hoá sinh y học tác giả: phan hải nam, bùi bá minh, Đoàn trọng phụ,.. nguồn gốc:...

8/13/2019 Ho sinh Y hc Tc gi: Phan Hi Nam, Bi B Minh, on Trng Ph,.. Ngun gc: Hc vin Qun Y, 2011

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ChChcc cccc emem mmtt nmnm hhcc mmii

mmnhnh khokho,, ththnhnhtt vv ththtt nhinhiuu maymay mmnn!!

HHiiNamNam


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BBI MI MUU

HOHO SINHSINH

Y HY HCC


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BBI MI MUU

NNii dung:dung:

1.1. nhnh nghnghaa HoHo sinhsinh

2.2. ChChngng trtrnhnh: HS y: HS y hhcc/ Y/ Y hhcc ccss** LL thuythuytt: + HS: + HS ii cngcng

+ HS+ HS lmlm ssngng..

** ThThcc hhnhnh: 7: 7 bbii ((ii cngcng + LS)+ LS)3.3. CCcc gigioo vinvin BB mnmn HoHo sinhsinh (9.2007).(9.2007).

4.4. TTii liliuu thamtham khkhoo..

5.5. MMtt ss yuyu ccuu vv kinhkinh nghinghimm hhcc HSHS


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11-- MMtt ss khkhii ninimm chungchung vv HSHS

HoHo sinhsinh ((BioBiochemistry):chemistry): HoHo hhcc && sinhsinh hhcc::** HSHS-- MnMn hhcc vv cccc ququ trtrnhnh sinhsinh hhcc && cccc hoho chchtt xxyy rara//

ccthth ssngng..

** GGmm:: -- HSHS ii cngcng, HS, HS lmlm ssngng,,-- HSHS cc hhcc,,

-- HSHS phphngng xx,,

--

HSHS

mimi

nn

ddchch

,,

-- HSHS ddcc ll,,

-- HSHS dinhdinh ddngng

++ HS yHS y hhcc ll HSHS nghinnghin ccuu,, ngng ddngng trongtrong lmlm ssngng,, cccc xxttnghinghimm cc chchnhnh xxcc caocao cc gigi trtr trongtrong chchnnoonn,, theotheo didittnhnh trtrngng bbnhnh nhnnhn trongtrong lmlm ssngng..


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22-- ChChngng trtrnhnh mnmn hhcc HS/HS/ DDcc

**LL thuythuytt 22 hhcc phphnn::

. HP 1. HP 1: HS: HS ii cngcng ggmm (2(266t): kt): k ThThcc hhnhnh

++ MMuu (2t),(2t), hoho hhcc ((PProtidrotid--6t ,6t , LLipidipid --4t,4t, GGlucidlucid--4t)4t)

-- CCss-->> ChuyChuynn hoho (CH)(CH)

++ EnzymEnzym (4t),(4t),HormonHormon (6t)(6t)

. HP2. HP2: HS: HS lmlm ssngng ggmm (4(488t):t):

--ii cngcng CH & OxyCH & Oxy hoho khkhSH (SH (ATPATP).).

-- ChuyChuynnhoho (P,L,G),(P,L,G), LinLin quanquanHCHHCH

-- CHCH nncc && mumuii, CH, CHXenobioticXenobiotic,, gangan mmtt,, ththnn && nncctitiuu,,

HSHS mmuu vv 11 ss ddchch thth khkhcc,, cncn bbngng acidacid-- base.base.

++ThThcc hhnhnh: 7: 7 bbii

ChCh :: KhiKhiii THTH mmii HVHV cc 11 quyquynn sschch THTH


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22-- ChChngng trtrnhnh mnmn hhcc ((BSDH & CSBSDH & CS))::

**LL thuythuytt 22 phphnn::..PhPhnn 11: HS: HS ii cngcng ggmm::

++ HoHo hhcc ((PProtidrotid ,, LLipid,ipid, GGlucidlucid))-- CCss-->> ChuyChuynn hoho

(CH)(CH)++ EnzymEnzym,, ii cngcng chuychuynn hoho & Oxy& Oxy hoho khkhSH (SH (ATPATP).).

++ ChuyChuynnhoho (P,L,G),(P,L,G), linlin quanquan vviiuu hoho CH.CH.

..PhPhnn22: HS: HS lmlm ssngng ggmm::-- HSHS ththnn kinhkinh,,HormonHormon, CH, CH nncc && mumuii,,HSHSttchchcccc,,

HSHS hh ththngng gangan mmtt, CH, CHXenobioticXenobiotic (DH)(DH), HS, HS ththnn vv nncctitiuu, HS, HS mmuu vv 11 ss ddchch thth khkhcc,, cncn bbngng acidacid-- base.base.

** ThThcc hhnhnh: (DH & BSCS): (DH & BSCS)-- 77 bbii

ChCh :: KhiKhiii THTH mmii HVHV cc 11 quyquynn sschch TH (TH (mmnn TV..)TV..)


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CCC GIC GIO VIN BO VIN B MN HSMN HS

AA-- GiGioo vinvin::

11-- PhanPhan HHii Nam:Nam: ii tt, TS, PCNBM., TS, PCNBM.

22--oonn TrTrngng PhPh:: ii tt, BSCK2, CNK., BSCK2, CNK.

33-- BBii BB Minh:Minh: ThiThiuu tt,, ThSThS, PCNK., PCNK.

44-- LL ThanhThanh HH:: ThThngng uu,, ThSThS, BSCK1., BSCK1.

55-- HuHunhnh QuangQuang ThuThunn:: ii yy,, ThSThS..

66-- NguyNguynn ThTh UyUynn:: ThSThS, BSCK2, BSCK2

BB-- KK thuthutt vinvin ::

11-- NguyNguynnnhnh KhangKhang:: ThiThiuu tt, DS, DS trungtrung ccpp..

22-- NguyNguynn ThTh HoHo: Y: Y ss, CNV., CNV.


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BSCKII.BSCKII.OON TRN TRNG PHNG PH CN KHOACN KHOA


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ThsThs.. BBii bb minhminh PhPh CNCN KhoaKhoa


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ThsThs. bsck1.. bsck1. LL thanhthanh hh


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TTI LII LIU THAM KHU THAM KHOO

** LL thuythuytt::11-- HoHo sinhsinh yy hhcc-- HHcc vivinn QunQun y, 1989 (2T); 2000.y, 1989 (2T); 2000.

22-- HoHo sinhsinh,, BB mnmnHSHS,, H YH Y HH NNii, 1991; 2001., 1991; 2001.

** ThThcc hhnhnh::

11-- ThThcc ttpp HoHo sinhsinh-- HHcc vivinn QunQun y, 2003 & 2006y, 2003 & 200622-- MMtt ss xxtt nghinghimm HoHo sinhsinh trongtrong LmLm ssngng -- HHcc vivinnQunQun y, 2004.y, 2004.

NguyNguynn ThTh KhKhnhnh,, PhPhmm TTDngDngVVnhnh VinhVinh:: HHngng ddnn ssddngng XN SHXN SH


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MMT ST S YU CYU CU VU V KINH NGHIKINH NGHIM HM HC HSC HS

++ ThamTham giagia hhcc ththii giangian quiqui nhnh (90%),(90%), nghimnghim ttcc,, ttgigicc..

((vvngng mmtt > 10% => 10% = kokoiiuu kikinn thithi).).

++ KiKimm tratra trtrnhnh,, thithi TH,TH, LL thuythuytt:: koko ddngng ttii liliuu(( 10%> 10%

2/32/3 bbii KTKT trtrnhnh>> 55,, ttngng 33 trtrnhnh== 1515 (DH)(DH)


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THi TH- YHCT1

1. f/ Ninhydrin

* NL: Ninhidrin + -A.A ----> f/h xanh tm, gm 2 g:

G1: N K + -A.A -->NO + aldehyd + CO2 + NH3G2: N K + NH3 + NO --> f/h Xanh tm

* /d: - Pht hin a.a/ P2 sc k aminoacid trn giy.- nh lng a.a/ P2 sc k aminoacid t ng.

2- f/ Biure:

3- L Protein TP HT (Gornall)

4- f/ fehling: c trng tnh kh ca Ms5- Pht hin glucose niu

6- L glucose mu (PP Folin-Wu).

7- L ure mu

8- L Creatinin mu9- L Bilirubin TP huyt thanh

10- L hemoglobin mu

11- Xc nh hot amylase NT (Wohlgemuth).


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Cc cht bt thng trong NT

* KN: L cc cht bt ko c hoc c N rt thp / NT (ko xc nh c..),khi c /NT th xc nh c = XN HS thng thng.

* Cc cht bt thng & c ch XH:1- Protein:

+ BT: Ko c P/NT.+ BL: - P c KLPT nh -> qua mng lc CT: Protein Bence-Jones/ a u tuxng (P trc thn).

- Tn thng CT: Vim CTC, thn h (P do thn)- Do ng dn niu b tn thng ( P sau thn).

2- Glucose: + BT: Ko c+ Glucose niu c :

. N glucose mu tng cao , > NT (10 mmol/l) -> NT (T do tu)

. N glucose M bt, ngng thn -> NT (T do thn).

3- Bilirubin (STM),BT: STM v MM c dng vt ko pht hin c -> ko c.BL: Bilirubin niu (+):

(+): tc mt, TB gan t.t -> Bili LH tng-> NT


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4- Cc th ceton:- BT: c N rt thp -> Ko c

- Ceton niu (+):. N th ceton tng cao, > kh nng "O" c th -> Thn -> NT. i ko di: tng thoi ho lipid d tr (TG) -> tng -oxy ho AB

-> tng ceton/M -> Thn -> NT5- Hemoglobin (Hb):

+ BT: Ko c.+ C = BL: - ph hu HC:

. St rt c tnh. thng hn. tan mu do cc NN(rn c cn, G-6PD, N-

- Tn thng niu o: U tin LT, Si bng quang, si thn..6- Dng chp:(DC- Chylomicron)

BT: Ko c

BL: khi h bch mch b tn thng,VD: bnh giun ch, lao thn -> dng chp /NT


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Bi ging

cn bng acid-base

TS. Phan Hi Nam


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i cng

I. Khi nim cn bng acid-base

II. Cc c ch n nh cn bng acid- base

2.1. Hot ng ca cc h m :+ H huyt tng

+ H ca hng cu

2.2. Hot ng sinh l ca phi

2.3. Hot ng sinh l ca thn.

III. Mt s thng s chnh nh gi trng thi CBAB

IV. Mt s ri lon CBAB

* Mt s lu v XN CBAB


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Khi nim cn bng acid-base

CBAB - S n nh nng ion hydro (pH) dch th/ l trngthi m H+ thch hp nht cho cc CH/ c th.

Nc (60-70%) phn ly:

H2O H+ + OH- trng thi cn bng phn ly (L tc dng khi):

[H+] [OH-] = k = 10-14 (k- hng s phn ly)H2O

V [H+ ]= [OH-] =>[H+]x[OH-] = [H+]2 = 10-14Log [H+]2 = Log 10 -14 =>2 Log [ H+] = - 14 -> Log [ H+] = -7

Qui c: pH l gi tri m ca Log nng H+, tnh:pH = - Log [ H+]


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nh hng ca pH ti cc phn t sinh hc

+pH thay i:

-> thay i cc lin kt hydro, LK disulfua (-S-S-)=> thayi cu trc, CN ca protein c bit protein l enzym ->

ri lon hng, tc v cng cc f/ m E xc tc.+pH nh hng:

- Receptor/ mng Tb (nhn bit v v.c cht qua mng TB)

- Hb & i lc gn O2 ca Hb- Acid nucleic (AND, ARN)- Di truyn.

