Bilirubin. Cov cai ntawm nws cov ntsiab lus. hom ntawm daj ntseg

Tag nrho cov neeg muaj ib qhov nqi ntawm muaj bilirubin nyob rau hauv cov ntshav. Cai nws yuav tsum tsis ntau tshaj 17.1 mmol / L. Tej zaum tej lub sijhawm tshwm sim thaum uas lub bilirubin nyob rau hauv lub cev yog ua nyob rau hauv ntau dua tus xov tooj tshaj yuav ua tau ib noj qab nyob zoo siab nyob rau hauv lag luam. Sawv bilirubin cov ntsiab lus zaum kuj yuav vim rau lub siab puas tsuaj, uas tej zaum yuav cuam tshuam nrog rau cov feem ntawm bilirubin. Ntxiv thiab, thaum plugging biliary siab maj mam thiab nyob rau hauv me me qhov ntau muab bilirubin. Cov cai ntawm nws cov ntsiab lus nyob rau hauv cov ntshav yog ua zoo tshaj. Qhov no mob yog hu ua hyperbilirubinemia. Nyob rau hauv no bilirubin yog sau nyob rau hauv lub cev mus rau ib tug predetermined concentration, thiab ces penetrates cov ntaub so ntswg, muab nws ib tug daj xim. Qhov no mob yog hu ua daj ntseg.

Nyob rau hauv thiaj li yuav ntau dua thiab raug to taub daj ntseg yuav tshwm sim rau txhua yam vim li cas, koj yuav tsum xub xyuas seb yuav ua li cas yuav ua li cas cov kev pauv ntawm bilirubin. Bilirubin los ntawm lub heme, uas lub cev yog tsuas yog pom raws li hemoprotein. Hemoglobin tso thaum lub sij hawm lwj ntawm mature ntshav liab, yog tus tseem ceeb tshaj plaws qhov chaw ntawm bilirubin (70-80%). Cov seem ntawm bilirubin nyob rau hauv kwv yees li sib npaug zos qhov chaw tsim los ntawm hemoglobin tsis paub qab hau erythrocytes thiab lawv precursors nyob rau hauv lub hlwb pob txha thiab heme-muaj enzymes xws li catalase, cytochrome, thiab lwm yam Nyob rau hauv cov ntaub ntawv no, 250-400 mg -. Yog tag nrho cov nyiaj nyob rau hauv uas yog tsim nyob rau txhua hnub nyob rau hauv ib tug neeg laus tib neeg bilirubin. Tej thaum lub sij hawm ntawm kev tsom xam - Performance index ntawm 0.2-1.0 mg / dL.

Yog hais tias lub bilirubin muaj nyob rau hauv ntshav tshaj ib tug pib, ces tus daj ntseg. Qhov no tshwm sim vim hais tias cov bilirubin, uas ho dhau tshaj ntawm lub cai, pib sib txuas lus nrog cov elastic fibers ntawm daim tawv nqaij thiab conjunctiva. Raws li cov mechanism ntawm nws tsim daj ntseg yog ntawm peb hom:

1. Hemolytic (los yog suprarenal).
2. Siab parenchymal kev puas tsuaj tshwm sim los ntawm (hepatocellular).
3. Vim raug yuam biliary ib ntsuj av tau rhuav txhua (obstructive los yog txhua yam).

Hemolytic daj ntseg yus muaj los ntawm ntau daim ntawv unconjugated bilirubin, los yog ib tug stagnation nyob rau hauv lub cev. Cov ntshav tag nrho bilirubin nce vim unconjugated. Cov Kev Kuaj Zis bilirubin yog tsis tuaj kawm ntawv ntawm tag nrho cov. Qhov no yog piav los ntawm lub cev tsis muaj unconjugated bilirubin txeem los ntawm lub raum lim, uas yog tsis puas. Hemolytic daj ntseg yuav tau los hemolytic ntsoog, malaria, intravascular hemolysis kev txiav txim ntawm toxins, vitamin B12 deficiency, thiab ntshav ntawm incompatible ntshav. Nce theem ntawm unconjugated bilirubin yuav nrog Gilbert lub syndrome. Cov neeg uas muaj no syndrome yog yuav luag ib txwm sau tseg nyob rau hauv nws daj txheej thiab daim tawv nqaij. Yog vim li cas rau qhov no yog lus dag nyob rau hauv lub fact tias lub siab yog tsis muaj peev xwm mus ntes tau, faib thiab conjugated kua tsib hlab ntsha bilirubin.

Thaum parenchymal daj ntseg nce li ob conjugated thiab unconjugated bilirubin. Cov uas keev ua qhov teeb meem no yuav ntxhov los ntawm tus clearance los ntawm cov ntshav ntawm unconjugated bilirubin feem nyob rau hauv cov kua tsib cuam tshuam cov hlab ntsha conjugated bilirubin los ntawm mob hlwb li zoo li ingress ntawm conjugated bilirubin hepatic kua tsib coob ntshav hlab ntsha, los ntawm cov puas mob hlwb. Nyob rau tib lub sij hawm kom ntau ntau cov bilirubin nyob rau hauv lub ntshav ntshiab yog nrog los ntawm ib qho kev nce rau hauv nws cov feem rau hauv cov zis. Txawm li cas los, nyob rau hauv thaum ntxov ua sawv ntawm tus kab mob nyob rau hauv cov zis bilirubin yog yuav luag txiav txim siab, yog li xws li ib tug xeem yuav tsis tau hu ua thaum ntxov kuaj mob.

Daj ntseg los hepatic biliary ib ntsuj av tau rhuav txhua, impaired outflow kua tsib los sis tag kaw ntawm lub channel tsib (qog, o, Pob zeb li al.). Nrog rau qhov no hom ntawm daj ntseg hepatic hlab ntsha ncav us txog vim hais tias accumulates nyob rau hauv lub siab kua tsib, hepatocytes pib nyem thiab dhau mus rau hauv lub ntshav hlab ntsha conjugated bilirubin. Cov cai nyob rau hauv cov ntshav ntshav nce, thiab yog hais tias kuv ntau tshaj cov permissible raum pib (txog 30 mmol / l), lub bilirubin tshwm nyob rau hauv cov zis.