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TRANG CH

LCH TIM CHNG

BNG GI VC XIN DCH V

BNG GI XT NGHIM

NGHA LM SNG CA XT NGHIM

QUY TRNH XT NGHIM

BNG GI SP DIT CN TRNG

BNG TNG KT NGHA LM SNG CA CC CH S XT NGHIM

STTXT NGHIMGI TR BNH THNG NGHA LM SNG

TNGGIM

1- AmylaseHuyt tng:20 - 220 U/LNc tiu:< 1000 U/L- -Amylase c nhiu trong tu ngoi tit v tuyn nc bt.- Hot - amylase huyt tng, nc tiu tng trong vim tu cp, vim tu mn, chn thng tu, ung th tu, cc chn thng bng, vim tuyn nc bt (quai b),...- Mc d - amylase huyt tng c vai tr chn on xc nh vim tu cp, nhng n t c lin quan n nng v tin lng ca vim tu cp.

2Apo-AINam: 104-202 mg/dLN: 108-225mg/dL- Nng Apo-AI huyt tng gim trong ri lon lipid mu, bnh mch vnh.

3Apo-B100Nam: 66-133 mg/dLN: 60-117mg/dL.- Nng Apo-B100 huyt tng tng , nguy c va x ng mch.

4T s Apo-B100/ Apo AI: < 1- T s Apo- B tng c nguy c va x ng mch.

5GlucoseHuyt tng:4,2-6,4 mmol/LNc tiu: m tnh- Bnh thng glucose huyt tng khi i < 6,1 mmol/L, nu mc glucose huyt tng khi i 7,0 mmol/L trong t nht 2 ln xt nghim lin tip cc ngy khc nhau th b i tho ng (diabetes mellitus).- Khi lm nghim php dung np glucose ng ung OGTT (oral glucose tolerance test):+ Nu mc glucose huyt tng thi im 2 gi sau th nghim < 7,8 mmol/L l bnh thng.+ Nu mc glucose t 7,8 n ALT) trong nhi mu c tim.- Hot AST huyt tng tng trong bnh c (lon dng c, vim c, tiu myoglobin) v cc bnh khc nh vim da, vim tu cp, tn thng rut, nhi mu phi, nhi mu thn, nhi mu no, ?

30ChENam: 4,9-11,5 kU/LN: 3,9-10,8 kU/L- ChE trong huyt tng c tng hp bi gan.- Hot ChE huyt tng gim trong suy gan, x gan (do kh nng tng hp ca gan gim), ng c ho cht tr su loi phospho hu c hoc carbamat.

31GGT (g-GT)5 ? 45 U/L- GGT c nhiu gan, do cc t bo biu m ng mt bi tit ra.- Hot GGT huyt tng tng khi cc t bo biu m ng mt b cm ng tng tng hp enzym nh trong tc mt, vim gan do ru, tn thng t bo gan.

32GLDHNam < 4 U/LN < 3 U/L- GLDH ch c trong ty th ca t bo, c nhiu gan.- Hot GLDH huyt tng tng do tn thng nng cc t bo gan nh vim gan nng, hoi t t bo gan, thiu oxy m.

33IL-6 (Interleukine-6)< 10 pg/mL- IL-6 ng vai tr trung gian ch cht trong qu trnh tng hp cc protein pha cp, trong c CRP, fibrinogen, ?, IL-6 c thi gian bn hu l 2 gi.- Nng IL-6 huyt thanh tng c vai tr trong nh gi mc , tin lng, bin chng ti ch hoc suy tng ca vim tu cp.

34Lipase7 - 59 U/L- Lipase c sn xut bi tu, mt t bi d dy, t trng, gan v li.- Hot lipase huyt tng tng c gi tr chn on vim tu cp.

35Microalbumin niu< 20 mg/L nc tiuMicroalbumin niu c gi tr theo di bin chng thn sm nhng bnh nhn tiu ng, cao huyt p.

362-Microglobulin(2-M)Huyt tng:0,6 - 3mg/LNc tiu:< 350 g/L- 2-Microglobulin c trn b mt hu ht cc t bo.- Nng 2-M huyt tng tng trong suy thn, bnh bch cu lympho mn, bnh Waldenstron, bnh Kahler, bnh Lupus ban ri rc, x gan, vim gan mn tin trin.- Nng 2-M nc tiu tng trong gim kh nng ti hp thu ca ng thn, nhim c kim loi nng, vim thn k do ng c thuc, trc cn thi loi mnh ghp cp.

37Nghim php Coombs-C trong cc bnh thiu mu, tan mu tr s sinh.- Thiu mu, tan mu t min.- Thiu mu, tan mu do truyn mu, bt ng nhm mu ngi cho v ngi nhn.

38ALP64-306 U/L- ALP c nhiu gan, xng, nhau thai v biu m rut. V vy, bnh thng, hot ALP huyt tng cng tng tr ang ln v ph n c thai qu 3 ca thai k.- Hot ALP huyt tng tng trong long xng, ci xng, u xng, gy xng ang hn gn, vim gan, tc mt, x gan.