- Khng th- bo v c th

- Hormon (HCH)


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Cc nguy c gy ri lon CBAB

S to thnh CO2, H2CO3:- CO2: Krebs & kh carboxyl ca amino acid (~ 200 ml/min).- CO2 kt hp vi nc, phn ly to H+ & HCO3-:CB ng

CO2 + H2O H2CO3 H+

+ HCO3-

Nu CO2 ko o thi -> nhim acid (cn bng -> phi). S to thnh acid HC, VC:

+ Chuyn ho G, L, P -> SPTG a s l acid1,3-DPG, a.pyruvic

RL:--> acid pyruvic, lactic, -Hydroxybutyric,-> nhim acid, RL cc CH -> xu hng nhim acid: acidose

Bnh l:

+ Bnh lm acid mu: - Tiu ng: acid cetonic/M


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Nguy c gy ri lon CBAB

+ Bnh lm kim mu:- Nn/ tc mn v, ht dch v DD: mt H+

- Dng qu nhiu thuc li niu.- Tim, truyn qu nhiu Nabicarbonat (sai .+:

pH mu M: 7,38

7,42 duy tr c do H+

= H+

o thi.=> CBAB thc cht l duy tr s n inh ion H+/ c th.

Cc c ch n nh CBAB:

1- H m (Ht, HCu).

2- H sinh l phi

3- H sinh l ca thn.


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Cc h m ca mu

KH2PO4/K2HPO4HHb/KHb,

HbO2

/KHbO2

( 35%)

H2CO3/KHCO3

(18%)

Hng cu

NaH2PO4/Na2HPO4Protein/Proteinat

natri

(10%)

H2CO3/NaHCO3

(35%)

Huyt

tng

PPhosphat

(1-2%)

Protein

(45%)

Bicarbonat

(53%)

H m

H m mu= H huyt tng + H Hng cu


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Vai tr ca cc h m/ iu ho CBAB H huyt tng:

* H m bicarbonat: H2CO3/ NaHCO3+ Quan trng: 35% DT/ c th, iu ho: nhanh, mnh.+ Cn bng ng: CO2 + H2O H2CO3 H

+ + HCO3-

+ Pt Handerson-Haselbalch:

pH = pK H2CO3 + log = 6,1 + log

+ C ch H: KM => Kim yu; Acid mnh => acid yu-> T- Kim (OH-) / M => Kim yu,XOH + H2CO3 XHCO3 + H2O, VD:NaOH + H2CO3 NaHCO3 + H2O.

- Acid (H+

) / M: RH + NaHCO3 RNa +H2CO3 (phn ly)VD: HCl + NaHCO3 NaCl +H2CO3 H2O

[HCO3- ]

[ H2CO3 ] 0.03. pCO2

[HCO3- ]

CO2Phi -> thi


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H m huyt tng

* H m protein:+ Cu to t cc A.A (COOH, NH2), c tnh lng tnh:

- COOH COO- + H+ ( + base) - chng li kim ho

- NH2 + H+ NH3+ - chng li acid ho.+ Chng li acid = a.a kim (Arg, Lys)/ NH2 + H+ NH3+.

+ Chng li kim = a.a acid (Glu, Asp)/ H+ + base (OH-).Vai tr m: ng k (60 80 g/l)

* H m phosphat (NaH2PO4/ Na2HPO4 )- Tt v c pK = 6,8 (~ 7,40).- Vai tr m: yu v c nng thp/ M (1 2 mmol/l)


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H m hng cu+ HC c H bicarbonat, phosphat nhng VT m ch yu do Hb

+ Hb c 2 H: HHb/ KHb & HHbO2/ KHbO2, m = 2 cch:1- To DX carbamin: NH2/ Hb + CO2 -> dx carbamin (5% CO2).

2- Nh hot ng ca nhn Imidazon/His:

Hb + O2 -> HbO2 + H+, H+ -> pH/ phi(*)

HbO2 + H+ -> HHb + O2 => H

+ -> pH/ TC (*)Vai tr m ca Hb l o thi CO2 cho c th -> chng acid ho (S )

K+HCO3- K+HCO3- K+HCO3-

H2CO3

H2OCO2

CA

KHbO2 KHbO2 KHbO2

CO2H2O

CA

O2

H2CO3

CA

HHb HHbHHb

H+

O2H+

K+K+HCO3

- HCO3-

M

Ch.ho Th ra

T chc Mu Phi

TM

Bt: CO2/TC = CO2 / Phi


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Phi iu ho CBAB

CO2

CO2 th raPhi

Mu

T chc

H+

HCO3 - +H

2

CO3

CO2

H2O

BT: CO2/TC = CO2/ phi

Nhim acid (H+ /M):

. TK phi (TS, B th)

-> o thi CO2 (chng acid)

. CO2 phi > CO2/ TC

Nhim base (OH- /M):

CO2

Mu

T chc

OH - HCO3

-

CO2

Phi

. TK phi (TS, B th) ->

o thi CO2

Tt: Phi o thi CO2, bn b, lintc => iu ho CBAB c hiu qu

Hn ch: k , TS, B th qu mc

CO2 + H2O H2CO3 H+ + HCO3-

. CO2 TC > CO2/ Phi


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Thn iu ho CBAB

* c im: chm, hiu qu mnh, duy tr HCO3-/H.t & DGB* Ti hp thu gn hon ton HCO3-: 90%/ TB L gn, 10% L xa.

TB ng ln gn Mao qunLng .T (NTB)

NaHCO3Na+ Na+Na+

K+K+

HCO3-

HCO3-

HCO3-

(90%)H2CO3

H2CO3

H2O +

H2O

CO2 CO2CO2

CA

H+H+E1

E2

E1- HCO3-.ATPase

E2- Na+,K+-ATPase

THT HCO3- : + PCO2 (CC b tr ca thn khi c th nhim base, acid h hp)

+ THT Na+/ TB ng thn.


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Thi H+, ti hp thu HCO3- ng ln xa

Lng T (NT u) TB ng ln xa Mao qun

HPO4--

Na+ Na+

K+

Na+

K+ K+

R

HCO3-

H2CO3

H2O CO2NH3

CO2

H+H+

H2 PO4-

RH

HCO3-

(~10%)

NH4+ Gln

E2 E1

GluGlutaminase

+ o thi H+: Acid (RH), mui amoni, mui phosphat+ Ti hp thu HCO3

- : ~ 10%+ Tn to HCO3-: : n bt-> 50- 100 mmol H+/ 24h/: H2SO4 (SPCH a.a S);

H3PO4 (SPTH ca P0-Lipid, acid nucleic); A.uric-(base purin) -> H+ .

H+ + HCO 3- -> Nguyn nhn mt HCO3-, b li? = Tn to HCO3 - ~ to NH4+


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Cc thng s nh gi trng thi cn bng acid- base

1. pH mu

2. PaCO2

3. Bicarbonat4. Bicarbonat thc ( Actual Bicarbonat = AB)

5. Bicarbonat chun (Standard bicarbonat = SB)

6. CO2 ton phn ( Total CO2 = t.CO2)

7. Base m (Bufer base = BB)

8. Base d (Base excess = BE)


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pH mu

pH mu/ M = 7,38

7,42.pH < 7,38 nhim acidpH > 7,42 - nhim basepH mu/TM < M 0,02

pH -> nh gi mc b tr ca c th:-Acidose: pH 7,38 7,42: b ton phn(nhim acid) 7,37 7,25: b 1 phn

< 7,25: mt b.-Alcalose: pH 7,38 7,42 : b ton phn(nhim base) 7,43 7,55: b 1 phn

> 7,55: mt b.+ pH < 7,30: Nhim toan h hp: ph qun ph vim

Nhim toan CH nng: T.+ pH > 7,55: Nhim kim h hp: CTSN

Nhim kim chuyn ho nng: a chy ko di..


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PaCO2, CO2 ton phn

: PaCO2 = 40 mmHg- Thng s cho bit cc ri lon CBAB do NN h hp

- Ph thuc thng kh ph nang: khi TKPN v ngc li.

BL: - nhim toan HH do o thi CO2 phi, gp:. Thng kh PN, tc nghn ph qun

. Bnh phi: PQPV, vim phi, hen

. Ht phi CO2, ht li Ko kh th

. B c ch TK: thuc ng, bi lit, nhim c, CTSN, u no t.CO2 = CO2 ha tan + CO2 carbaminat + CO2/bicarbonat

PaCO2-5% (+Hb)- 5% HCO3-- 90%

. : t.CO2 = 25 - 30 (mmol/l).t.CO2: Nhim toan h hp, nhim kim CH


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Bicarbonat ( HCO3-)

+ L lng HCO3- c trong H.T 37OC, gm B thc v B chun.- Bicarbonat thc (actual bicarbonat = AB):. L nng thc t HCO3- ca mu muM ly K ko tip xc vi ko kh,n tng ng vi pH v PaCO2 thc ca mu mu.

. : AB = 25 mmol/l.- Bicarbonat chun (standard bicarbonat= SB):

. SB: l lng HCO3- (mmol/l) ca h.t c qui v K chunnh PaCO2= 40 mmHg, T

o= 37oC, pH = 7,40.. : SB = 24 2 (mmol/l).

+ L TS cho bit RLCBAB lin quan ti NN chuyn ho.BL: HCO3-: NT h hp, NKCH: nn nhiu, ht dch DD, a chy: Nhim toan CH, gp:

. T do ng cc th cetonic

. Ph phi cp, ng kinh: RLCH glucid-> ng acid lactic.. Vim thn cp; mn: ko thi c acid

. a chy cp lm mt HCO3-

Base m (Buffer base BB) Base d (Base exess BE)


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Base m (Buffer base = BB), Base d (Base exess = BE)

Base m: L tng cc anion m trong mu (mmol/l).

BB = [HCO3-] + Protein- + Hb- + Phosphat-

: 46 - 48 (mmol/l) Base d: L s chnh lch gia BB ca BN v BB ca ngi bnh

thng.: BE = 0 (pH = 7,40; PaCO2= 40 mmHg; Hb TP = 150 g/l, 37OC).BE cng vi Bicarbonat l 2 TS c ngha xc nh nguyn nhn

RLCBAB do chuyn ho.

BE dng () gp: Nhim kim CH (nn nhiu, a chy ko di..)BE m () gp : Nhim toan CH (T..)Ch : + Cc TS: pH, PaCO2 - o = CCL

Cc TS khc: HCO3- (AB), t.CO2, BB, BE- tnh ton

+ Kt qu CBAB chnh xc khi:- Ly mu:. M (tr, quay,cnh tay), MM ho - u ngn tay, di tai. Dng c chuyn bit-> Mu ko tip xc vi ko kh.- My c chy chun, o ngay.


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Nhim toan h hp


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Nhim toan h hp

Ri lon khi pht lpCO2

do thi tr CO2

phi, gp:* Bnh phi: - P. Qun, ph vim

- Vim phi- Hen

- Kh thng phi* HCTK: - Thuc ng

- Bi lit

- CTSN, u no- Ri lon tun hon no* Ht phi CO2/ k.kh th* XN: pH (< 7,38)

pCO2 (> 40mmHg)HCO3- mu (> 25 mmol/l)t CO2 , cc TS khc t thay i


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Nhim kim chuyn ho

L trng thi tha Base hoc mt acid (ko phi l H2CO3)* Nguyn nhn:

+ Qu tha base: - qu nhiu bicarbonat (T)

- n ung: qu nhiu cht t/c kim+ Do mt acid: - Nn nhiu (HCL , K+ )

- Ht D.dy (Cl- ), a chy(H+ )

- Thuc li niu nhiu -> K+ * KQXN cc thng s:

- pH mu(> 7,5, mt b)

- pCO2 (> 40mmHg do thng kh )- HCO3- (> 25mmol/l) v tCO2, BB , BE


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Nhim kim h hp

Ri lon khi pht l pCO2 Gp: + Thng kh phi : - Giai on u vim phi

- St cao

- H hp nhn to qu mc

- CTSN

+ Th trong kh quyn c pCO2 thp (ln cao)

KQXN: - pH mu (> 7,42) (khi mt b)- pCO2 mu

- t.CO2

- BB

- BE (-)

Nhim toan chuyn ho


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Nhim toan chuyn ho

L s mt anion m- ch yu l HCO3

- mu&D ngbo; Tchlu cc acid C/ thc t l acid mnh m anion ca chng ko

th bi xut qua thn*KQXN - pH mu(< 7,24- mt b)

- pCO2 (f/ b tr ca phi)- t.CO2 Hoc bnh thng- SB - BB , BE (-)

- HCO3- * Gp: - tiu ng ( acid cetonic)

