肝脏病常用实验室检测

ALT and AST
80%AST in mitochondrion
ALT in cytoplasm
Reference Range
• ALT: <40U/L • AST: <40U/L • DeRitis Ratio: AST/ALT≥1
Clinical Significance
• Acute Viral Hepatitis
• Intra-liver：ALT, AST, LDH • Synthesis in liver：coagulation factor and thrombin • Excreted with bile: γ-GT, ALP • Related to fibrosis：MAO, III-collagenase, Hyaluronic Acid
hemolytic hepatocellular
UCB CB CB/STB U-BIL UBG stool
obstructive ↑ ↑↑↑ >0.5 ++ ↓ pale
↑↑↑ ↑ <0.2
—
↑↑ ↑↑ 0.2-0.5 + ↑, N lighter
↑↑↑
darker
Related Enzymes
Related Enzymes
Physiological↓：infants Immunosuppressive state long-term treatment with glucocorticoid or immunosuppressants Congenital gamma-globulinemia
A/G: 1.5-2.5:1
Bilirubin Metabolism Pathway
http://ahdc.vet.cornell.edu/clinpath/modules/chem/tbili.htm
Types of Jaundice
Hemolytic Jaundice: pre-hepatic Hepatic Jaundice Obstructive Jaundice: Post-hepatic
Mass lose：
nephrotic syndrome, severe burn, acute or severe hemorrhage
Consumption increased ：chronic consumptive disease
e.g. Serious Tuberculosis, malignant tumor, hyperthyroidism
血清总蛋白
• STP，serum total protein
• 血清中所含各种蛋白的总称
Albumin
α1
STP
Globulin
α2 β
Synthesis in Liver
others γ From Lymphocytes and
plasmacyte
Serum Protein
TP(serum total protein)
Intra-liver
ALT
– Alanine aminotransferase – Most specific for hepatocyte injury – Known formerly as GPT
AST
– Aspartate aminotrasferase – Less specific than ALT (present outside liver, such as heart, muscles and kidney) – called formerly as GOT
malignant tumor
Bilirubin: Secretion and Excretion functions
• Serum Total Bilirubin, STB • Unconjugated Bilirubin, UCB and Conjugated Bilirubin, CB • Urine Bilirubin • Urobilinogen
ALT: sensitive ALT>300U/L, AST>200U/L, AST/ALT<1
Clinical Significance
• Chronic Viral Hepatitis
Reference Range
STB： Adult 3.4-17.1μmol/L CB： 0-6.8μmol/L UCB ：1.7-10.2μmol/L CB/STB：1:5 Urine bilirubin： 阴性 urobilinogen： 0.84-4.2μmol/24h negative or weak positive
Clinical significance: Alb ↓
Malnutrition: hypoalbuminemia
•Normal: >35g/L
•Mild: 28-34g/L
•Moderate: 21-27g/L
Edema
•Severe: <21g/L
球蛋白 (globulin ， Glo)

More Sensitive than ALB
Malnutrition grading
• Normal: 200-400 mg/L
• Mild: 100-150 mg/L
• Moderate: 50-100 mg/L
• Severe: <50 mg/L
PAB ↓
• Hepatobiliary disease
– Common bile duct stones – Pancreatic cancer – Cholangiocarcinoma – Liver metastases
Hemolytic Jaundice
Hepatic Jaundice
×
Obstructive Jaundice
×
The types of jaundice
STP-A=G made up of different proteins called alpha, beta, and gamma types Some are made by the liver, while others are made by the immune system （γ-globulin) 参考值： G
Related Enzymes
• ALT (`alanine aminotransferase) 丙氨酸氨基转移酶 • AST (aspartate aminotransferase)天冬氨酸氨基转移酶 • GGT (γ-glutamyltransferase) γ-谷氨酰转移酶 • ALP (`alkaline phosphatase) 碱性磷酸酶 • MAO (monoamine oxidase) 单胺氧化酶
诊断学
肝功能实验室检查
山东大学医学院 陆楠
Contents of Liver Function Test
• • • • • • Protein Metabolism Bilirubin Metabolism Bile Acid Metabolism Lipid Metabolism Related Serum Enzymes Extraction and Excretion
Stage of jaundice
STB (μmol/L)
>342
Severe Jaundice
171~342
Moderate Jaundice
34.2~171
Mild Jaundice
17.1~34.2
Latent or Subclinical Jaundice
28
Differential diagnosis of Jaundice types
Clinical significance: Alb <25g/L
Synthesis decrease in liver： damage of liver cells
Chronic liver disease e.g. hepatitis, liver cirrhosis, liver cancer
↓
↓
Prealbumin, PAB

Run faster than ALB on electrophoresis gels
Acute phrase protein(half-life=2 days),
more sensitive than albumin for liver damage

Adult: 280-360mg/L
– SLE, rheumatic fever, rheumatoid arthritis
• Chronic inflammation or infections:
– tuberculosis, malaria, schistosomiasis
Clinical significance: Globulin ↓
• 又称为白蛋白 • major protein in serum,≈60% • Half-life: 15-19 days • Synthesis in Liver • Function：
– Maintain plasma osmotic pressure – transport
– nutrition
Serum Protein Electrophoresis
Liver Cirrhosis
↓↓
AFP特异峰，肝癌
β-γ bridge
↑
Nephrotic Syndrome
↓ ↑
↑ ↓
Multiple Myeloma
IgG type
↑
Protein loss through intestine
Acute hepatitis: 30% Alb normal Chronic hepatitis, serious hepatitis, liver cancer, liver cirrhosis: ↓ >50%
↓ continously：poor prognosis
Monitoring the liver recipient • Others: acute infections, advanced


20-30 g/L
Clinical significance: Globulin ↑
Chronic liver disease M-proteinemia
– Multiple Myeloma, Malignant Lymphoma, Macroglobulinemia • Autoimmune disease ：
• A/G ↓: A↓or G↑ –Liver function damage
• Alb<30g/L or reverse : poor prognosis
• Alb>30g/L: better progosis • Obstructive jaundice: not reverse
–M-proteinemia: reverse
e.g. Severe diarrhea, vomit, high fever、shock
• <60g/L Hypoproteinemia
– See also albumin <25g/L – hypervolemia: e.g. water-sodium retention
清蛋白（ albumin ,Alb）
物质代谢、 合成
糖、蛋白质、脂质
储存பைடு நூலகம்量
激素、维生素……
生物转化
分泌排泄
Protein Metabolism Bilirubin Metabolism
Related Serum Enzymes
Protein Metabolism: Synthesis and Storage function
• Serum Total Protein, albumin and globulin • Serum Protein Electrophoresis • Serum Prealbumin
albumin and globulin Reference value:
•
•
including
TP
Alb
60-80 g/L
40-50g/L
•
•
Glo
20-30 g/L
1.5-2.5 : 1
A/G ratio
Total Protein
• >80g/L Hyperproteinemia
– See also Globulin>35g/L, especially in γ-globulin – hypovolemia ：