39MyoglobinNam: 28-72 g/LN: 25-58 g/L- Myoglobin l mt protein c trong bo tng ca c tim v c xng. Myoglobin c vai tr vn chuyn v d tr oxy trong t bo c.- Nng myoglobin tng rt sm (sau 2 gi) trong nhi mu c tim cp, trong nhi mu c tim ti pht Nng myoglobin huyt tng t cc i 4-12 gi v tr v mc bnh thng sau 24 gi.- Nng myogolbin tng cng c th xy ra sau tn thng c xng v trong suy thn nng.

40-HBDH72-182 U/L- V -HBDH c thi gian bn hu (half-life) kh di (4-5 ngy) nn s tng hot isooenzym -HBDH huyt tng ko di, iu ny gip chn on nhi mu c tim nhng bnh nhn n khm mun.

41TnI< 0,4mg/ml- Nng TnI huyt tng tng cao khi tn thng c tim (nhi mu c tim).

42TnT< 0,01 mg/ml- Nng TnT huyt tng tng cao khi tn thng c tim (nhi mu c tim).

43NT-ProBNP< 50 tui: < 55pmol/L50-75 tui 75 tui > 220pmol/L- Nng NT-ProBNP huyt tng tng vt qu cc gi tr ct tng ng vi cc la tui, c gi tr trong chn on suy tim, hi chng mch vnh cp (vi gi tr chn on m tnh rt cao, t 97-100%).

44in gii (Natri, Kali, Clo, Calci, Calci ion ho)Cc ri lon in gii trong bnh thn, tim mch, co git, mt n c? bnh h calci mu.

45FibrinogenBnh ri lon ng mu, gan, khp.

46Peptid C0,2-0,6 mmol/L- Peptid C c to thnh do s thu phn proinsulin thnh insulin, khi t bo ca tu hot ng.-Nng peptid C gim trong trng hp tu hot ng km hoc khng hot ng (i tho ng typ I).

47PCT (Procalcitonin)< 0,05 ng/ml- PCT c thi gian bn hu l 24 gi. PCT tng nhanh sau nhim khun 2 gi v t ti a sau 24 gi, sau gim dn nu tnh trng nhim khun c ci thin.- PCT l marker c hiu cho nhim khun v nhim khun huyt.- PCT c th c s dng trong chn on, theo di v tin lng tnh trng nhim khun.

CC XT NGHIM NC TIU

48Tng phntch nc tiuTng phn tch nc tiu thng c s dng trong cc bnh i tho ng, nhim ceton, i nht, bnh gan, mt, thn, bnh vim ng tit niu, i mu... pht hin sm ng c thai nghn.Bnh thng, tr t trng v pH nc tiu c gi tr c th, cc cht bt thng trong nc tiu l nhng cht c nng rt thp trong nc tiu, bng cc xt nghim thng thng khng pht hin c (m tnh-negative). Khi pht hin c (dng tnh, positive), chng dc gi l nhng cht bt thng trong nc tiu, c ngha lm sng.

1.T trng(SG: specific gravity)1.015-1,025- Tng trong: nhim khun gram (?), gim ngng thn, bnh l ng thn. X gan, bnh l gan, tiu ng, nhim (keton) do tiu ng, tiu chy mt nc, i ma, suy tim xung huyt.- Gim trong: vim thn cp, suy thn mn, vim cu thn, vim i b thn.

2.Bch cu (LEU)m tnhBch cu trong nc tiu xut hin trong: nhim khun thn, nhim trng nc tiu, nhim trng khng c triu chng, vim ni tm mc do vi khun.

3.Nitrit (NIT)m tnhNitrit trong nc tiu xut hin trong: nhim khun thn, nhim khun nc tiu, vim ni tm mc, nhim khun nc tiu khng triu chng.

4. pH4,8-7,4- pH nc tiu tng trong nhim khun thn (tng hoc c lc gim), suy thn mn, hp mn v, nn ma.- pH nc tiu gim trong nhim ceton do i ng, tiu chy mt nc.

5. Hng cu (ERY)m tnhHng cu xut hin trong nc tiu khi: vim thn cp (ung th thn, bng quang, si thn, si tin lit tuyn), vim cu thn, xung huyt thn th ng, hi chng K Wilson, hi chng thn h, thn a nang, vim i b thn, au qun thn, nhim trng niu, nhim khun nc tiu, nhim khun nc tiu khng c triu chng, x gan vim ni tm mc bn cp, cao huyt p c tan huyt ngoi mch thn, tan huyt ni mch c tiu hemoglobin.

6. Protein (PRO)m tnhProtein xut hin trong nc tiu khi: vim thn cp, bnh thn do i tho ng, vim cu thn, hi chng suy tim xung huyt, K Wilson, cao huyt p c tnh hi chng thn h, bnh thn a nang, vim i b thn, bnh l ng thn, cao huyt p lnh tnh, vim ni tm mc bn cp.

7. Glucose (GLU)m tnhGlucose xut hin trong nc tiu khi: gim ngng thn, bnh l ng thn, i tho ng, vim tu, glucose niu do ch n ung.