- RLCH Glucid: ng a.pyruvic, a.lactic- Tn thng thn: THT HCO3- RL => HCO3-

- T nhiu thuc li niu -> thi HCO3- => HCO3-

Nhim toan hn hp


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Nhim toan hn hp

L s kt hp nhim toan CH v h hp => pH mu* XN: - pH mu mnh

- p CO2- HCO3-

- SB va- BB - BE(-)

Nhim kim hn hpL kt hp ca nhim kim h hp v nhim kim chuynho => pH mu rt nhiu

* XN: - pH mu

- pCO2 t- HCO3- - SB : 34-36 mmol/l (bt 24mmol/l)

B QUC PHNG


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BQUC PHNGHC VIN QUN Y

CHUYN HO LIPID


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NNIIDUNGDUNGBBIIGIGINGNG

II CNGCNGI.I. TIUTIU HOHO,, HHPP THUTHU VV VVNN CHUYCHUYNN LIPIDLIPID

II.II. CHUYCHUYNN HOHO ACIDACID BBOO

2.1.2.1. -- OXYHOOXYHO ACIDACID BBOO NNO,O, CC CHCHNN ((--O/TKSGK)O/TKSGK)

2.2.2.2. TTNGNG HHPP ACIDACID BBOO (B(BOO TNGTNG,, TYTY

THTH))III.III. CHUYCHUYNN HOHO TRIGLYCERIDTRIGLYCERID

3.1.3.1. THOTHOII HOHO TGTG

3.2.3.2. TTNGNG HHPP TGTG

IV.IV. CHUYCHUYNN HOHO GLYCEROPHOSPHOLIPIDGLYCEROPHOSPHOLIPID//LECITHINLECITHIN

V.V. CHUYCHUYNN HOHO CCAA CCCC THTH CETONCETON


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IICNGCNGI.I. TIUTIU HOHO,, HHPP THUTHU VV VVNN CHUYCHUYNN LIPIDLIPID










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Hot chtsinh hc

Dung mi Bo v

Cu to

Nng lng

lipid

Vitamin A, D, E, K


46/675


II CNGCNGI.I. TIUTIUHOHO,,HHPPTHUTHUVVVVNNCHUYCHUYNNLIPIDLIPID









I. TIU HO, HP THU V VN CHUYN LIPID


47/675

,

TIU HA LIPID- Btut trng , ch yurutnon

A.mt, mui mt: - Nh tng ho lipid- Hat ho lipase


48/675

Cu trc ca nh tng

I. TIU HO, HP THU V VN CHUYN LIPID


49/675

TIU HA LIPID- Btut trng , ch yurutnonA.mt, mui mt: - Nh tng ho lipid

- Hat ho lipase

TG Glycerol + 3 a.bo

Cholesterol este CholesterolTD + a.bo

GlyceroPL Glycerol + a.bo + H3PO4+ Base nit

(Base nit: cholin, ethanolamin, serin, inositol)

Enzym: - lipase dch tu- 1 phn nh ca dch rut


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R2

R1

R3

R1R2

OH

TG.lipase

R3

COOH

DG.lipase

R

1

COOH OH

R2

OHng phn ho

TG DG MG MG

OH

R2

OH R2COOH

MG.lipase

OH

OH

OH

Glycerol

Sthuphn triglycerid

Triglycerid


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Sthuphn cholesterol ester ha

Cholesterol


52/675

CCuu trtrcc ccaaphospholipidphospholipid

HHppthuthu PHN CUI CA RUT


53/675

PHN CUI CA RUT

NON.

Hp t h u t do (a.bo < 10C, MG,glycerol,) NMRNTMCGan

Ti t bo NMRN

- Tip tc thu phnMG AB + Glycerol

-T i tng hp lipid(# G v P)

AcylCoA + glycerol TG

Cholesterol TD + a. bo Cholesterol E

AB + glycerol + H3PO4 + base nit

PL

VVnnchuychuynn


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T chc kh c(c,tim, thn)

acid bo t do

acid bo t doChylomicron VLDL

VLDL

Chylomicron VLDL

T chc m

Rut non Gan

Lipid ( tng hp)Lipid ( thc n)

4 dng vn chuyn lipoprotein:


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+ Chylomicron

+ LP c ttrng rt thp (VLDL - very low density lipoprotein)+ LP c ttrng thp (LDL - low density lipoprotein)

+ LP c ttrng cao (HDL - high density lipoprotein)

CCuu trtrcc ccaa lipoproteinlipoprotein

NNII DUNGDUNG BBII GIGINGNG


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II.II. CHUYCHUYNNHOHOACIDACIDBBOO

2.1.2.1. --OXYHOOXYHOACIDACIDBBOONNO,O,CC CHCHNN2.2.2.2. TTNGNG HHPP ACIDACID BBOO (B(BOO TNGTNG,, TYTY

THTH))

III.III. CHUYCHUYNN HOHO TRIGLYCERIDTRIGLYCERID3.1.3.1. THOTHOII HOHO TGTG




VI.VI. CHUYCHUYNN HOHO CCAA CHOLESTEROLCHOLESTEROL

II.II.CHUYCHUYNN HOHOACIDACIDBBOO


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2.1.2.1. --oxyoxy hohoAcidAcid bboo--OxyOxyhohoAB no, CAB no, Cchchnn

XXyy rara trongtrong tyty thth ccaa tt bboo

++ HoHott hoho AB:AB: ABAB ++ CoACoA + ATP+ ATP Acyl CoA + AMP ++ AMP + PPiPPiAcylAcylCoACoASyntethaseSyntethase

AMP + PPi

R-CH2-CH2-CH2-COOH Acid bo (n chn, no)

Acyl-CoASyntetase

HS-CoA ATP

Acyl-CoAR-CH2-CH2-CH2-CO~S-CoA

++ VVnn chuychuynn a.ba.boo tt bboo tngtng tyty thth


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--AcylAcylCoACoA ++ CarnitinCarnitin AAcylcyl--CarnitinCarnitin

--AcylAcyl--CarnitinCarnitin chuychuynn tt bboo tngtng tyty thth

-- GiGiii phphngng CarnitinCarnitin AcylCoAAcylCoA

Vn chuyn acid bo vo trong ty ththeo h thng vn chuynacyl-carnitin/carnitin

hh A lC AA lC A (( CC)) hh 44 hh


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++ -- oxyoxy hoho AcylCoAAcylCoA ((nCnC)) trongtrong tyty thth qua 4qua 4 phphnnngng

11.. KhKh hydrohydro llnn 11 ttoo..--DehydroDehydro AcylAcyl CoACoA

2.2. HHpp HH22OO ttoo--HydroxyHydroxy AcylAcyl CoACoA

3.3. KhKh hydrohydro llnn 22 ttoo--CetoCeto AcylAcyl CoACoA

4.4. PhnPhn cctt

--CetoCeto AcylAcyl CoACoA

AcylAcyl CoACoA (n(n--2)C +2)C + AcetylAcetyl CoACoA (2C)(2C)

ThiolaseThiolase

AcylAcyl CoACoA (n(n--2)C2)C --> 1, 2, 3, 4> 1, 2, 3, 4 -->>.. -->> AcylAcyl CoACoA (4C)(4C)AcylAcylCoACoA(4C)(4C)=> 2 Acetyl=> 2 Acetyl CoACoASn phm thuc: Acetyl CoA

+ Vng -Oxy ho


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+ Vng-Oxy ho

R-CH2-CH2-CH2-CO~S-CoA

R-CH2-CH=CH-CO~CoA

R-CH2

-CH-CH2

-CO~S.CoA

OH

R-CH2-C-CH2-CO~S.CoA

O

R-CH2-CO~S-CoA + CH3CO~S-CoA

Acyl-CoA DH

Acyl-CoA (n-2)C Acetyl-CoA

CoA.HS

-HydroxyacylCoA DH

Enoyl Hydrase

FAD+

FADH + H+

HOH

NAD+

NADH + H+

-CetoAcyl-CoA

-HydroxyAcyl-CoA

,-DehydroAcyl-CoA( Enoyl-CoA)

Thiolase

Acyl-CoA

(1)

(2)

(3)

(4)


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VngVng

xoxo

nn

LynenLynen

Feodor Lynen (c)1911-1979

GiGiii ththngngNobel 1964Nobel 1964

NGHNGHAA--OXYOXYHOHO ACIDACIDBBOO NNGNNG LLNGNG:


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NNGNNG LLNG:NG:

++ 11 VNGVNG--OXYOXY HOHO:: 5 ATP5 ATP-- FF//1: 1 FADH1: 1 FADH22 QUAQUAHHTBHHTB 2 ATP2 ATP-- FF//3: 1 NADH3: 1 NADH22 QUAQUAHHTBHHTB 3 ATP3 ATP

ATP =ATP = 5 ATP5 ATP++ OXYOXY HOHO HOHONN TOTONN 11 ACIDACID BBOOCC2N2NCC

-- SS VNGVNG--OXH:OXH: (N(N--1)1) ATP=ATP= 5(N5(N--

1)1)-- SSACETYLACETYL--COACOA:: NN ATP=ATP= 1212NN

ATP =ATP = 17N17N55TRTRII2ATP2ATP SSDDNGNGHOHOTT

HHAA

ATP =ATP = 17N17N77

CHUYCHUYNN HOHO::

++ --OxyOxy hohobutyric acidbutyric acid (2n=4C)(2n=4C)


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CH3-CH2-CH2-CO~S-CoA

CH3-CH=CH-CO~CoA

CH3

-CH-CH2

-CO~S.CoA

OH

CH3-C-CH2-CO~S.CoA

O

2 CH3-CO~S-CoA

Acyl-CoA DH

Acetyl-CoA

CoA.HS

-HydroxyacylCoA DH

Enoyl Hydrase

FAD+

FADH + H+

HOH

NAD+

NADH + H+

-CetoButyryl-CoA

-HydroxyButyryl-CoA

,-DehydroButyryl-CoA

( Enoyl-CoA)

Thiolase

Butyryl-CoA

(1)

(2)

(3)

(4)

y y

2n C = 4 n=2

SSvngvng--OXH:OXH:11

ATP=ATP= 55

SSAcetylAcetyl--CoACoA::22

ATP=ATP=12x2= 2412x2= 24

TrTrii2ATP2ATP hohotthhaa

ATP = 29ATP = 29


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NHN XT- OXY HO ACID BO

1. HOT HA ACID BOBO TNG.

2. VN CHUYN VO TY THTHEO HTHNG ACYL-

CARNITIN/CARNITIN.

3. - OXY HO TRONG TY THQUA 4 PHNNG:

KH-HP-KH-CT.

