Bi tiu lun

TRNG I HC DUY TNKHOA DC

BO CO THC HNH HA SINH CN BN

Gio vin hng dn :Ths H Vit Hiu.Nhm:: Lp:BCG 201 F2.Thnh vin : Phan Vn So Th Ngc TrmNg Th Ngc Trmo Thy Phng Uyn

Nng, thng hai, nm 201510

BI 2XC NH HOT CA ENZYME.A. Mc tiu:- Nm c phng php o quang v ng dng.- nh lng sGOT, sGPT, Amylase.B. Ni dung thc hnh:*Th nghim 1. Xac inh hoat sGOT(ASAT) ,sGPT(ALAT) trong huyt thanh.*1.Nguyn tc: -Transaminase la enzyme co nhiu tim,thn,rut va c bit gan. -Enzyme tham gia vao qua trinh chuyn amin manh nht la : +GOT (Glutamate Oxaloaxetate Transaminase)hay ASAT(Asparate Aminotransferase),c xac inh da trn phan ng: L-Aspartate +Ketoglutarate=>Oxaloacetate+L-Glutamate Oxaloacetate +NADHH+ =>L-Malate + NAD+ *MDH:Matlat dehydrogenase +GPT(Glutamate Pyruvate Transaminase) hay ALAT(Alanine Aminotransferase) Alanine + Ketoglutarate=>Pyruvate + L-Glutamate Pyruvate + NADHH+ => L-Latate + NAD+ *LDH:Latate dehydrogenase -Tri s binh thng: Gii tinhASAT(GOT)ALAT(GPT)

Nam13-46 U/L11-59 U/L

N11-39 U/L9-37 U/L

-Ty s Deritis (ASAT/ALAT)=1-1.3 -Nhng yu t gy bin thin sinh hoc: +Yu t gy giam:thiu vitamin B6 +Yu t gy tng:thuc iu tri tiu ng,giam au co tht,chng thng phong,tr tin,chng ng kinh,nga thai.*2.Cac bc tin hanh: -o bc song 340 nm(334-365nm) -Nhit :30oC,37oC -oc i chiu vi nc ct -Trong ng nghim cho vao: thuc th:500.10-6 l Huyt thanh :50.10-6 l -Trn u va sau o u 1 phut,oc gia tri*3.Kt qua :*Nam:Chi sBinh thng(U/L)Gia tri thc t(U/L)

ASAT(GOT)13-4626.29

ALAT(GPT)11-5915.90

Hnh nh cho kt qu th nghim :

*N :Chi sBinh thng(U/L)Gia tri thc t(U/L)

ASAT(GOT)11-3941.77

ALAT(GPT)9-3725.15

*Hnh nh cho kt qu th nghim :

*4.Nhn xet,kt lun:Hai ch s ny nam nm trong gii hn cho php, n ch s GOT hi cao hn so vi bnh thng,do bn n cn i xt nghim tng qut c c kt qu chnh xc hn. ngha hai ch s ny v mt lm sng : Trong cc bnh v gan: khi c tn thng t bo nhu m gan, c GPT v GOT u tng trong huyt thanh. Nhng ty theo din tn thng v mc tn thng m GOT v GPT thay i khc nhau.Trong trng hp tn thng gan nng nh vim gan nhim c hay x gan, ung th gan, khng nhng t bo b tn thng m c ty th cng b tn thng. Cho nn trong trng hp ny GOT tng nhiu hn GPT.Trong trng hp vim gan virut cp, din tn thng rng nhng mc tn thng khng su ( ch tn thng mng t bo) cho nn GPT tng cao hn GOT.V vy vic xc nh hot GOT v GPT khng nhng c ngha trong chn on m cn c ngha theo di iu tr v tin lng bnh gan.Trong bnh nhi mu c tim, t bo c tim b ph hy cng gii phng nhiu GOT ra huyt tng. Cho nn xc nh hot GOT cng c tc dng gp phn chn on nhi mu c tim. Tuy nhin GOT ch tng sau cn au u tin khong 6-12h v tang cao nht khong 36-48h sau nhi mu c tim.Mt s nguyn nhn hay gp lm tng nng men gan bao gm nhng nguyn nhn ti gan v nguyn nhn ngoi gan nh:- Vim gan cp do bt k nguyn nhn g u lm men gan tng c bit l tng rt cao, gp 7-8 ln tr ln.- Vim gan mn tin trin, vim gan dn n x gan do ru, cht c, thiu dng, ung th gan.- Tc ng mt do giun, si; vim ty, tc rut, vim d dy cp cng lm tng men gan nhng mc tng khng nhiu nh trong vim gan.- Cc bnh truyn nhim nh st rt, si, st xut huyt, nhim trng mu... trong giai on ton pht cng lm tng men gan.- Ngoi ra cn rt nhiu bnh mn tnh khc hay do iu tr thuc, ch n ung khng iu , ung nhiu bia ru cng lm thay i men gan so vi bnh thng.