8. Th ceton (KET: ketonic bodies)m tnhTh ceton xut hin trong nc tiu khi: nhim ceton do i tho ng, tiu chy mt nc, nn ma.

9. Bilirubin (BIL)m tnhX gan, bnh l gan, vng da tc mt (nghn tc mt phn hoc ton phn, vim gan do virus hoc do ng c thuc, K u ty, si mt).

10. Urobilinogen (UBG)m tnhX gan, bnh l gan, vim gan do nhim khun, virus, hu t bo gan, tc ng mt ch, K u ty, suy tim xung huyt c vng da.

49Soi cn nc tiuPht hin cc t bo, tr niu, ... trong vim nhim thn, ng tit niu, si ng tit niu, ...

Cc xt nghim Huyt hc

50Tng phn tch mu

1. S lng bch cu(white blood cells: WBC):40-10 Giga / L

Tng trong vim nhim, bnh mu c tnh, cc bnh bch cu, v d nh: bnh bch cu dng tu cp, bnh bch cu lympho cp, bnh bch cu dng tu mn, bnh bch cu lympho mn, bnh u bch cu. Vic s dng mt s thuc cng c th gy tng s lng bch cu, v d: corticosteroidGim trong thiu mu do bt sn (gim sn xut), thiu ht vitamin B12 hoc folate (khng trng thnh c), nhim khun (gim s sng st). Vic s dng mt s thuc cng c th gy gim s lng bch cu: cc phenothiazine, chloramphenicol, aminopyrine.

2. S lng hng cu(red blood cell count: RBC):3,8-5,8 Tera / L.Tng trong mt nc, chng tng hng cuGim trong thiu mu

3.Lng huyt sc t(hemoglobin: Hb): 12-16,5 g / dL.Tng trong mt nc, bnh tim v bnh phi.Gim trong thiu mu, chy mu v cc phn ng gy tan mu.

4.Khi hng cu(HCT: hematocrit): nam: 39-49%;n: 33-43%.Tng trong cc ri lon d ng, chng tng hng cu, ht thuc l, bnh phi tc nghn mn tnh (COPD), bnh mch vnh, trn ni cao, mt nc, chng gim lu lng mu (hypovolemia.Gim trong mt mu, thiu mu, thai nghn.

5.Th tch trung bnh ca mt hng cu(mean corpuscular volume: MCV):85-95 fLTng trong thiu ht vitamin B12, thiu acid folic, bnh gan, nghin ru, chng tng hng cu, suy tuyn gip, bt sn tu xng, x ho tu xng.Gim trong thiu ht st, hi chng thalassemia v cc bnh hemoglobin khc, thiu mu trong cc bnh mn tnh, thiu mu nguyn hng cu (sideroblastic anemia), suy thn mn tnh, nhim c ch.

6.Lng Hb trung bnh hng cu(mean corpuscular hemoglobin: MCH): 26-32 pg.MHC tng trong thiu mu tng sc hng cu bnh thng, chng hng cu hnh trn di truyn nng, s c mt ca cc yu t ngng kt lnh.MCH gim trong bt u thiu mu thiu st, thiu mu ni chung, thiu mu ang ti to.

7.Nng Hb trung bnh hngcu(mean corpuscular hemoglobin concentration: MCHC): 32-36 g/ dLTrong thiu mu tng sc hng cu bnh thng, chng hng cu hnh trn di truyn nng, s c mt ca cc yu t ngng kt lnh.Trong thiu mu ang ti to, c th bnh thng hoc gim trong thiu mu do gim folate hoc vitamin B12, x gan, nghin ru

8. phn b hng cu(red distribution width: RDW):10-16,5%- phn b hng cu RDW bnh thng v:+ MCV tng, gp trong: thiu mu bt sn, trc bnh bch cu.+ MCV bnh thng, gp trong: thiu mu trong cc bnh mn tnh, mt mu hoc tan mu cp tnh, bnh enzym hoc bnh hemoglobin khng thiu mu.+ MCV gim: thiu mu trong cc bnh mn tnh, bnh thalassemia d hp t .- RDW tng v:+ MCV tng: thiu ht vitamin B12, thiu ht folate, thiu mu tan huyt do min dch, ngng kt lnh, bnh bch cu lympho mn.+ MCV bnh thng: thiu st giai on sm, thiu ht vitamin B12 giai on sm, thiu ht folate giai on sm, thiu mu do bnh globin.- Gim MCV: thiu st, s phn mnh hng cu, bnh HbH, thalassemia.

9.S lng tiu cu(platelet count: Plt): 150-450 Giga/L.Trong nhng ri lon tng sinh tu xng: chng tng hng cu, bnh bch cu dng tu mn, chng tng tiu cu v cn, x ho tu xng, sau chy mu, sau phu thut ct b lch, chng tng tiu cu dn n cc bnh vim.- S lng tiu cu trong mu gim trong:+ Gim sn xut: c ch hoc thay th tu xng, cc cht ho tr liu, cc thuc khc, v d: ethanol.+ Tng ph hy hoc loi b: chng ph i lch, s ng mu trong lng mch ri rc, cc khng th tiu cu (ban xut huyt do gim tiu cu t pht, st Dengue, ban xut huyt sau truyn mu, gim tiu cu do min dch ng loi tr s sinh, cc thuc: quinidin, cephalosporin.

