Clinical significance of determination of 1. alanine aminotransferase (ALT or GPT);

Elevated: common in acute and chronic hepatitis, drug-induced liver injury, fatty liver, liver cirrhosis, myocardial infarction, myocarditis and biliary tract diseases.

2. Clinical significance of aspartate aminotransferase (AST or GOT) determination;

Elevated: common in myocardial infarction, acute and chronic hepatitis, toxic hepatitis, cardiac insufficiency, dermatomyositis and so on.

3. Clinical significance of total protein determination:

Increase: It is common in high dehydration (such as diarrhea, vomiting, shock and high fever) and multiple myeloma.

Decrease: It is common in malignant tumor, severe pulmonary tuberculosis, nutrient absorption disorder, liver cirrhosis, nephrotic syndrome, ulcerative colitis, burns, blood loss, etc.

4. Clinical significance of albumin determination:

Elevated: It is common that severe water loss leads to an increase in plasma concentration and albumin concentration.

Decrease: basically the same as total protein, especially liver disease and kidney disease.

5. Clinical significance of alkaline phosphatase determination;

Elevated: common in liver cancer, liver cirrhosis, obstructive jaundice, acute and chronic icteric hepatitis, osteoblastoma, bone metastatic cancer and fracture recovery period. In addition, the skeletal system is active during children's growth and development, which can increase ALP.

Note: When using different washing solutions, the results may be obviously different.

6. Clinical significance of R-glutamyltransferase (GGT or r-GT) determination:

Elevated: common in primary or metastatic liver cancer, acute hepatitis, chronic hepatitis, active cirrhosis, acute pancreatitis and heart failure.

7. Clinical significance of determination of total bilirubin;

Added: liver diseases, extrahepatic diseases, primary biliary cirrhosis, hemolytic jaundice, acute icteric hepatitis, neonatal jaundice, chronic active hepatitis, obstructive jaundice, viral hepatitis, cholelithiasis, obstructive jaundice, pancreatic head cancer, cirrhosis, and transfusion errors.

8. Clinical significance of direct bilirubin determination;

Increase: common in obstructive jaundice, liver cancer, pancreatic head cancer, gallstones, etc.

9. Clinical significance of triglyceride determination:

Increase: it can be caused by genetic and dietary factors or secondary to certain diseases, such as diabetes and nephropathy. TG value above 2.26mmol/L increased; More than 5.65mmol/L is severe hypertriglyceridemia.

Decrease: It is common in hyperthyroidism, hypoadrenocortical function, liver parenchymal lesions, primary B lipoprotein deficiency and malabsorption.

10. Clinical significance of determination of total cholesterol;

(1) Diagnosis and classification of hyperlipoproteinemia and abnormal lipoprotein;

(2) To judge the risk factors of cardiovascular and cerebrovascular diseases;

(3) 3) The increase or decrease of CHO can be primary (including hereditary), nutritional factors or secondary to some diseases, such as thyroid diseases and nephropathy. When the CHO value is 5. 17-6.47mmol/L, it is the dangerous edge of atherosclerosis; 6.47-7.76mmol/L is the risk level of atherosclerosis; > 7.76 mmol/L is the high risk level of atherosclerosis; & lt3. 1 mmol/l or

1 1. Clinical significance of high-density lipoprotein measurement;

Increase: primary hypercholesterolemia, insulin, estrogen, exercise, drinking, etc.

Decrease: It is common in hyperlipoproteinemia, cerebral infarction, coronary atherosclerosis, chronic renal insufficiency, liver cirrhosis, diabetes, obesity, etc.

12. Clinical significance of determination of low density lipoprotein;

Increase: Hyperlipoproteinemia.

Clinical significance of serum apolipoprotein AI determination: Apolipoprotein AI is the main structural protein of high density lipoprotein and the best index to reflect HDL level.

Decrease: it is common in hyperlipidemia, coronary heart disease and liver parenchymal lesions.

13. Clinical significance of apolipoprotein B determination;

Apolipoprotein B is the structural protein of low density lipoprotein, which mainly represents the level of LDL. APOB changes more obviously than low density lipoprotein in pathological state.

Increase: common in hyperlipidemia, coronary heart disease and psoriasis.

Decrease: Common in liver parenchymal lesions.

Clinical significance of determination of 14.CK;

Elevated: myocardial infarction began to increase in 4-6 hours, and 18-36 hours reached 20-30 times of the normal value, which was the highest peak and returned to normal in 2-4 days. In addition, viral myocarditis, dermatomyositis, muscle injury, muscular dystrophy, pericarditis, cerebrovascular accident and heart surgery can all increase CK.

15. Clinical significance of CK-MB determination;

CK-MB mainly exists in myocardium, accounting for about 14% of total CK. Serum CK-MB rose before the total activity, reaching the peak in 24 hours, and its fluctuation curve was parallel to the total activity in 36 hours, and disappeared in 48 hours.