4. SN PHM THUC: ACETYL COA5. TNG SNNG LNG: 17N - 7



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II.II. CHUYCHUYNNHOHOACIDACIDBBOO


2.2.2.2. TTNGNGHHPPACIDACIDBBOO(B(BOOTNGTNG,,

TYTYTHTH))III.III. CHUYCHUYNN HOHO TRIGLYCERIDTRIGLYCERID


3.2.3.2. TTNGNG HHPP TGTGIV.IV. CHUYCHUYNN HOHO GLYCEROPHOSPHOLIPIDGLYCEROPHOSPHOLIPID//

LECITHINLECITHIN


2.2.2.2. TTngnghhppacidacid bboobbootngtng


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gg

++ NguynNguyn liliuu:: AcetylAcetyl--CoACoA// MalonylMalonyl--CoACoAE*E* v/cv/c nhnhmm acylacyl ((AcylAcyl Carrier ProteinCarrier Protein -- ACPACP))

CoECoE khkh NADPHNADPH22 (Pentose(Pentose--P) &P) & ff// tt a.malica.malic

+ V/c+ V/c tt tyty thth -->> BBoo tngtng:: nhnhcitratcitrat,, carnitincarnitin++ GGmm 66 ff//::

1.1. CarboxylCarboxyl hoho (+ CO(+ CO22)) AcetylAcetyl CoACoA MalonylMalonyl--CoACoA

2.2. V/c acetylV/c acetyl--CoACoA,, malonylmalonyl--CoACoA + E*+ E* AcetylAcetyl--EE** ++ MalonylMalonyl--EE**

3.3. NgngNgng tt,, loloii COCO22 AcetoacetylAcetoacetyl--EE** ((--CetoAcylCetoAcyl--EE**))4.4. AcetoacetylAcetoacetyl-- EE** khkh CCetoeto ttoo--HydroxyHydroxy ButyrylButyryl-- EE** ((OHOH/C/C))5.5. LoLoii HH22OO,, ttoo--DehydroDehydro AcylAcyl-- EE*

* ((CrotonylCrotonyl--EE**))

6.6. KhKh llnn 22 bobo hoho LK =,LK =, ttoo ButyrylButyryl EE** (4C).(4C).ff//cc llpp llii,, nnii ddii bbngng MalonylMalonyl--EE** AcylAcyl--EE** (C AcidAcid bboo (C(C


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MalonylMalonyl--CoACoA

AcetoacetylAcetoacetyl--EE**

AcetylAcetyl--EE**

--HydroxyHydroxyButyrylButyryl--E*E*

--DehydroDehydroAcylAcyl--E*E*

ButyrylButyrylE*E*

AcylAcyl--E*E*((C


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AcylCoAAcylCoA((C 16)

Ty th Mng ty th Bo tng

OxaloacetatOxaloacetat

KrebsKrebsHSCoAHSCoA

AB (C>16)AB (C>16)


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70/675





THTH))III.III. CHUYCHUYNNHOHOTRIGLYCERIDTRIGLYCERID



LECITHINLECITHIN


III.III.CHUYCHUYNN HOHO TRIGLYCERIDTRIGLYCERID


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3.1.3.1. ThoThoiihohotriglycerid(TGtriglycerid(TG)) ThuThuphnphnTG:TG:

+X+Xyy rara chch yyuu mm mm((gangan,, ththnn).).

++EnzymEnzym : lipase: lipase tutu

R2

R1

R3

R1R2

OH

TG.lipase

R3COOH

DG.lipase

R1COOH OH

R2

OHng phn ho

TG DG MG MG

OH

R2

OH R2COOH

MG.lipase

OH

OH

OH

Glycerol

+ TG+ TG Glycerol + 3 AcidGlycerol + 3 Acid bboo


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yy

+ AB:+ AB: -- OxyOxy hoho AcetylCoAAcetylCoA Krebs (ATP)Krebs (ATP)-- NguynNguyn liliuu ttngng hhpp TG, CholesterolTG, Cholesterol esteeste, PL, PL

+ Glycerol+ Glycerol titipp ttcc thothoii bibinn theotheo cccc k/nk/n::

SauSau::NgNgcc,,xuixuingngphnphn

Glycerol Glycerophosphat GAP DOA" P " " O "" iso "

" O "

GAP + DOAP F-1,6DP

Adolase

hoc

GAP ... Acid pyruvic AcetylCoA Krebs

Glucose hoc

PAK

3.2.3.2. TTngnghhppTGTG


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++ XXyy rarabboo tngtng ccaa TB/ (TB/ (gangan,, tt chchcc mm).).

++ NguynNguyn liliuu:: -- TT lipid: glycerol (TG), acidlipid: glycerol (TG), acid bbo/acylo/acyl--CoACoA

-- TT glucidglucid: DOAP, GAP: DOAP, GAP (sp(sp ngngphnphn))

++ CCcc ff//::

-- TToo glyceroglycero phosphatphosphat:: PP glycerolglycerol hohocc khkh DOAPDOAP

-- TToo a.a. phosphatidicphosphatidic tt ff//:: GlyceroGlycero--P +P + acylacyl CoACoA-- TToo diglyceriddiglycerid:: loloii HH33POPO44 ccaa a.a. phosphatidicphosphatidic

-- DiglyceridDiglycerid ++ Acyl.CoAAcyl.CoA TriglyceridTriglycerid

++ nghnghaa:: ttngng hhpp lipidlipid dd trtr chocho ccthth..

CH2OH

CHOH

CH2OH

CH2OH

CHOH

CH2O -P

CH2OH

C=O

CH2O -P

NAD NADH2ATP ADP

Glycerokinase Glycerophosphat-DH


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CH2OH CH2O P CH2O P

CH2O-COR1

CHO-COR2CH2O -P

CH2O-COR1CHO-COR2CH2OH

CH2O-COR1CHO-COR2CH2O-COR3

Acid phosphatidic

1,2-Diglycerid

Triglycerid

2RCO~CoA(AcylCoA)

2HSCoA

HSCoA

R3CO~CoA

Glycerophosphat

H2O

H3PO4

1

2

3

Glycerol DOAP

SS ttngng hhpp triglyceridtriglycerid



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3.2.3.2. TTNGNG HHPP TGTGIV.IV. CHUYCHUYNNHOHOGLYCEROPHOSPHOLIPID/GLYCEROPHOSPHOLIPID/

LECITHINLECITHIN


IV.IV. CHUYCHUYNNHOHOPHOSPHOLIPIDPHOSPHOLIPID(PL)(PL) Thoi ho PL (Lecithin/t chc)


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Thoi ho PL(Lecithin/tchc)

Lecithin

Lysolecithin

Glycerophosphorylcholin (~)

Glycerophosphat + cholin (?)

Phospholipase A

LysoPhospholipaseH2O

H2O

(~) esterase

R2COOH

R1COOH

H2O

Ncc rn: NP-Lipase Aqu cao ->LysoLecithin -> Peroxy ho mng TB ->

-> bn mng TB -> Tan mu


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CCuu trtrcc ccaaphospholipidphospholipid

H2C-O-C-R1Phospholipase BPhospholipase A

O

O


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R2

-C-O-CH

H2C-O-P-O-X

Phospholipase C Phospholipase D

Phospholipid

O

O

Sthuphn glycerophospholipid

Sthuphn lecithin

TTngnghhpplecithinlecithin(CS(CS--TK)TK)

T Base nit (Cholin Ethanolamin )


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Cholin

PhosphoCholin

XDP-Cholin

PhosphatidylCholin

(Lecithin)

ATP

ADP

XTP

PPi

XMP

Diglycerid

(CH3)3N+-CH2-CH2OH ( hoc Ethanolamin)

(CH3)3N+-CH2-CH2O- ( hoc P-ethanolamin)P

(CH3)3N+-CH2-CH2O-XDP ( hocXDP-thanolamin)

T Base nit(Cholin, Ethanolamin)

P

H.Ho

T acid Phosphatidic (Chyu, quan trng & ?)


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Acid Phosphatidic

XDP-diglycerid

Phosphatidyl cholin

(Lecithin)

Phosphatidyl serin

Phosphatidyl ethanolamin

XTP

PPi

XMP

Serin

CO2

S-Adenosyl methionin

S-Adenosyl homocystein

HOCH2-CHNH2-COOH (Serin)

CH2

O-COR1CHO-COR2

CH2O- - OCH 2 CHNH2-COOHP

+ CH3

p ( y q g )

1- GPL

2- GPL

3- GPL



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LECITHINLECITHIN

V.V. CHUYCHUYNNHOHOCCAACCCCTHTHCETONCETON

V.V.CHUYCHUYNNHOHOCCCCTHTHCETONCETON


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33 thth cetonceton:: AcetonAceton CHCH33COCHCOCH33

AcetoaceticAcetoacetic acid (CHacid (CH33COCHCOCH22COOCOOH)H)

-- hydroxybutyrichydroxybutyric acid (CHacid (CH33CCHHOOHHCHCH22COOH)COOH)

(2H)

-CO2

Oxyho:t chc (tim, c, no), cung cp NL (W)

*- Hydroxybutyrat (- H. Butyrat) :

- H.Butyrat

- H. Butyryl CoA AcetoacetylCoA 2 AcetylCoA

ATP AMP + PPi

HSCoA

NAD NADH2 Thiolase

O

Krebs

CoA

W

ThoThoiihohoccccththcetonceton

Acetoacetat: => AcetoacetylCoA- 2 cch:


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+ Hot ho (~ hot ho AB):

(CH3-CO-CH2-COOH) CH3-CO-CH2-CO~SCoA

ATP AMP + PPi

HSCoA

Acetoacetat AcetoacetylCoA

+ NhsuccinylCoA:

Acetoacetat AcetoacetylCoA

SuccinylCoA Acid Succinic

SuccinylCoA Acetoacetat transferase

Phn ct Acetoacetyl-CoA = 2 AcetylCoA -> Krebs --> W

TTngnghhppccccthth cetonceton(CS(CS--TK)TK)

--gangan,, ss/GK/GK:: -->>


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gg ,

-- AcetylAcetyl--CoACoA, AB, AB tt dodo

-- NADHNADH22

ThiokinaseATP CoA

Acyl-CoA

-Oxy ho

-Hydroxybutyryl-CoANAD

NADH2O

n (Acetyl-CoA)

2Acetyl-CoA

AcetoAcetyl-CoACoA

CoAH2O

HMG-CoA

H2OCoA

Acetoacetat

LyaseHMG-CoA

-Hydroxybutyrat

NADH2

NADDH

Krebs

CO2

Acid bo TD

2 AcetylCoAThiolase


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Aceton: : - Hm lng aceton rt thp/mu

- KhCO2tpht Acetoacetat

-> Aceton (ko

c ngha sinh l)

Acetoacetyl-CoACoA

HMG-CoA (.Hydroxy-Metyl- Glutaryl-CoA)

AcetylCoA

CoA

H2O

AcetylCoA

Acetoacetat

-Hydroxybutyrat

HMG-CoA Syntethase

HMG-CoA Lyase

K NADH

2NAD

ooththiiccccththcetoniccetonicacidacid


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+ : N cc th ceton/mu, NT rt thp

+ Bnh l: Gp/i ko di, tiung.

- Tng ceton mu:

Khi N ceton > kh nng O ca chng/t chc

-> Mu nhim acid (pH mu v NT )

- C ceton niu: pHNT < 5 (: pHNT 5-8)

Aceton thi qua phi -> hi thc mi aceton/N.trng nng



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LECITHINLECITHIN


VI.VI.CHUYCHUYNNHOHOCCAACHOLESTEROLCHOLESTEROL VaiVaitrtr


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TTngng hhpp acidacid mmtt,, mumuii mmtt

++ GanGan: NL: NL -->> TTngng hhpp a.Ma.M tintin

phpht(Litocholic,chenodeoxycholict(Litocholic,chenodeoxycholic).).

+ AM+ AM theotheo mmtt -->> rurutt --> T/h> T/h a.Ma.M thth phphtt:: a.cholica.cholic,, a.deoxycholica.deoxycholic

(tiu(tiu hoho lipid). 1lipid). 1 phphnn a.Ma.M theotheo mmuu vv gangan -->> chuchu trtrnhnh RuRutt--GanGan.. T/h hormon: H steroid v thng thn, tuyn sinh dc... T/h Vit. D3: nhnh sng mt tri

Cholesterol => tin vita D3 -> t/h Vita D3 Bi tit theo phn:

Cholesterol (T, mt) di t c dng ca vi khunng rut bini

thnh cholestanol, rio thi theo phn. EsteEste hoho

EsteEste hoho++ tt chchcc: (: (gangan,, vv ththngng ththnn,, rurutt non): Cholesterolnon): Cholesterol


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+ huyt tng: nhlecithin cholesterol transferase (LCAT)

Cholesterol TD Cholesterol este

Lecithin Lisolecithin

LCATP/ to cholesterol este t cholesterol TD c tc dng chng XVM.