10.Th tch trung bnh tiu cu(mean platelet volume: MPV): 6,5-11fLTrong bnh tim mch (sau nhi mu c tim, sau tc mch no, i tho ng, tin sn git, ht thuc l, ct lch, stress, chng nhim c do tuyn gip, ...Trong thiu mu do bt sn, thiu mu nguyn hng cu khng l, ho tr liu ung th, bnh bch cu cp, lupus ban h thng, chng tng nng lch, gim sn ty xng, du c, chng tng tiu cu hot ng.

11. Khi tiu cu(plateletcrit: Pct): 0,1-0,5 %Tng trongung th i trc trng.Gim trong nghin ru, nhim ni c t.

12. phn b tiu cu(platelet disrabution width: PDW): 6-18 %Trong ung th phi (PDW ung th phi t bo nh SCLC cao hn ung th phi t bo khng nh NSCLC), bnh hng cu lim, nhim khun huyt gram dng, gram m.Gim trong nghin ru.

13.T l % bch cu trung tnh(% neutrophils: NEUT%): 43-76 %Trong cc nhim khun cp, nhi mu c tim cp, stress, cc ung th (neoplasms), bnh bch cu dng tu.Trong cc nhim virus, thiu mu bt sn, cc thuc c ch min dch, x tr .

14.T l % bch cu lympho(% lymphocytes: LYM%): 17-48%Tng trong nhim khun mn, chng tng bch cu n nhn do nhim khun v nhim virus khc, bnh bch cu dng lympho mn, bnh Hodgkin, vim lot i trng, suy tuyn thng thn, ban xut huyt do gim tiu cu t pht ITP.Gim trong hi chng suy gim min dch mc phi (AIDS), c ch ty xng do cc ho cht tr liu, thiu mu bt sn, cc ung th, cc steroid, tng chc nng v thng thn, cc ri lon thn kinh (bnh x cng ri rc, nhc c, hi chng thn kinh ngoi bin do ri lon t min Guillain-Barr syndrome)

15.T l % bch cu mono(% monocytes: MON%): 4-8%Tng trong cc trng hp bnh nhim virus, nhim k sinh trng, nhim khun, cc ung th, vim rut, bnh bch cu dng monocyte, u lympho, u tu, sarcoidosis, ...Gim trong cc trng hp thiu mu do bt sn, bnh bch cu dng lympho, s dng glucocorticoid.

16. T l % bch cu i toan(% eosinophils: EOS%): 0,1-7%Tng trong cc trng hp hn ng d ng nh st, hen hoc tng nhy cm thuc.Gim trong cc trng hp: s dng cc thuc corticosteroid.

17.T l % bch cu i kim(% basophils: BASO%): 0,1-2,5%Trong cc trng hp: cc ri lon d ng.Trong cc trng hp: s dng cc thuc corticosteroid, cc phn ng min dch, nhim khun cp.

18. S lng bch cu trung tnh(neurophil count hoc neutrophils: Neut ): 2-6,9 Giga/ LTng trong cc nhim khun cp, nhi mu c tim cp, stress, cc khi u (neoplasms), bnh bch cu dng tu.Trong cc trng hp nhim virus, thiu mu do bt sn, s dng cc thuc c ch min dch, x tr.

19.S lng bch cu lympho(lymphocyte count hoc lymphocytes: LYM ):0,6-3,4 Giga/ LTrong nhim khun mn, chng tng bch cu n nhn do nhim khun v nhim virus khc, bnh bch cu dng lympho mn, bnh Hodgkin, vim lot i trng, suy tuyn thng thn, ban xut huyt do gim tiu cu t pht ITP.Gim trong hi chng suy gim min dch mc phi (AIDS), c ch ty xng do cc ho cht tr liu, thiu mu bt sn, cc khi u, cc steroid, tng chc nng v thng thn, cc ri lon thn kinh (bnh x cng ri rc, nhc c, hi chng thn kinh ngoi bin do ri lon t min Guillain-Barr syndrome).

20. S lng bch cu mono(monocyte count hoc monocytes: MON#):0,0-0,9 Giga/ LTrong cc bnh nhim virus, nhim k sinh trng, nhim khun, cc khi u, vim rut, bnh bch cu dng monocyte, u lympho, u tu.Gim trong thiu mu do bt sn, bnh bch cu dng lympho, s dng glucocorticoid.

21. S lng bch cu i toan(eosinophil count hoc eosinophils: EOS#):0,0-0,7 Giga/ LTng trong d ng, nhim k sinh trng (bnh giun xon, bnh nm aspergillus, bnh nang sn), bnh ph thn kinh-mch, cc phn ng thuc, nhy cm warfarin, cc bnh mch mu-collagen, hi chng tng bch cu i toan cp, vim mi a bch cu i toan khng do d ng, cc ri lon tng sn tu (u bch huyt Hodgkin, x tr,...Gim trong s dng cc thuc corticosteroid.