16. Clinical significance of determination of α-hydroxybutyrate dehydrogenase;

Elevated: it is almost the same as LDH, and the high value of this enzyme in blood can reach about 2 times in acute myocardial infarction.

17. Clinical significance of blood glucose determination:

Hyperglycemia: Some physiological factors (such as emotional stress, 65438+ 0-2 hours after meals) and intravenous epinephrine can cause hyperglycemia. Pathological increase is common in all kinds of diabetes, chronic pancreatitis, myocardial infarction, acromegaly, and some endocrine diseases, such as hyperthyroidism, eosinophilic adenoma of anterior pituitary, alkalophilia of anterior pituitary, hyperthyroidism of adrenal gland, etc. Intracranial hemorrhage, craniocerebral trauma, etc. It can also lead to an increase in blood sugar.

Hypoglycemia: abnormal glucose metabolism, islet cell tumor, pancreatic tumor, severe liver disease, neonatal hypoglycemia, pregnancy, breastfeeding, etc. Can cause hypoglycemia.

18. Clinical significance of urea determination:

Rise: It can be roughly divided into three stages. When the concentration is 8.2- 17.9mmol/L, urea overproduction is common (such as high protein diet, diabetes, severe liver disease, high fever, etc. ) or urea has diarrhea disorder (such as mild renal insufficiency, hypertension, gout, multiple myeloma, urinary tract obstruction, postoperative anuria, etc. ). When the concentration is 17.9-35.7mmol/L, it is common in pre-uremia, liver cirrhosis and bladder tumor. The concentration is above 35.7mmol/L, which is common in severe renal failure and uremia.

19. Clinical significance of creatinine (CREA) determination;

Elevated: common in severe renal insufficiency, various renal diseases, acromegaly, etc.

Decrease: common in decreased muscle mass (such as malnutrition, the elderly) and polyuria.

20. Clinical significance of uric acid determination:

Elevated: common in gout, eclampsia, leukemia, polycythemia, multiple myeloma, acute and chronic glomerulonephritis, severe liver disease, lead and chloroform poisoning, etc.

Decrease: It is common after treatment with drugs such as pernicious anemia, celiac disease and adrenocortical hormone.

2 1. lipoprotein? Determination of clinical significance:

Lipoprotein? Synthesized in the liver, it is a special lipoprotein composed of apolipoprotein A and apolipoprotein B through disulfide bonds, and its composition is similar to that of low density lipoprotein. Its main function is to prevent the dissolution of blood clots in blood vessels and promote the formation of atherosclerosis. Lipoprotein? The continuous increase of this level is closely related to angina pectoris, myocardial infarction and cerebral hemorrhage. Because of lipoprotein? There is no obvious correlation with hypertension, smoking, high density lipoprotein cholesterol, low density lipoprotein cholesterol and other factors, so it is regarded as an independent risk factor of coronary heart disease.

22. Clinical significance of prealbumin determination;

Reduce: diagnose and monitor malnutrition, diagnose liver disease and diagnose acute reaction.

Elevated: nephrotic syndrome >; 500 mg/L (albumin

PA increased and ALB decreased during the attack.

Prealbumin and liver disease;

* Early liver disease will reduce the synthesis of prealbumin.

* Early liver function damage index

It is more specific than transaminase and more sensitive than albumin, and the prealbumin in most patients with liver diseases decreases by 50%.

* When the death index drops to zero, the prognosis is extremely poor.

Prealbumin and malnutrition

* The occurrence of malnutrition.

After infection, appetite decreases, protein and diseases with low calorie intake themselves lead to increased consumption, decreased resistance of the body to enter negative nitrogen balance, increased complications and delayed disease recovery.

* At this point, the serum prealbumin concentration decreased rapidly.

Medium100-160mg/l is serious.

23. The clinical significance of glycosylated hemoglobin determination:

The reference unit of glycosylated hemoglobin refers to the percentage of total hemoglobin. The average blood glucose level was 65438 0-2 months ago, and the glycated hemoglobin concentration response was measured. Especially for type I diabetes, test 1-2 times a month to better understand the degree of disease control.

24. The clinical significance of amylase (AMY) determination:

Elevated: common in acute and chronic pancreatitis, pancreatic cancer, biliary tract diseases, gastric perforation, intestinal obstruction, mumps, salivary adenitis, etc.

Decrease: it is common in liver diseases (such as liver cancer and cirrhosis). ).

25. Clinical significance of serum high-sensitivity CRP determination;

(1). It is related to coronary heart disease.

CRP level is related to coronary heart disease and a series of factors that have been proved to be related to cardiovascular diseases (such as the increase of fibrinogen, total cholesterol, triglyceride and apolipoprotein B, smoking and the decrease of high-density lipoprotein), and is related to coronary atherosclerosis.