LCAT ( gan b tn thng) => cholesterol este ho ->

-> Choles este/ Choles TP.

esteeste hohocc ththcc hihinn nhnhff// chuychuynn acylacyl::

Cholesterol TD

Acyl CoA HS CoA

Acyl CoA cholesterol transferase

Cholesterol este

TTngnghhppcholesterolcholesterol

+ gan (ch yu), v thng thn, rut, da, tinh hon


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+ NL: ch yu t Acetyl CoA (acetoacetat, alhydric acid)

+ Coenzym cn thit: NADPH2

+ Gm: 35 f/ Enzym, chia 3 giaion:- G1: T/hp acid Mevalonic t Acetyl-CoA

- G2: To Squalen (30 C) t acid Mevalonic

- G3:ng vng Squalen (-3C) to Cholesterol

+ Bnh thng: Cholesterol TP = 3,9 4,9 mmol/l.

tui, gii..+ Bnh l:/XVM

iiuuhohottngnghhppcholesterolcholesterol


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HMG-CoA

Mevalonat

Cholesterol

HMG-CoA-ReductaseCholesterol T.(-)

(-)

Acetyl-CoA

(> 5,2 mmol/l)


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Bi ging

TS. Phan Hi Nam

CHUYCHUYN HON HO GLUCIDGLUCID******ii cngcng

I ChI Ch hh GlGl


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I.ChuyI.Chuynn hoho GlucoseGlucose1.1.1.1. ThoThoii hhaa:: ngng phnphn:: YYmm khkh,, ii khkh.. ChuChu trtrnhnh PentosePentose phosphatphosphat VngVng UronicUronic acidacid1.2.1.2. TTngng hhpp:: TnTn ttoo GlcGlc ttpyruvatpyruvat vv cccc chchtt khkhcc..

TTngng hhpp GlcGlc ttccccngngnn (Ms)(Ms) khkhcc..II.II. ChuyChuynn hoho GlycogenGlycogen2.1.2.1. ThoThoii hhaa2.2.2.2. TTngng hhpp

III.III. ngng mmuu vv cccc ccchchiiuu hahangng mmuu3.1.3.1. NguNgunn ggcc,, nnngng GlcGlc mmuu bbnhnh ththngng3.2.3.2. CCcc ccchchiiuu haha GlcGlc mmuuRRiilolonnchuychuynnhohoglucidglucid

TiuTiuhoho::

I CNGI CNG


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-- MMtt phphnnmimingng nhnhamylaseamylase nncc bbtt..

-- ChCh yyu/ruu/rutt non: Enon: E ddchch tutu ((chch yyuu), 1), 1 phphnn ccaa ddchch rurutt..

--GlucidGlucid::DisaccharidDisaccharid(Maltose, lactose,(Maltose, lactose, SaccharoseSaccharose))PolyPoly--rid (rid (TinhTinhbbtt, Glycogen), Glycogen) --> Ms (> Ms (GlcGlc,, GaGa, F,M), F,M)

HHppthuthu::

++ TTcc khkhcc nhaunhau:: GaGa > G > F > M.> G > F > M.++ HHpp thuthu ttrurutt nonnon -->> mmuu: 2: 2 ccchch::

-- KhuKhuchch ttnnnn giginn (F, M):(F, M):

TheoTheo gradiengradien nnngng (C(C caocao --> C> C ththpp),), kkoo ccnn NL.NL.-- VVnn chuychuynn ttchch cccc:: GaGa,, GlcGlc. Do. Do chnhchnh llchch NaNa++

trongtrong vv ngongoii TBTB vv hohottngng ccaa NaNa++,K,K++-- ATPaseATPase..

DIDIN BIN BINN

1.11.1PP YYmmkhkh--HexosediphosphatHexosediphosphat::

K/NK/N:: LL qqaa trtrnhnh OO glucose/glucose/ thithiuu OO22 chchtt uu tintin ll GlcGlc/ G/ G PP


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K/NK/N:: LL qqaa trtrnhnh OO glucose/glucose/ thithiuu OO22,, chchttuu tintin ll GlcGlc/ G/ G--PPvv SPCCSPCC ll acid lactic. 2acid lactic. 2 giaigiaioonn (11(11 ff..).).

GG11: 2: 2 llnn phosphorylphosphoryl hoho GG --> DOAP, GAP (5> DOAP, GAP (5 ff..).).

++ff..1:1: PhosphorylPhosphoryl hoho GG llnn 1:1: ccnn ATP,ATP, hexokinasehexokinase//glucokinaseglucokinase++ ff.. 2:2: ngng phnphn hoho GG--6P fructose6P fructose--66 phosphatphosphat (F(F--6P)6P)++ff.. 3:3: phosphorylphosphoryl hoho llnn 2, F2, F--6P6P --> F> F--1,6DP;1,6DP; ccnn ATPATP thth2,2,

PP--fructokinasefructokinase -- EE dltdlt: ADP, AMP: ADP, AMP hohott hohoATPATP vv CitratCitrat nnngng caocaocc chch..

++ ff..4:4: phnphn cctt FF--1,6DP = DOAP + GAP,1,6DP = DOAP + GAP, nhnh aldolasealdolase..

++ ff.. 5:5: ngng phnphn hoho DOAP = GAP.DOAP = GAP.

GG22:: OxyOxy hoho GAPGAP -- PyruvatPyruvat-->> LactatLactat (6(6 ff..))

++ ff 6: GAP6: GAP bb oxyoxy hoho bbii GAPDHGAPDH ttoo 1 31 3 DPGDPG ((1 31 3


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++ ff.. 6: GAP6: GAP bb oxyoxy hoho bbii GAPDHGAPDH ttoo 1,31,3--DPGDPG ((1,31,3--Diphosphoglycerat)Diphosphoglycerat)-- (LK ~/C(LK ~/C11)) vv NADHNADH22..++ ff..7:7: cctttt l.kl.k (~),(~), ccnn PP--glyceratkinaseglyceratkinase ::

1,31,3--DPG 3P--G +G +ATPATP++ ff.. 8:8: ChuyChuynn 3P3P--G = 2G = 2--PG,PG, glyceromutaseglyceromutase++ ff..9:9: loloii HH22O, 2O, 2--PG =>PG => P.E.PP.E.P ((cc l.kl.k ~~/C/C22))

P.E.PP.E.P == PhosphoPhospho EnolEnol PyruvatPyruvat

++ff..1010:: P.E.PP.E.P cctttt l.kl.k ~~ ttoo ATPATP vv PyruvatPyruvat,, pyruvatkinasepyruvatkinase++ ff.. 11:11: khkhPyruvatPyruvat =>=> LactatLactat,, ccnn LDH,LDH, vv NADHNADH22

((SS -->)>)

Hexokinase(Glucokinase)

F- 6P2

G - 6P

GLUCOSEATP

ADP1

G1: 2 ln Phosphoryl


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S: NG PHN YM KH (EMBDEN- MEYERHOF)

P-fructokinaseF- 6P

GAPDOAP

4

5

2-PG

8

F-1,6DP

ATP3 ADP

3-PG

ADP7 ATP

LactatLDH

11Pyruvat

ADPATP10Pyruvatkinase

G1: 2 ln Phosphorylha : G-> GAP

G2: OGAP..-> Lactat

1,3-DPG

NADNADH2

6 Pi

P.E.P

9 H2O

CH2OH

CH2O-PG-6P

ATP

Glucose

G1: 2

ln P G-

1

1-Hexokinase/Glucokinase

(-)


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OCH2O-P

F-6P

F-1,6DP

ATP

ln P G-> 2 GAP

G2:

OGAP

--->Lactat

3

C=O

CHO

CH2O-PCHOH GAP

DOAP

5

P-OH2C

CH2O-P

CH2OH1,3-DPG

3-PG

2-PG

P.E.P

Pyruvat

O=CO~PCHOHCH2O-P

COOHCHOHCH2O-P

HCO-PCOOH

CH2OH

O

H2O

CH2O-P

ATP

ATP

CO~PCOOH

CH2

CO

CH3

COOHCOOH

CH3

HCOHLactat

LDH

3 -P.fructokinase

(Edlt)

10-Pyruvatkinase

( )

ADP

ADP

NAD

NADH2

PhngPhng trtrnhnh TQ:TQ:

NGNG PHNPHN YYMM KHKH ((EMBDENEMBDEN--MEYERHOFMEYERHOF))


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PhngPhng trtrnhnh TQ:TQ:Glucose + 2 ADP + 2 Pi 2Glucose + 2 ADP + 2 Pi 2 LactatLactat + 2 ATP+ 2 ATP

nghnghaa::

++ NngNng llngng: G: Glucoselucose -->> 2 ATP,2 ATP, GlucosylGlucosyl/ Glycogen/ Glycogen --> 3 ATP> 3 ATP

-- tt,, nhngnhng ll ququ trtrnhnhduyduynhnhtt ttoo NLNL chocho ccthth//thithiuu OO22..

++ ThThcc titi

nn: Lao: Lao

ngng vv

ii c

c

ngng

caocao =>=> acid lactic =>acid lactic =>

cc

chch ththnn kinhkinh cc,, llmm chocho ccthth,, bbppauau nhnhcc..

** PP YKYK:: ss,, didinn bibinn vv nghnghaa??

* 3 ATP* 3 ATP ttGlucosylGlucosyl/glycogen?/glycogen?

NGNG PHNPHN II KHKH

GiGingngPP""yymmkhkh":": 1010 ff..:: GlucoseGlucose ------>> pyruvatpyruvat..

KhKhcc:: OO pyruvatpyruvat ttoo acetylCoAacetylCoA sausau acetylCoAacetylCoA => Krebs=> Krebs


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KhKhcc:: OO pyruvatpyruvat ttoo acetylCoAacetylCoA,, sausau acetylCoAacetylCoA => Krebs=> Krebsoxyoxy hoho hohonn totonn = CO= CO22 + H+ H22OO vv NADHNADH22, FADH, FADH22 -->>

ii vvoo chuchuii HHTB => NLHHTB => NL

PyruvatPyruvat-->>AcetylCoAAcetylCoA::++ f/hf/haa EE PyruvatPyruvat--dehydrogenasedehydrogenase::

-- PyruvatPyruvat DH (EDH (E11))-- DihydrolipoylDihydrolipoyl transacetylasetransacetylase (E(E

22))

-- DihydrolipoylDihydrolipoyl DH (EDH (E33))+ 5+ 5 CoECoE: NAD, FAD,: NAD, FAD, CoACoA;; ThiaminThiaminpyrophosphatpyrophosphat (vitamin B1)(vitamin B1)

& acid& acid lipolipoicic linlin kktt vvii nhaunhau = LTPP= LTPP

PhPhnnngngTQ:TQ:PyruvatPyruvat AcetylCoAAcetylCoA KrebsKrebs

PyruvatPyruvatDHDH

NAD NADH2

CoACoA

LTPPLTPP

DIDINN BIBINN

QuQu trtrnhnh ggmm 55 f/f/::

f/f/1: Oxy1: Oxy hoho,, khkhCOCO22 ccaa PyruvatPyruvat ttoo f/hf/h EnzymEnzym-- AcetalAcetal vv COCO22::


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yy ,, 22 yy yy 22CHCH33COCO--COOH + ECOOH + E11--TPPTPP ----> E> E11--TPPTPP--CHOHCHOH--CHCH33 + CO+ CO22

f/f/2: E2: E-- acetalacetal kktt hhpp vvii acidacid LipoicLipoic "O""O" ttoo AcetylAcetyl --E2,E2, --> E1> E1--TPP:TPP:

EE11--TPPTPP--CHOHCHOH--CHCH33 + E+ E22--LL EE22--LL + E+ E11--TPPTPP

f/f/33:: AcetylAcetyl--E2E2 kktt hhpp vvii CoACoA ttooAcetylCoAAcetylCoA && ttoo acidacid lipoiclipoic "K":"K":

EE22--LL ++ HSCoAHSCoA CHCH33CO~SCoACO~SCoA ++ EE22--LL

f/f/4: "O" acid4: "O" acid lipoiclipoic "K""K" nhnhEE33 ttoo FADHFADH22,, --> a.> a. lipoiclipoic "O":"O":

EE22--LL + E+ E33--FAD EFAD E22--L + EL + E33--FADHFADH22

f/f/5:5: KhKhEE33 --FADH2FADH2 ttooNADHNADH22 && gigiii phphngng EE33--FAD:FAD:

EE33--FADHFADH22 + NAD E+ NAD E33--FAD + NADHFAD + NADH22

S

S

SH

S~CO-CH3

SH

S~CO-CH3

SH

SH

SH

SH

S

S

F- 6P

G - 6P

GLUCOSE(6C)Hexokinase ATP

ADP1

2

1


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SS::NGNG PHNPHN II KHKH

GAP (3C)

1,3-DPG

3-PG

DOAP

F-1,6DP

2-PG

Acetyl CoA Pyruvat

P.E.P

P-fructokinase ATP

ADP

ADPATP

NADNADH2

3

45

6

7

8

9

10

ADP

ATP

Krebs

NADNADH2

(11A)(11A)

CoACoA

PyruvatPyruvatDHDH

H3PO42

2

NGHNGHAA

1.1. PP"" ii khkh "":: CungCung ccpp NL >NL > nhinhiuu soso vviiPP "" YYmm khkh "" --hh 38 ATP38 ATP tt 1 l 39 ATP1 l 39 ATP tt l ll l/ l/ l


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1.1. PP ii khkh :: CungCung cc pp NL >NL > nhinhiuu soso vvii PP YYmm khkhchocho 38 ATP38 ATP tt1 glucose, 39 ATP1 glucose, 39 ATP ttglucosylglucosyl/glycogen/glycogen

ff//11--10: 2 ATP10: 2 ATP

ff//6: 2NADH6: 2NADH22 6 ATP6 ATPff//11A: 2 NADH11A: 2 NADH22 6 ATP6 ATP

22 AcetylCoAAcetylCoA 24 ATP24 ATP

38 ATP38 ATP

2.Cung2.Cung ccpp cccc SPTGSPTG quanquan trtrngng: a.: a. PyruvicPyruvic,, AcetylCoAAcetylCoA..