22. S lng bch cu a base(basophil count hoc basophils: BASO):0,0-0,2 Giga/ LTng trong bnh bch cu, vim, chng a hng cu, Hodgkin's, thiu mu tan mu, sau ct lch, d sn tu xng, chng ph nim.Gim trong stress, phn ng qu mn, cc steroid, thai nghn, cng gip, sau x tr.

51Nhm muABO, nhmmu Rh- Kim tra sc kho, ngoi khoa, sn khoa, ni khoa,...- Truyn mu- Bt thng nhm mu m- con

52Huyt Tu Cc bnh l v mu v c quan to mu: ung th mu, thiu mu, suy tu...

53Mu lng- Tng trong vim khp, cc tnh trng vim nhim.- Gim trong a hng cu, c mu, ...

54Tp trung bch cuPht hin sm cc bnh v mu (ung th mu, suy ty, RLST?).

55T bo HargravesLupus ban , min dch d ng...

56ng mu ton bXt nghim tng hp chn on, nh gi cc bnh l ri lon v ng - cm mu.

57Thi gian HowellXc nh ri lon ng mu theo con ng ni sinh.

58Thi gian Prothrombin (PT = thi gian Quick), t l Prothrombin , ch s INRXc nh ri lon ng mu theo con ng ngoi sinh.

59Tiu th ProthrombinXc nh cc ri lon ng mu.

60o ng ng tp tiu cunh gi cht lng tiu cu.

61Nghim php Ru;D-DimerXc nh ng mu ni mch lan to.

62Nghim phpVon-Kaulla, FDPnh gi tnh trng tiu si huyt.

63Thi gian Cephalin kaolinXc nh ri lon ng mu theo con ng ni sinh.

64Co cc munh gi tnh trng tiu cu, ca fibrin, yu t XIII.

65Mu chy, mu ngnh gi tnh trng ng, cm mu.

66Cc yu tng mu(VIII, IX)Chn on cc ri lon ng mu v bnh a chy mu.

67St huytthanh (Iron)Nam: 11-28mol/LN: 6,6-26 mol/L- Thiu mu do tan mu, thiu mu Biermer; hi chng nhim st huyt t (Hemochromatosis).- Vim gan cp tnh (tng cao nht vo khong ngy th 15 ri gim dn vo tun th 4 -6 ca bnh), x gan.- Thiu mu nhc sc thiu st do b mt mu.- Trong mt s bnh nhim khun, ung th, bnh cht to keo.

68FerritinNam: 67-899 pmol/LN 50 tui: nh gi tr ca nam.Trong bnh nhim sc st t m, thiu mu (c tnh, tan mu, Thalassemia), bnh bch cu (Leucemia) cp, t tin trin ca Leucemia mn, u lympho (lymphoma), u ty, Hodgkin, nhim trng cp v mn, tn thng m, ...Gim trong thiu mu thiu st (iron deficiency anemia).

69Transferrin25,2-45,4 mmol/LTransferrin l mt glycoprotein c khi lng phn t 79570 Da, l mt protein vn chuyn st trong huyt thanh.Mc transferrin huyt thanh gim khi st d tr gim.

70TfS (Transferrin saturation )Nam = 20-50%N = 15-50%Trong thiu ht st, bo ho transferrin (= st huyt thanh/ transferrin) gim l mt ch dn rt nhy ca thiu st.

71TIBC(Total iron- binding capacity)43,0-80,6 mol/L (240-450g/dL)Kh nng gn st ton phn (TIBC) l tng lng st huyt thanh v kh nng gn st khng bo ho (UIBC). Nh vy, TIBC l nng st ti a m transferrin c kh nng gn.TIBC tng v bo ho transferrin gim trong thiu mu, thiu st.St huyt thanh gim v TIBC gim l c im ca thiu mu do cc ri lon mn tnh, ung th hoc do cc nhim trng.

72UIBC(Unsaturated iron-binding capacity)20-62 mmol/L- Kh nng gn st khng bo ho (UIBC) l s lng st c th gn thm c vo transferrin. UIBC cng st huyt thanh, TIBC v ferritin c s dng nh gi xem c hay khng s thiu ht st.

73sTfR(Soluble transferrin receptor)9,6-29,6 nmol/LReceptor ca transferrin ho tan (rTfR) l mt protein xuyn mng thy tt c cc t bo. N c vai tr l cung cp st cho t bo bng cch gn transferrin cha st vo b mt t bo v vn chuyn st vo bn trong t bo.Vic xc nh nng rTfR huyt thanh c ngha trong:+ rTfR tng sinh hng cu qu mnh nh trong thiu mu tan mu t min, chng tng hng cu v Thalassemia.+ rTfR huyt thanh cng tng trong thiu mu thiu st, c bit l thiu mu do bnh mn tnh.

M bnh hc

74T bo hc- Hch .- Cc khi u.- Cc loi dch (dch mng phi, bng, khp, dch m o, c t cung).Chn on vim nhim, ung th, u lnh tnh.