*Th nghim 2: Xc nh Alpha Amylase huyt thanh.1. Nguyn tc:- Alpha Amylase huyt thanh l mt nhm enzyme thy phn tinh bt c ngun gc t tuyn ty.- Tr s bnh thng ca Alpha Amylase trong huyt thanh l t 20 n 220U/L 370C.- Amylase tng trong vim ty, gim trong mt s trng hp tc ng dn ty.- Nguyn tc: 5CNPG3 Alpha Amylase 3 CNP + 2 CNPG2 + 3 G3 + 2G CNPG3 : 2-Chloro-4Nitrophenyl-Manltotrioside CNP : 2-Chloro-4Nitrophenol Cng mu ca CNP t l vi nng Alpha Amylase.2. Cch tin hnh: Thuc th : dung dch RGT pha sn Mu th : huyt thanh. Bc song o : 400 n 410 nm Nhit phng th nghim : 250C n 370C c i chiu vi nc ct:Cho vo ng o (Cuvet)370C

Mu th (Huyt thanh)5l

Thuc th RGT500l

Trn u, cho vo my o v c kt qu sau 5 pht.3. Kt qu th nghim :Nam197,6 U/L

N199,8 U/L

*Hnh nh cho kt qu th nghim:

4.Nhn xt nh gi kt qu th nghim v kt lun:Gi tr thc nghim nu trn i vi bn nam v n l bnh thng (nm trong gii hn cho php)* ngha lm sng ch s xt nghim nng Allpha Amilase y hc :Amylase bnh thng trong huyt tng:Ngi bnh thng: 20 - 220 U/L hay 0,88 - 2,05 nkat/L.Ngi c tui: Tng nh so vi gi tr bnh thng.Tng hot amylase muCc nguyn nhn chnh thng gp l:- Vim tu cp: do ru, t min.- t tin trin cp ca vim ty mn.- Vim ty cp do thuc (drug-induced acute pancreatitis) (Vd: acid aminosalicylic, azathioprin,corticosteroid,dexamethason, acid ethacrynic, ru, furosemid, thiazid, mercaptopurin, phenformin, triamcinolon).- Tc nghn ng ty do si hoc ung th biu m.- Bnh l ng mt: Si ng mt ch, vim ti mt cp.- Bin chng ca vim ty (nang gi ty, c chng, apxe).- Chn thng ty (Vd: chn thng bng, sau khi tin hnh chp ty- ng mt ngc dng qua ni soi).- Tnh thm ca ng tiu ha b bin i:Bnh rut do thiu mu cc b hoc thng rut non.Thng lot d dy t trng hay thng lot vo hu cung mc ni.Thng thc qun.- Ng c ru cp.- Bnh l tuyn nc bt: Vim mng m tuyn nc bt, quai b, tc nghn ng dn nc bt do si, sau tia x.- Cc khi u c tnh nht l ung th ty, phi, bung trng, thc qun, v v i trng (thng hot amylase tng rt cao > 25 ln gii hn bnh thng cao v mc tng ny him khi c gp trong vim ty cp).- Suy thn giai on cui (hot amylase mu tng ngay c khi khng c vim ty).- Cc nguyn nhn khc:Bnh gan mn (Vd: x gan vi hot amylase mu thng tng 2 ln gi tr bnh thng).Nhim toan cetn do T.Tng lipid mu.Cng chc nng tuyn gip.C thai (bao gm c cha ngoi t cung v).U nang bung trng.Bng.Phu thut lng ngc gn y, phnh tch ng mch ch.i myoglobin (myoglobinuria).V lch.Mt s trng hp chy mu ni s (c ch khng c bit).Gim hot amylase muCc nguyn nhn chnh thng gp l:- Tnh trng ph hy ty nng v lan rng (Vd: vim ty cp bng pht, vim ty mn giai on cui, x ha nang giai on cui).- Tn hi gan nng (Vd: vim gan, nhim c, nhim c thai nghn, nhim c gip nng, bng nng).Cc yu t gp phn lm thay i kt qu th nghim : - Mu b v hng cu c th lm thay i kt qu xt nghim.- Mu b nhim bn nc bt c th gy tng gi to kt qu xt nghim.- Tng triglycerid nng (> 5 ln gi tr bnh thng cao) c th gy tnh trng c ch hot enzym. Suy thn cng c th gy tng va hot amylase huyt thanh.- Cc thuc c th lm tng hot amylase huyt thanh l: Acetaminophen, khng sinh, aspirin, corticosteroid, estrogen, furosemid, thuc khng vim khng phi steroid, prednison, salicylat v cc li tiu nhm thiazid.- Cc thuc c th lm gim hot amylase huyt thanh l: Citrat, oxalat do gn vi ion canxi.