3.3. ThThcc titinn:: bboo ququnn ggoomm bboo vita Bvita B11,, trtrnhnh thithiuuddii ngngyy cc thth gygy nnnn phph..

Krebs

KhKhiininimm:: LL QT "O"QT "O" trtrcc titipp ccaa glucose (Gglucose (G--6P)6P)cc iimm::

ChuChutrtrnhnh pentosepentose phosphatphosphat ((HexoseHexosemonophosphatmonophosphat))


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QQ pp g (g ( ))cciimm::++ GlcGlc khngkhng bb phosphorylphosphoryl hoho llnn 2,2, mm GG--6P6P bb "O""O" ttoo COCO22,,

PentosePentose--5P5P vv NADPHNADPH22..

++ XXyy rara:: bboo tngtng TB,TB, hohottngng mmnhnhtt chchcc mm,,tuytuynnththngng ththnn,, t/ct/c phiphi,, tuytuynn ssaa vv gg sinhsinh ssaa..

++ GGmm 22 gg::--GG//11: Oxy: Oxy hoho,, khkh COCO22 ttoo RibuloseRibulose--5P5P (Ru(Ru--5P5P):):GG--6P6P 66--Pgluconolacton 6Pgluconolacton 6--PgluconatPgluconat RuRu--5P5P

G6PDH: GG6PDH: G--6PhosphatDH; PGD6PhosphatDH; PGD--P.gluconatP.gluconatDHDH

--GG//22:: BiBinnii khngkhng OO Pentose PhosphatPentose PhosphatGG--6P ban6P ban uu. 2. 2 ff//transcetolasetranscetolase ((v/cv/c nhnhmm 2C)2C). 1. 1 ff//transAldolasetransAldolase ((v/cv/c nhnhmm 3C)3C)

-->> ttoo 5G5G--6P ban6P ban uu ((theotheoss))

NADPNADPH2

NADPH2O

G6PDHNADPH2

CO2

6.G-6P

6.6Phosphogluconolacton

6.6Phosphogluconat

6NADPH2

6NADP

6NADP

G6PDH

H2O G1:

O, kh CO2


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6.Ru-5P

2.Xy-5P 2.Xy-5P2.Ri-5P

2.Se-7P 2.G.A.P

2.F-6P 2.Er-4P

2.F-6P2.G-6P

2.G-6P

2.G.A.P

F-1,6DP

F-6P

G-6P5.G-6P

Transaldolase

Transcetolase

Transcetolase

2 G.A.P

6NADPH2CO2

ChuChutrtrnhnh PentosePentose phosphatphosphat

O , kh CO2

->Ri-5P, Xy-5P

G2:

Bini koO

-> G-6P banu


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NGHNGHAACHUCHUTRNHTRNHPENTOSEPENTOSEPHOSPHATPHOSPHAT

11 nghnghaa quanquan trtrngng nhnhtt ll:: cungcung ccpp NADPHNADPH2--


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1.1. nghnghaa quanquan trtrngng nhnhtt ll:: cungcung ccppNADPHNADPH22--

CoEnzymCoEnzym khkhccnn thithitt ttngng hhpp::

+ Acid+ Acid bboo ((--> TG, PL..)> TG, PL..)

+ Cholesterol (Acid+ Cholesterol (Acid mmtt, MM,, MM, CholesCholes esterester hoho).).

2.2. CungCung ccpp RiboseRibose--5P:5P:TTngng hhpp acid nucleicacid nucleic ((cc bibitt quanquan trtrngng trongtrong mm hoho vv

thngthng tintin didi truytruynn).).

VNGVNG ACIDACID URONICURONIC VV ACIDACID ASCORBICASCORBIC

XXyy rara:: --ngng vvtt:: tt bboo gangan,, bboo tngtng TBTBTh


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-- ThThcc vvtt..GGmm 33 giaigiaioonn:: ((SS))

--TToo acidacid glucuronicglucuronic ttGG--6 P (QT6 P (QT nhnhtt))-- BiBinnii LL--GulonatGulonat => acid ascorbic/=> acid ascorbic/ ththcc vvtt-- TToo xyxy--5P5P tt LL--GulonatGulonat,, sausau XyXy--5P => G5P => G--6P ban6P ban uu..

nghnghaa::

-- CungCung ccpp acidacid glucuronicglucuronic:: linlin hhpp vvii bilirubinbilirubin TDTDttoo BiliBili LH (LH (vaivai trtr LHLH khkhc/ganc/gan).).

-- TTngng hhpp vitamin Cvitamin C ((ththcc vvtt).).

A ascobic

2 Ceto-L- gulonolacton

GulonolactonO2

2 H2

H O

Thc vt


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Glucose-1P

Vng Uronic Acid

Glucose-6PG

H2O

NAD+NADH

L-Gulonat

K

L-Xylulose

L-Xylitol

D-Xylulose

D-Xylulose-5PVng Pentose-P

ATPADP

NAD+

CO2

NADPH

NADP

NADH

NAD+O

.Vt

3 Ceto gulonat

NADH

O

H2O

D-GlucuronatUDP

NAD+

UDP-Glucuronat

NADH

O

UTP

UDP-GlucosePP


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TTNGNG HHPP GLUCOSEGLUCOSE

TTSPTGSPTG ccaa vngvng KrebsKrebs vv cccc aminoacidaminoacid sinhsinhngng::

-- OxaloacetatOxaloacetat llchchttmangmang ccaa KrebsKrebs vv ll titinn chchtt ccaaPEP.PEP. VV vvyy tttt cc cccc SPTG KrebsSPTG Krebs nhnh -- cetoglutaratcetoglutarat,,


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succinylCoAsuccinylCoA...... uu cc ththcc tntn ttoo glucoseglucose (ho(hocc glycogen).glycogen).-- CCcc aminoacidaminoacid cc khkh nngnng bibinnii = SPTG= SPTG ccaa vngvng

KrebsKrebs

uu cc thth

tt

oo glucoseglucose nh

nhAla, AspAla, Asp ((T

ATA**), Val..), Val..

TTcccc oseose khkhcc::-- fructose:fructose:

Fructose

GAP

Glucose

G-6P

F-6P

DOAP

F-1,6DP

Glycogen

F-1P

ng phn

Hexokinase

Fructokinase

+ ATP+ ATP

TTNGNG HHPP GLUCOSEGLUCOSE--TTMannose:Mannose:

Mannose Mannose-6PHexokinase

IsomeraseATP ADP


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--TTGalactoseGalactose::

thithiuu GUT =>GUT => ngng vv nhinhimmcc GaGa--1P1P ((bbnhnhGaGahuyhuytttrtrsssinhsinh).).

GlucoseGlucose-6PFrutose-6P

Isomerase

GalactoseGalactokinase

Galactose-1P

UDP-Galactose

Glycogen G-1P G-6P

UTP PPi

Galactouridyltranferase

UTP

UDP-Glucose

UDP-Glucose

PPi Glucose-1P

Glucose

CHUYCHUYNN HOHO GLYCOGENGLYCOGEN

** ThoThoii bibinn glycogen:glycogen:


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* ThoThoiibibinnglycogen:glycogen:

-- XXyy rara chch yyuugangan vvcc..

-- SPSP ttoo: glucose: glucose hohocc GG--1P1P-- GGmm 33 giaigiaioonn::

11--PhnPhnccttglycogen:glycogen:--TToo GG--1P:1P:

3 E (3 E (phosphorylasephosphorylase aa, E, E chuychuynn,, vv EE cctt nhnhnhnh..QuQu trtrnhnh phnphn cctt glycogenglycogen cc thth minhminh hoho nhnhsausau::

THOTHOII HOHO GLYCOGENGLYCOGEN

O

Glycogen


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O

OO

O

OOOOO

O

O

O

O

O

O

O

OO

O

OO

O

O

O

O

O

O

O

O

O

O

OO

O

O

O

O

O

O

OO

O

O

O

O

O

OOO

O O

OOO

O

O

O

O

O

OO

O

G-1PPhosphorylase a E chuyn E ct nhnh Phosphorylase a

NGHA (HM): KHIM -> PHN CT GLYCOGEN DTR GA

G-1P

THOTHOII HOHO GLYCOGENGLYCOGEN

22--TTooGlucoseGlucose--6P:6P:

Glucose-1P Glucose-6PPhosphoglucomutase


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33--TTooGlucoseGlucosettdo :do :

** TTngnghhppglycogen.glycogen.

NguynNguynliliuu::

--gangan:: tt glucose,glucose, cccc ms.ms.--cc::chchttglucose.glucose.

GGmm33giaigiaioonn::

11--TTooUDPUDP--glucose:glucose:

Glucose-6P Glucose-6Phosphatase

GlucoseH3PO4H2O

Glucose-6PGlucose Glucose-1P UDP-GlucoseATP ADP

PPiUTPHexokinase

TTNGNG HHPP GLYCOGENGLYCOGEN

22--TToommchchththngng: Glycogen: Glycogen SyntethaseSyntethasexxccttccff//::UDP Glucose + (C H O ) UDP + (C H O )


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33--TToommchchnhnhnhnh::

KhiKhi cc >10>10 ggcc glcglc nnii vvii nhaunhau bbii l.kl.k(1(1 -- 4);4); nhnhenzymenzym"g"gnn nhnhnhnh"" ll 1,41,4 -- 1,61,6 transglucosidasetransglucosidase..

EE "g"gnn nhnhnhnh-- EE cc khkh nngnng cctttt l.kl.k (1(1 -- 4)4) vv vvnnchuychuynn 11 oonn osidosid ccaa mmchch nnyynn CC66 ccaa glucoseglucose ccaa mmchchkhkhcc =>=> mmchch nhnhnhnh (t(too LKLK (1(1 -- 6)6) mmii).).

UDP-Glucose + (C6H10O5)n UDP + (C6H10O5)n+1Glycogen mi

TTNGNG HHPP GLYCOGENGLYCOGEN

O

O

OO

O

OO

O

O

O

O


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O

O

O

O

O

O

O

O

O

O O

OO

O

O

OO

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

O

Glycogen syntetase E gn nhnh

(1,4)

(1,6)

(1,4)(1,6)

(1,6)

UDP.G

Glycogen mi Glycogen

(1,4)Glycogen

(1,4) v(1,6)

NGHA (HM): KHIM -> TNG HP GLYCOGEN DTR

GAN -> M

NGNG MMUU VV CCCHCHIIUU HOHONGNG MMUU

KN:KN:MM LLngng khkhcc trongtrong mmuu,, mm chch yyuu ll GlucoseGlucose mmuu11--NguNgunnggcc..

++ NgoNgoii sinhsinh:: TT glucidglucid ththcc nn hohocc timtim truytruynn


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++ NgoNgoii sinhsinh:: TTglucidglucid ththccnn hohocc timtim truytruynn..++ NNii sinhsinh:: -- TTphnphn cctt glycogenglycogen gangan// cc..