75M bnh hc- Lm vi tt c cc t chc: hch, v, tuyn gip, d dy, xng, cc t chc khc...- Chn on vim nhim, ung th , u lnh tnh? K (ung th) t bo gan nguyn pht, K t bo mm.

76Hormon(Tuyn gip)- T3- Free T3- T4- Free T4- TSH- TPO- Anti TPO- TG- Anti TGChn on chc nng tuyn gip:- Tng trong cng gip (Basedow), bu gip c.- Gim trong nhc gip, ngi ln nhc gip bm sinh, bu c n thun: T3, T4.- Bnh thng.

Hormonsinh dcLHEstradionCorticoidTestosteronProgesteronAndrostenedionXc nh cc ri lon v hormon sinh dc v gii tnh trong cc trng hp nh: thiu nng tinh hon, u nang tinh hon, thiu nng bung trng, thiu nng nhau thai, bung trng khng pht trin, b kinh do u nang ni tit.

Virus vim gan

77HBsAg- Khng nguyn b mt virus vim gan B.- Xt nghim ch im sm nht chn on v theo di vim gan B.

HBV DNACh im chc chn ang c virus vim gan B c trong mu bnh nhn.

HBeAgXt nghim theo di khng nguyn sm nhn ln ca virus vim gan B, c gi tr theo di s ang nhn ln ca virus vim gan B.

HBeAb(Anti HBe)Xt nghim theo di khng th chng khng nguyn sm ca virus vim gan B ang nhn ln.

HBsAb(Anti HBs)HBsAb (hay Anti HBs) l khng th chng khng nguyn b mt vim gan B, th hin s c min dch vi vim gan B, s dng trong theo di trong tim phng vacxin.

78HBcAb(Anti HBc)Khng th chng khng nguyn li vim gan B,xc nh tnh trng vim gan B (cp, mn tnh).

79HAVAb(Anti HAV)Khng th chng khng nguyn ca vius tp A, c gi tr xc nh hi chng min dch vi vim gan A.

HAV-IgMKhng th IgM chng vim gan virus tp A, chn on vim gan A cp.

80HCVAb(Anti HCV)Khng th chng virus vim gan tp C, chn on, theo di vim gan C.

81HDVAb(Anti HDV)Khng th chng virus vim gan tp D, chn on, theo di vim gan D.

Xt nghim du n ung th

82CEA0-10 ng/ ml- CEA l mt thnh phn ca mng nhy i trc trng.- Tng trong K ng tiu ho nh: K thc qun, d dy, gan, tu, i trc trng, v, bung trng, c t cung, tuyn gip.- C th tng khng nhiu trong polyp i trng, vim rut non, vim tu, suy thn mn.

83AFP0-7 ng/ ml- AFP huyt tng tng trong K t bo gan nguyn pht, K t bo mm (tinh hon).- Gi tr chnh ca AFP l theo di tin trnh bnh v hiu qu iu tr K t bo gan nguyn pht, K tinh hon sau iu tr phu thut, x tr hoc ho tr liu.- AFP huyt tng c th tng trong vim gan, x gan.

84PSA0-10 U/ L- PSA huyt tng tng trong K tuyn tin lit; c th tng trong u ph i, vim tuyn tin lit.- PSA c gi tr trong tm sot K tuyn tin lit, thng c s dng kt hp vi chp trc trng, siu m v sinh thit (biopsy) nhng n ng trn 50 tui.

85CA 1250-35 U/ ml- CA 125huyt tng tng trong K bung trng, K c t cung; c th tng trong cc bnh l thanh dch nh c trng, vim mng tim, vim mng phi, vim mng bng,...- CA 125 c vai tr ch yu trong chn on K bung trng, nh gi s thnh cng ca iu tr v theo di tin trnh ca bnh.

86CA 15-30-32 U/ ml- CA 15-3huyt tng tng trong K v, c th tng trong u v lnh tnh, vim gan, vim tu.- CA 15-3l mt marker hu ch theo di tin trnh bnh bnh nhn K v di cn. Xt nghim ny khng ph hp cho vic chn on v nhy qu thp khi K v cha c di cn.

87CA 72-40-5,4 U/ ml- CA 72-4huyt tng tng trong K d dy, c th tng trong x gan, vim tu, vim phi, thp khp.- c s dng theo di v hiu qu iu tr K d dy.

88CA 19-90-33 U/ ml- CA 19-9 huyt tng tng trong cc K ng tiu ho nh K gan (th cholangiom), ng mt, d dy, tu v i trc trng.- CA 19-9 huyt tng cng c th tng trong vim gan, vim tu, i tho ng, x gan, tc mt.- Vai tr ch yu ca CA 19-9 l pht hin sm s ti pht v theo di hiu qu iu tr cc K ng tiu ho nh nu trn.

89CT(Calcitonin)hochCT(Human Calcitonin)0,2 - 17 pg/ ml- CT l mt hormon peptid c bi tit bi t bo parafolliculaar C ca tuyn gip.- CT c hiu cho chn on v theo di ung th vng tu tuyn gip (C-cell carcinoma).- CT huyt tng tng trong K tuyn gip; c th tng trong suy thn mn, bnh Paget.

