt bnh (R tr&n c g3n mt =O k8nh 5c / =O k8nh

5c tr&n bnh (R ny t%j th%c vo 5o0i my# $c b

5c ny 5 cc cch t>/ k8nh 5c/ 5ng k8nh kt h!- v6i

cc thC% k8nh A th% !c mt ;i rCt h- b6c =ng

S

\% ra

M6c =ngwnmx

Cnh 1.%9. ] ra ca m3t

pn ]trikh%ch 0i

`h

7ng

t&

i


62/106

Snm/ Snm/ Snm/ nm/ eSnm/ SSnm/

Snm/ eSSnm###

!.1.!. 7: )ht hin -angM -ht hin .%ang c ch7c nng 5 bin Fi

t8n hi% .%ang th% !c khi nh =ng i .%a c%v)t

thnh t8n hi% in# M -ht hin .%ang 5 mt

trong cc 5inh kin .%ang, in ()t + -hn tr6c/

tr&n th2c t hin nay th1ng ;Eng 5 -hoto iOt hay

-hoto tranito ;o k8ch th6c nh@/ th8ch h!- cho cc

my (ch tay hoc nhng my c cC% trc nh@# \Qng

th1i 50i c nh0y cao hn cc 5inh kin khc#

!.1.+. Ri`n thMKt .% o =} !c hiAn th' tr&n khOi hiAn th'#

T%j t*ng 5o0i my m c cc cch hiAn th' kt .%

khc nha%/ c thA ch n gin 5 hiAn th' ;6i ;0ng

=O tr&n 5R; e thanh/ hiAn th' tr&n mn hHnh $PT

hoc 5 hiAn th' tr&n mn hHnh tinh thA 5@ng w[$x#

T* / kt .% hiAn th' c thA + m7c n gin 5

c1ng ;?ng in th% !c/ hoc !c t8nh tonA hiAn th' chi tit n hC- thI/ nQng

chCt/ t&n bnh nhn/ =O th7 t2/ ngy thng ()t

nghim###

W


63/106

7.2. $c ph%ng php 0 )0ng -) nghi/, &inhh0.

!.2.1. Whng )h) Ai`m c;i SUnd)ointV

`hng -h- ny ch o hC- thI c9a hn h!--hn 7ng mt 5n/ 5 5c -hn 7ng t0o m% =y

ra hon ton/ v nQng cc chCt trong ;%ng ;'ch

=a% -hn 7ng Fn 'nh# $ thA o hC- thI +

mt b6c =ng wmonochromaticx hoc hai b6c =ng

wbichromaticx# d> ;Ing ;%ng ;'ch ch%n wdtan;ar;xA ;2ng 1ng ch%n hay h =O ci t tr6c#

$hia thRo =O ;%ng ;'ch ch%n => ;Ing khi o ta

c 5o0i

\ MhY/ o ch sB ;


64/106

UQng c9a mJ% !c ni =%y t* 1ng cong ch%n

w=am-5R, b5ankx#TP

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ny 5 o ngay khi b3t % -hn 7ng/ =a% mt


65/106

khong th1i gian tru wR5ay timRx no / khng c

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67/106

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68/106

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70/106

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71/106

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eS


72/106

#hn 2

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73/106

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74/106

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75/106

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76/106

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77/106

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78/106

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79/106

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80/106

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81/106

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82/106

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83/106

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84/106

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85/106

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86/106

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