-- TTququ trtrnhnh tntn ttoongng:: ttpyruvatpyruvat,, ttlaclac tat,tat, ttSPTGSPTGvngvng Krebs.Krebs.

22--NNngngngngmmuu:: (gi(giii hhnn bbnhnh ththngng,, llccii))-- NNngng GlcGlc mmuu btbt::4.44.4 --6.16.1 mmol/lmmol/l (0.8(0.8 -- 1.11.1 g/lg/l))-- SauSau khikhinn: 1.2: 1.2 -- 1.31.3 g/lg/l;; khikhiii < 0.7< 0.7 g/lg/l..

33--CCccccchchiiuuhohoM:3M:3-- GanGan,, hormonhormon,, ththnn** GanGan::

-- KhiKhi NN glucoseglucose mmuu btbt:: gangan ll nini cungcung ccpp glcglc chocho mmuu..-- KhiKhi glucoseglucose caocao:: ssgigiii phphngng glcglc vvoo mmuu ngngngng llii,, vvmmcc caocao thth

gangan ssddngng glcglc =>=> ttngng hhpp glycogen (glycogen ( GlcGlc/M)./M).

-- KhiKhi glucose Mglucose M:: gangan phnphn cctt glycogenglycogen --> glucose> glucose chocho mmuu (( GlcGlc/M)./M).

NGNG MMUU VV CCCHCHIIUU HOHONGNG MMUU

**

HormonHormon

::

++ HormonHormonmm:: InsulinInsulin (tu(tu):): HormonHormon llmmgigimm glcglc mmuu, do:, do:


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-- TngTng nhnhpp glcglc vvoo tt bboo (( ttnhnh ththmm vv v.cv.c ttchch cccc).).

--

ssddngng glcglc ((gangan):): ccmmngng EE "ch"chtt"" PP =>=>

ngng phnphn..--cc chch cccc E"chE"chtt"" ccaa sstntn ttoongng (4) =>(4) => ttoongng..

=>=>gigimm(()) ngngmmuu..

++ HormonHormon llmm

MM::AdrenalinAdrenalin (tu(tu ththngng ththnn),), glucagonglucagon (tu(tu),), ACTH, TSH, STHACTH, TSH, STH hohott hoho

phosphorylasephosphorylase thngthng quaqua AMPvAMPv.... vv theotheo ccchch hhnhnh bbcc thangthang llmmngngmmuu..

** ThThnn::

-- THT 100%THT 100% glcglcngng llnn ggnn nnuuMM < 9,5< 9,5 mmol/lmmol/l (NT).(NT).

-- ThThii glucoseglucose theotheo nncc titiuu nnuu ngng mmuu > 9,5> 9,5 mmol/lmmol/l ..

Adrenalin, GlucagonACTH, STH, TSH Prostaglandin

CCCHCH IIUU HOHONGNG MMUU


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Adenylatcyclase

ATP AMPv ( ) + P.Pi

Phosphorylase a

G-1PGlycogenPhosphorylase b

Phosphorylase Kinase(h)

Proteinkinase(koh)

Proteinkinase(h)

Phosphorylase Kinase(koh)

4ADP4ATP

4H2O H3PO4

+

Glc


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Pros

taglandinAdrenalin, GlucagonACTH, STH, TSH

+

CCH IU HONG MU


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Adenylatcyclase

Proteinkinase(koh)

Proteinkinase(h)

Phosphorylase Kinase(h)

Phosphorylase Kinase(koh)

+

ATP AMPv + P.Pi

Phosphorylase aPhosphorylase b

4ADP4ATP

4H2O H3PO4

G-1P-->Glycogen G

NPNP tngtngngng mmuu theotheo PPPP uungng NghiNghimm phphpp dungdung nnpp glucose (WHO 1998):glucose (WHO 1998):

++ ChChnhnh:: GlcGlc MM llccii: 6,1: 6,1-- < 7,< 7, bbtt kk:: 7,87,8-- 11,111,1 mmol/lmmol/l+ Glucose+ Glucose niniuu (+).(+).


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++ NgNgii cc nguynguy ccTT:: chacha mm bbTT,, sinhsinhii ccngng trtrngng++ BBnhnh nnii tititt cc linlin quanquannnTT..++ LiLiuu llngng:: NgNgii llnn-- 75g /25075g /250-- 300 ml300 ml nnc/uc/ungng/ 5/ 5 phphtt..++ ThThii giangian:: BuBuii ssngng,, sausau 1212-- 14h14h nhnhnnii..++ LLyy mmuu: 2: 2 ththiiiimm:: -- TrTrcc khikhi uungng GlcGlc (0h)(0h)

-- SauSau khikhi uungng 2 h.2 h.++ KKtt ququ:: --TT khikhi glcglc mmuu 11,111,1 mmol/lmmol/l..-- RNDNGRNDNG khikhi glcglc mmuu: 7,8: 7,8 -- 1111 mmol/lmmol/l..-- DungDung nnpp: < 7,8: < 7,8 mmol/lmmol/l..


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NGHIM PHP DUNG NP GLUCOSE


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BB

iigigi

ngng


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chuychuynn hoho protidprotid && a.na.n

Ts.PhanTs.PhanHHiiNamNam

NNI DUNGI DUNG::

ii cngcngI.TiuI.Tiu hoho vv hhpp thuthu


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I.TiuI.Tiu hoho vv hhpp thuthuII.ChuyII.Chuynn hoho amino acidamino acid

** KhKhaminamin oxyoxy hoho** TraoTraoii aminamin (GOT,GPT) &(GOT,GPT) & linlin quanquan** VngVng ureure vv nghnghaa..

........IIIIII.. ChuyChuynn hoho HbHbIV.IV. ChuyChuynn hoho acid nucleicacid nucleic

I.I. TiuTiu hoho && hhpp thuthu..

CCcc protidprotid TATA bb 22 loloii Peptidase:Peptidase:++ EndoEndopeptidasepeptidase ((E1E1):): chch phnphn cctt l.kl.k peptidpeptid//


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p pp p (( )) pp p pp ppolypeptidpolypeptid == mmnhnh peptidpeptid llnn..

++ ExoExopeptidasepeptidase ((EE22):): chch phnphn cctt a.aa.auu NN--ttnn ((carboxycarboxypeptidasepeptidase && aminoaminopeptidasepeptidase).).-- EE11 phnphn cctt polypeptidpolypeptid ddii == peptidpeptid nhnh hnhn-- EE22 phnphn cctt cccc peptidpeptid ---->SPC>SPC chch yyuu ll a.aa.a ttdodo && cccc didi--,, tripeptidtripeptid -->> hhpp thuthu/TBNM/TBNM rurutt nonnon

1.11.1 TiuTiu hoho::++ dd ddyy: 1ph: 1phnn nhnhpepsin,pepsin, thuthu phnphncc hihiuu cccc l.kl.k peptidpeptid

ccaa cccc a.aa.a TyrTyr,, PhePhe-->>mmnhnh peptidpeptid llnn vv ss a.aa.a ttdodo

++ rurutt non:non: chch yyuu,, cccc enteroenteropeptidasepeptidase hohott hohoTrypsinTrypsinogenogen ((koko hh) =>) => trypsintrypsin ((hh);); -->> chymotrypsinchymotrypsin ((hh),),C b id


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CarboxypeptidaseCarboxypeptidase..CCccEEphnphnccttprotein =protein =a.aa.a,,peptidpeptid

1.2.1.2. HHpp thuthu::++ CCcc a.aa.a ttdo:do: v.cv.cttchchcccc quaqua nimnim mmcc RN.RN.

++ CCcc peptidpeptid::DiDi-- vv tripeptidtripeptidcc v.cv.c ccngng NaNa++ vvoo tt bboo,, chchngng bbphnphn cctt == cccc a.aa.a rriicc v.cv.c =>=> mmuu..

II. CHUYII. CHUYN HON HO AMINO ACIDAMINO ACID

2.1.2.1. ThoThoii hoho chungchung ccaa cccc a.aa.a::2 1 12 1 1 KhKh aminamin


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2.1.1.2.1.1. KhKhaminamin..

-- LL ttchch --NHNH22 rara khkhii cccc a.aa.a. SP. SP chungchung ccaa KAKA--NHNH33..-- cc 44 kikiuu KA:KA:KAKAthuthuphnphn, KA, KAkhkh(hydro), KA(hydro), KAnniiphnphntt, &, &chchyyuu llKhKhaminamin --oxioxihoho (K A(K A--O)O)

**KhKhaminamin --oxioxihoho::22gg..oonnGG..11:: khkh hydrohydro ttoo acidacid iminimin nhnhEE dehydrogenasedehydrogenase..

GG.. 22: Acid: Acid iminimin thuthu phnphn tt phphtt = acid= acid --cetoniccetonic vv

NHNH33..

R-CH-COOH

NH2

R-C-COOH

Aminoacid

[O]R-CO-COO

H2ONH3

NH2

+ NH

3Flavin

-cetoacid

FlavinH2

Imino.acid

Glu l acid duy nht K A-O trc tip -> NH3 v-Cetoglutarat:


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Glutamat

GLDH

NAD(P) NAD(P)H 2

-Cetoglutarat + NH 3

GLDH: - cty th v bo tng ca t bo gan. V- l E dlt: GDP, ADP hot ho, & GTP, ATP c ch- CoE: NAD (chyu) & NADP.

- hotng mnh, tiu tn t nng lng


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R1-CH-COOHNH2

R1-CO-COOH

aminoacid I N

O = C - H

HO

H3C

CH2OPO32-...Enz

CH2OPO32-...EnzHO

H2N - C - H

aminoacid II

NH2

R1-CH-COOH

R1-CO-COOH

Transaminase


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CC 22 transaminasetransaminase quanquan trtrngng nhnhtt -- GOT,GPTGOT,GPT::GOT:GOT: GGlutamatlutamat OOxaloacetatxaloacetat TTransaminaseransaminase::

ASTAST/ GOT/ GOT

AspAsp ++ --cetoglutaratcetoglutarat GluGlu ++ OxaloacetatOxaloacetatGPT:GPT: GlutamatGlutamat--pyruvatpyruvat--transaminasetransaminase..

ALTALT/GPT/GPT

AlaAla ++ --cetoglutaratcetoglutarat GluGlu ++ PyruvatPyruvat nghnghaa: XN GOT, GPT: XN GOT, GPT trongtrong lmlm ssngng....

-cetoacid I2 3

H3CN

-cetoacid II

MMii linlin quanquangigiaaTT vvkhkhaminamin ((giginntitipp):):

PhPhnn llnn a.aa.auu KAKA--OO giginn titippqua TAMqua TAM,, vv lldo :do :

-- GluGlu ll a.aa.a duyduy nhnhtt khkhAA--OO mmnhnh vv cc llii vv nngnngllngng vv hohott ttnhnh ccaa GLDHGLDH mmnhnh..


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-- CCcc OxidaseOxidase hohottngng yyuu vv KAKA--OO cccc aminoacidaminoacid

ththngng sinhsinh rara chchttcc (NH(NH33).).

NH3

Transaminase GLDH

Cetoglutarat

L-Glu tamat-Cetonic acid

Aminoacid

NAD(P) + H2O

NAD(P)H2+

S :

2.1.3.2.1.3.KhKhcarboxylcarboxyl ((-- COCO22))

K/N:K/N:

LL

q.tq.t

cc

cc

aminoacidaminoacid

khkh

COCO

22 tt

oo

aminamin

tngtng

ngng

((phph bibinnngngii, E, E-- decarboxylasedecarboxylase, CoE, CoE--B6):B6):AminoacidAminoacid COCO22 ++ AminAmin (R(R--CHCH22 --NHNH22))

Nhi i h h i h h V d


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NhiNhiuu aminamin cc hohott ttnhnh sinhsinh hhc.Vc.Vdd::

* His* His -->>histaminhistamin ((gingin mmchch, co, co cctrntrn vv ttnhnhththmm ththnhnh mmchch).).** GABAGABA ((amino butyric acid)amino butyric acid)

GluGlu -->> GABA + COGABA + CO22

((-- AAmino butyric acid)mino butyric acid)VaiVaitrtr:: --cc chch ddnn truytruynnXTKXTK ccaa nono vv tutu ssngng

(TKTW).(TKTW).-- ChuyChuynn hoho NLNL ccaa nono// thithiuu OO22 ((nhnhnhnh thngthng

GABA/365)GABA/365)-- GABAGABA --> co> co gigitt..