90TG(Thyroglobulin)1,4 - 78 ng/ ml- TG huyt tng tng trong K tuyn gip, c th tng trong u lnh tuyn gip.

91 892-M(2-Microglobulin)0 - 2000 g/ L- 2-M huyt tng tng trong K h lympho nh:+ U lympho (lymphoma) hoc a u tu xng (multiple myeloma),+ U lympho Hodgkin (Hodgkin lymphoma),+ U lympho khng Hodgkin (No-Hodgkin lymphoma).- 2-M huyt tng cng tng trong nhim khun, mt s bnh min dch nht nh. V 2-M bi tit ch yu theo ng thn nn nng ca n trong huyt tng v nc tiu c th thay i theo bnh l ca cu hoc ng thn.

92-hCG0 - 5 U/ L- -hCG c s dng chn on, theo di hiu qu iu tr u t bo mm nhau thai v tinh hon, cng c s dng chn on u t bo mm ngoi sinh dc.- -hCG v hCG huyt tng tng trong K t bo mm nh K tinh hon nam v K nhau thai (choriocarcinoma) n; trong qu trnh thai nghn bnh thng, cha trng hoc dng thuc chng co git, an thn, chng Parkinson

93SCC (SCCA)0- 3 g/ L- SCC khng ph hp cho mc ch tm sot ung th t bo vy v nhy v c hiu thp.- Tuy nhin, SCC c th c s dng theo di tin trnh bnh v nh gi p ng iu tr K t bo vy (K c t cung, thc qun) nguyn pht v ti pht.- SCC huyt tng cng c th tng trong tc nghn phi, hen.

94MCA0-15 U/ ml- MCA hu ch cho theo di di cn bnh nhn ung th v.- MCA khng s dng cho chn on hoc tm sot K v v nhy v c hiu thp.- MCA huyt tng cng c th tng trong bnh tuyn v lnh tnh, khi c thai hoc bnh gan mt.

95MSA121-128,9 U/ml- MSA huyt tng tng theo giai on ca ung th v, c s dng theo di din bin ca bnh v nh gi p ng i vi iu tr bng hormon v ho tr liu.- MSA huyt tng cng tng trong cc ung th khc nh K phi, K i trng, K tu, K tuyn (adenocarcinogen),...- MSA huyt tng cng tng nh trong u v lnh tnh.

96CYFRA 21-10 - 3,3 U/ L- CYFRA 21-1 huyt tng tng trong K phi (t bo khng nh), bng quang (du n la chn 2).- CYFRA 21-1 c s dng chn on nh gi p ng iu tr v theo di din bin ca K phi t bo nh; n cng c s dng theo di din bin K bng quang.- CYFRA 21-1 huyt tng cng c th tng trong mt s bnh phi, thn.

Bnh x hi

97Opiate(thuc phin, heroin, morphin, codein)Chn on, theo di nghin ma tu.

98Soi dch m oTm trichomonas, nm, vi khun, Gardnerella vaginalis.

99Giang mai(cc k thut: RPR, TPHA, VDRL)S dng chn on nhim xon khun, bnh giang mai.

Chn on cc bnh v khp

100g-latex nh lng (Gamma Latex) = RF-Q(rheumatoid factors-quantitative determination)0-12 U/L- - y l phng php o c min dch (Latex immunoturbidimetric method) nh lng cc yu t thp RF (rheumatoid factors) trong huyt thanh bnh nhn.- - Yu t thp (RF) c mt phn ln cc bnh nhn b vim a khp mn tin trin (evolutive chronicle poli-arthritis).- - Phng php ngng kt latex cho php phn bit vim a khp mn tin trin vi bnh thp khp (articulation rhematism) hoc vi st thp (rheumatic fever), 2 bnh ny RF khng c mt trong huyt thanh.

101ASLO0 - 200 U/mL- ASLO (antistrptolysin O) l xt nghim huyt thanh o lng khng th khng lin cu khun xut hin trong mu.- ASLO c s dng chn on vim khp, thp khp, thp tim, nhim trng lin cu.

102CRP- CRP huyt thanh tng trong cc phn ng vim cp nh nhi mu c tim, tc mch, nhim khun, bnh mn tnh nh bnh khp, vim rut, cng nh trong mt s ung th nh bnh Hodgkin, K thn.- CRP dng nh gi mc nng v tin lng ca vim tu cp.

103TNF-a- Vai tr ch yu ca TNF-a l iu ho hot ng ca cc t bo min dch. N cng c vai tr cm ng s cht a t bo theo chng trnh, cm ng s vim v c ch s to khi u v s sao chp ca virus.- TNF-a tng trong nhim trng lin cu, st thp khp, bnh t min.