+ Serotonin:+ Serotonin:++ TrpTrp 55--hydroxyTrphydroxyTrp SerotoninSerotonin (5(5-- HydroxyHydroxy

tryptamintryptamin))VaiVaitrtr:: -- CC linlin quanquan ttii QTQT ngng && trtrnhnhccmm xxcc..-- cc chch TK (TK (cc ttcc ddngng ccaa tete && thuthucc gygy mm

O2 - CO2


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cc chch TK (TK (cc ttcc ddngng ccaa tete && thuthucc gygy mm

khkh

cc).).

-- GyGy coco ththtt mmchch nhnh..-- LL chchtt bboo vv phphngng xx (+(+ggcc ttdo &do & nhnh hhngng

trntrn hh hhpp tt chchcc).).

((TrpTrp -->> TryptaminTryptamin + CO+ CO22 , DOPA, DOPA-->> DopaminDopamin + CO+ CO22).).

2.1.4.2.1.4. SSphphnnccaaAmoniacAmoniac (NH(NH33):):

NHNH33 ttoo ththnhnh:: chch yyuu tt khkh NHNH22 ccaa cccc a.aa.a,, mmtt phphnn

ccaa basebase purinpurin,, ll mmtt chchttccii vvii ccthth..

11-- TToo glutaminglutamin -- ddngng vvnn chuychuynn ccaa NHNH33::


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11 TToo glutaminglutamin ddngng vvnn chuychuynn ccaa NHNH33::

NHNH33ttooththnhnht.ct.c,,kktthhpp vvii GluGlu -->>glutaminglutamin,,ccnnATP:ATP:GlutaminGlutaminsyntethasesyntethase

GluGlu + NH+ NH33 + ATP+ ATP GlutaminGlutamin + H+ H22O + ADP + PiO + ADP + Pi

GlutaminGlutamin,,kokocc,,theotheommuu-->>gangan,,ththnn..--gangan: NH: NH33 ((cc))ttooththnhnh -->>ttngnghhpp ureure ((kk cc))

--ththnn: NH: NH33ccddngngttooamoniamoni (NH(NH44++))--> NT> NT

--nono::ssttooththnhnhglngln llconcon ngngchchnhnhgigiiiccNHNH33..

22-- TTngng hhpp urur ((VVngng urur).).

-- XXyy rara::chchyyuugangan ((ththnn,, phphii,, nono))-- NguynNguyn liliuu: NH: NH33, CO, CO22((-- COCO22 ccaa a.aa.a & Krebs), 3 ATP& Krebs), 3 ATP

C f


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CCcc ff..ccaa vngvng urur::

++PP..11:: TTngng hhpp carbamyl.Pcarbamyl.P ttCOCO22, NH, NH33, ATP, ATP

++PP..22:: Carbamyl.PCarbamyl.P ++ OrnitinOrnitin -->> CitrulinCitrulin,, nhnhOCT.OCT.

++PP..33:: CitrulinCitrulin + Asp =>+ Asp => ArginosuccinatArginosuccinat (( ATPATP,, MgMg++++

))++PP..44:T:Tooargininarginin ((aarginosuccinatrginosuccinat -->> ArnArn ++ FumaratFumarat))

++PP..55:: ThuThu phnphn argininarginin ttoo urur vv ornitinornitin..


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NGHNGHAA ::

-- TToo ureure ll concon ngng chchnhnhgigiiicc NHNH33// ccthth..

:: UreUre// mmuu = 3 3= 3 3 6 66 6 mmol/lmmol/l ; LS: 2 5; LS: 2 5 7 57 5 mmol/lmmol/l


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:: UreUre// mmuu = 3,3= 3,3 6,66,6 mmol/lmmol/l ; LS: 2,5; LS: 2,5 7,57,5 mmol/lmmol/l

NT = 250NT = 250 500500 mmol/lmmol/l..-- KhiKhi suysuy gangan,, ttngng hhpp urur, NH, NH33// mmuu vv cc thth -->>

hnhn mm ((hnhn mm gangan do NHdo NH33).).

-- KhiKhi suysuy ththnn,, oo ththii urur,, ureuremmuu,, ureure NTNT,, TLTLurur=>XN NH=>XN NH33 mmuu,, urur mmuu vv NTNT cc gigi trtr trongtrongbbnhnh gangan,, ththnn..

2.2. SINH T2.2. SINH TNG HNG HP AMINO ACIDP AMINO ACID ((TKGKTKGK).).

2.2.1.T2.2.1.Tngng hhpp amino acidamino acid koko ccnn thithitt..TTccccchchtttrungtrunggiangianccaa vngvngKrebs:Krebs: GluGlu,, GlnGln++ GlutamicGlutamic acidacid ((GluGlu):):


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-Cetoglutarat + NH 3

NADPH2 NADP

GLDH

GLu

+ Glutamin ( Gln):

Glutamin SyntetaseGlutamin

ATP ADP +Pi

Glu + NH3

**AlaninAlanin, Aspartic acid,, Aspartic acid, asparaginasparagin

+ Ala, Asp+ Ala, Asp:: SSttoo ththnhnhAlaAla, A, Asp (sp (TAMTAM):):GPT:GPT: GluGlu ++ pyruvatpyruvat Ala +Ala + cetoglutaratcetoglutarat

GOT:GluGOT:Glu ++ oxaloacetatoxaloacetat AspAsp ++ cetoglutaratcetoglutarat


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pp gg

++ AsparaginAsparagin ttAspAsp tngtng ttGlnGln** SerinSerin vvglysinglysin::

++ SerinSerin:: tt33--PGPG -->> hydroxypyruvathydroxypyruvat::

HydroxypyruvatHydroxypyruvat ++ AlaninAlanin SerinSerin ++ PyruvatPyruvat++ GlysinGlysin:: ttff..carboxylcarboxyl hhaa serinserin ::COCO22+Serin+2H+Serin+2H+

+ + FH+ FH44 22 glysinglysin+ H+ H22O + 5,10O + 5,10--methylenmethylen--THFTHF

( FH( FH44 = acid= acid tetrahydrofolictetrahydrofolic ))

++ CysteinCystein:: MethioninMethionin -->> SerinSerin++ TyrosinTyrosin:: ttPhePhe ::

Ph O2

NADPH 2 NADP

T i H O


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Phe + O2 Tyrosin + H 2O

2.2.2.Tng hp amino acid cn thit- TKGK

III. CHUYN HO PROTEID - HB3.1. THOI BIN CA HB.

HC (120 ngy)/VNM (TX,Gan, Lch..): Hb-> Bilirubin

1- O mvng, loi CO: to Vecdoglobin1


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S thoi bin ca Hb v chu trnh rut-gan ca bilirubin

2- Loi Fe +2, globin: to Biliverdin (xanh),

3- Khbiliverdin (+2H): -> Bilirubin (vng)

1

2

3

++ hhththngngvngvngnniimm ((ttyy xxngng,, gangan,, llchch..)..)

-- SauSau ~120~120 ngngyy HCHC chtcht HbHb -->>BilirubinBilirubin

-- LoLoi COi CO nhnhoxidaseoxidase ttoo VerdoglobinVerdoglobin ((ccnn FeFe2+2+ vv globinglobin))-- TTchch FeFe2+2+ vv globinglobin ttoo biliverdinbiliverdin (Fe(Fe2+2+ -- ccthth ssdngdng lli,i,

ccnn globinglobin --> amino acid).> amino acid).


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gg ))

-- BiliverdinBiliverdin bb khkhttoo bilirubinbilirubin ((TD,vTD,v

ngng

,,

cc), E), E-- reductasereductase..-- KhiKhi bilirubinbilirubin TD/TD/ HtgHtg > 25> 25 mol/ l =>mol/ l => vvngngdada..

** nghnghaa XNXN bilirubinbilirubin -->> chchnn oonn phphnn bibitt bbnhnh vvngng dada ::

-- Do tanDo tan mmuu:: BiliBili TDTD ,, BiliBili TPTP ,, BiliBili niniuu ((--))

-- Do tDo tcc mmtt:: BiliBili LHLH ,, BiliBili TPTP ,, BiliBili niniuu (+),(+), phphnn trtrng.ng.--VD doVD do gangan:: BiliBili TDTD ,, BiliBili LHLH ,, cc bilibili niniuu,, stercobilinstercobilin phphnn

++ ChuChu trtrnhnh rurutt--gangan ccaa BiliBili::

((BiliBili + a.glucuronic0/Gan+ a.glucuronic0/Gan -->> BiliBili LHLH -->> rurutt::

11 phphnn bb oxy hooxy ho-->> urobilinogenurobilinogen,, stercobilinogenstercobilinogen,,

11 phphnn theotheo TMCTMC vv gangan => t=> too chuchu trtrnhnh RR--GG ccaa bilirubinbilirubin

3.2.3.2. TTngnghhpphemoglobin.(CShemoglobin.(CS--TKGK)TKGK)


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S tng p Hb

ChuyChuynn hhaa acid nucleicacid nucleic::

* TB* TB purinpurin ((nucleotidnucleotid):):

AMP

GMP

Guanosin

AdenosinH2O

H2O

Pi

Pi

H2O

NH3Nucleotidase

Nucleotidase

AdeninDeaminase


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Guanosin

H2O

H2O

H2O

H2O

Inosin

Hypoxanthin (ceto)Guanin

Xanthin (enol)

RiboseRibose

H2O2+ O2

+ O2

H2O2

NH3

NH3

H2O

Acid uric

Xanthinoxidase

Guanindeaminase

NucleotidaseNucleotidase

Xanthinoxidase

NGH NGHAA THOTHOI BII BINN PURINPURIN(NUCLEOTID):(NUCLEOTID):

Acid uricAcid uric ll SPTHSPTH cucuii ccngng ccaa purinnucleotidpurinnucleotid,, GuaninGuanin,, AdenosinAdenosin-- BBnhnh ththngng: Acid uric: Acid uric mmuu :: 180180-- 420420 mol/lmol/l,,

NT: 3,6 mmol/24hNT: 3,6 mmol/24h


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-- Acid uricAcid uric mmuu,, cctrngtrng chocho bbnhnh Gout.Gout.Do acid uricDo acid uric mmuu,, tinhtinh thth mumuii uraturat natrinatri-- tt tantan ,, nnuungng::

.. cccc khkhpp nhnh ((ngngnn chnchn ccii..)..) -->> vimvim,, auau khkhpp..

.. ththnn gygy ssii ththnn,, ssiingng tititt niniuu..

.. ddii dada -->> nntt phphngng vimvim nhinhimm..


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S thoi bin ca Pyrimidinnucleosid (CS-TK)

NGH NGHA:A: ((CSCS--TKTK))

ThoThoii bibinn Pyrimidinnucleosid to-Alanin, NH3; BAIB:

+ -Alanin: tham gia cu tao CoA+ NH3 (Uracil, Thymin), CO2 -> Tng hp ure/gan.+ BAIB (-Aminoisobutyric acid) ::


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( y )

-- BAIB bbii tititt theotheo nncc titiuu:: sausau khikhinnTT gigiuumm......- Bnh nhn K iu tr = ho cht / chiu x --> bbii tititttheotheo nncc titiuu.

=> Xcnh BAIB c th nh gi s i mi ca ADN/Thymidin nucleotid.

QuQu titi

QuQu mmnhnh pp llmm mm ii


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QuQu mmnhnhpp llmm mmii

XnXn xaoxao ccnhnh nn chnchn trtrii llaa reoreoSngSng llngng mm trongtrong veoveo

HoHongng hnhn mymy ttmm lnglngoo nhnhpp nhnh

CC mmtt ququ hnghng trongtrongaa raurau mumungng lulucc

ThTh

hoá sinh y học tác giả: phan hải nam, bùi bá minh, Đoàn trọng phụ,.. nguồn gốc:...

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