V sinh nam

104nh gi tinh dch nh gi s lng, cht lng tinh trng, chn on v sinh (i chiu tinh dch bnh thng). C tnh trng bt bnh thng, c th lin quan n kh nng sinh sn khi:- < 20 triu tinh trng: gim tinh trng- < 1 triu tinh trng: n tinh trng- > 250 triu tinh trng: a tinh trng- < 50% tinh trng di ng v pha trc (loi a v b) v < 20% tinh trng loi a: suy nhc tinh trng- < 30% tinh trng c hnh dng bnh thng: d dng tinh trng.- Khng c tinh trng trong tinh dch: khng c tinh trng.- Th tch tinh dch < 2mL: t tinh dch- Th tch tinh dch > 6mL: nhiu tinh dch- Khng c tinh dch: khng c phng tinh.- C hng cu trong tinh dch: tinh dch c mu

Xt nghim vi sinh - virus - vi khun

105Soi nmNm da, nm tc, nm c t cung.

106Cy nc tiu, cy mu, dch cc loi lm khng sinh ,Tm vi khun gy bnh, dng khng sinh thch hp.

107Cy phn, lm khng sinh , vi khun ch,Tm vi khun gy tiu chy, ri lon tiu ho, dng khng sinh thch hp.

Xt nghim vi sinh - virus - vi khun

108St xut huyt "Dengue"Pht hin chng Dengue trong mu iu tr c hiu.

109Tm mu trong phnGip xc nh chy mu ng tiu ho.

110K sinh trng ng rutChn on giun a, giun mc, giun tc.

111K sinh trng st rtChn on st rt.

112Tm u trng giun chChn on bnh giun ch.

113Sn l gan nh(huyt thanh)Sn l gan nh gy bnh cho ngi v ch mo. ngi, sn l gan nh lm tc, vim ng mt v ti mt; nu qu nhiu c th gy vim gan, x gan, c th gy vim ty.

114Sn l gan to( huyt thanh) ngi, sn l gan ln k sinh h thng tnh mch ca, con ci i ngc dng mu, chy ti nhng huyt qun nh v tnh mch ca .

115Soi m tm BKChn on bnh lao phi.

116Phn ng: Mantoux, TB testPht hin khng th chng lao.

117Soi m, phn, tm trng sn l phiChn on bnh sn l phi.

118Dch no tu:phn ng Pandy, protein, ure, glucose.Gip chn on bnh vim mng no, vim no, xut huyt no, u tu.

Nhum ho hc t bo

119- Esterase c hiu- Myelo peroxidase- Periodic acid Schiff (PAS)- Soudan en- Granulocyte alkaline phosphatase (GAP)Xc nh cc dng t bo ung th mu.

120Cc marker bch cu: CD4, CD8,- Bit c gim min dch trong HIV (AIDS), CD4 gim nng, t l CD4/CD8 gim nng.

Cc enzym chng oxy ha

121SOD:876-1328 U/ gHbGPx:41-76 U/ gHbGR:5,4-10,0 U/ gHbTAS:1,07-1,96 mmol/LMDA:1,75-3,07 nmol/ml- nh gi kh nng chng oxy ho ca c th trong nhiubnh l v hi chng ton th: tui gi, ung th, nhim bt, ng c thuc, ung ru nhiu, qu ti st, bnh min dch, suy dinh dng,...- nh gi kh nng chng oxy ho ca c th trong nhiubnh l v hi chng c quan: bnh tim mch, thn, gan, rut, khp, no, mu, mt, phi, da, thiu mu cc b, ...

122Sng lc trc sinh Hi chng Down, Hi chng Edward hoc d tt ng thn kinhSng lc trc sinh Hi chng (HC) Down hocHi chng Edward: khi thai ph > 35 tui, hoc bnh s c con d tt bm sinh.- Qu 1 ca thai k (11-14 tun): cn th double test:b-hCG v PAPP-A.+ Ngng nguy c i vi HC Down :b-hCG 2 MoM (multiples of the median = cc bi s ca trung v) v PAPP-A0,3 MoM.+ Ngng nguy c i vi HC Edward :b-hCG 0,2 MoM v PAPP-A0,2 MoM.- Qu 2 ca thai k (15-22 tun): cn th triple test:AFP, b-hCG, uE3.+Ngng nguy c i vi HC Down l AFP 0,7 MoM, b-hCG 2 MoM, uE3 0,7 MoM;+ Ngng nguy c i vi HC Edward l AFP 0,7 MoM, b-hCG 0,7 MoM, uE3 0,7 MoM.Hi chng trn c mt phn mm my vi tnh chuyn dng tnh ton, ngi thy thuc s cn c vo kt qu sng lc trc sinh ny quyt nh chn on thm bng cho chc i (ly 10-20 ml dch i) chn on xc nh bngK thut lai ti ch hunh quanghocNhim sc th nu pht hin:+ 3 nhim sc th 21 (Trisomy 21), l Hi chng Down;+ 3 nhim sc th 18 (Trisomy 18) hoc chuyn on nhim sc th 18 sang nhim sc th 14, l Hi chng Edward.Cng c th pht hin ccd tt ng thn kinh(Neural tube defects: NTD) qu 2 ca thai k khi AFP 2,5 MoM v nh siu m.

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