(2) It is a good prognostic marker.

The release of CRP is related to acute myocardial infarction, death caused by acute myocardial infarction and the condition of patients receiving emergency vascular exchange.

It is also confirmed that 3mg/L is the best critical value to distinguish low-risk patients from high-risk patients.

(3) It forms complementary information with cardiac troponin T(CTNT) white.

When CRP and CTNT tests are positive, it is possible to predict cardiovascular risk.

Studies have proved that CRP can still be used as a marker to predict the risk after 6 years of onset, and the determination of CRP' level is an effective means to measure whether oral aspirin is effective in preventing cardiovascular diseases.

26. Clinical significance of determination of angiotensin converting enzyme:

Increased ACE activity is a risk factor for myocardial infarction, and detecting ACE in patients with coronary heart disease is an effective measure to prevent myocardial infarction. The positive rate of increased ACE activity in sarcoidosis is between 75% and 88%, and the degree of increase is related to the activity and scope of the disease. The serum ACE activity of lung cancer patients decreased, and the lower the activity, the lower the cure rate and the higher the mortality rate. In addition, serum ACE activity in patients with liver cirrhosis and hyperthyroidism increased.

27. The clinical significance of potassium:

Promotion:

(1), oral and intravenous intake increased.

(2) Potassium flows into extracellular fluid, leading to severe hemolysis, infection and burn, tissue destruction and insulin deficiency.

(3) Tissue hypoxia, cardiac insufficiency, respiratory disorder and shock.

④ Dysuria, renal failure and adrenal cortex dysfunction.

(5) take a lot of digitalis.

Reduce:

(1), oral intake decreased.

(2) After transplanting potassium into intracellular fluid to treat alkalosis and using insulin, IRI secretion increased.

(3) Lack of potassium in digestive tract, frequent vomiting and diarrhea.

(4) Urine potassium loss leads to renal tubular acidosis.

Clinical significance of urinary potassium: When diuretics are used, urinary potassium excretion increases. The urinary sodium-potassium ratio of patients with primary aldosteronism decreased to 0.6: 1. When aldosterone secretion increases, urinary potassium excretion increases.

28. The clinical significance of serum sodium determination:

Promotion:

(1), severe dehydration, profuse sweating, high fever, burns, diabetic polyuria.

(2) Hyperadrenocortical function, primary and secondary aldosteronism.

Reduce:

(1), renal cortical insufficiency, severe pyelonephritis, diabetes and other renal sodium loss.

(2), gastrointestinal sodium loss such as gastrointestinal drainage, vomiting, diarrhea.

(3) Excessive antidiuretic hormone.

Clinical significance of urinary sodium determination;

The important clinical significance of urinary sodium determination is to know whether there is a large amount of salt loss, to judge whether the intake is sufficient, to assist in monitoring the low-salt diet and postoperative electrolyte supervision, and to help judge the electrolyte balance of patients with vomiting, severe diarrhea and heat failure. It is also used for the definite diagnosis of patients with salt deficiency and water deficiency; Sodium chloride in the urine of the former is quite low, while sodium chloride in the urine of the latter is normal or elevated. Patients with central nervous system diseases, cerebral hemorrhage, inflammation, tumor, Addison's illness, adrenocortical hypofunction, severe renal tubular injury, bronchial lung cancer, etc. , has increased urinary sodium compounds.

29. Clinical significance of serum chlorine determination;

Promotion:

Common in hypernatremia, respiratory alkalosis, hypertonic dehydration, nephritis oliguria and urethral infarction.

Reduce:

It is common in hyponatremia, severe vomiting, diarrhea, massive loss of gastric juice, pancreatic juice and bile, renal insufficiency and Addison's disease.

Clinical significance of determination of chlorine in urine;

Under normal circumstances, sodium and chlorine in urine remain relatively balanced. But the two are not always balanced. For example; After taking sodium chloride or potassium chloride continuously, urine chlorine is higher than urine sodium. On the contrary, when taking a large amount of basic sodium salt continuously, urine sodium is higher than chlorine. In addition, urine is alkaline, which may be because the sodium content in urine is higher than chlorine.

30. The clinical significance of determination of serum carbon dioxide binding capacity:

Increase: excess alkali reserve.

(1) Metabolic alkalosis: pyloric infarction (massive loss of gastric acid), upper intestinal obstruction, potassium deficiency, alkaline drug overdose (or poisoning).

(2) Respiratory acidosis: airway obstruction, severe emphysema, bronchiectasis, pneumothorax, emphysema, pulmonary encephalopathy, pulmonary fibrosis, respiratory muscle paralysis and compensatory respiratory acidosis.

(3) High fever and exhaled excessive carbon dioxide.

(4) Hyperfunction of adrenal cortex, excessive use of adrenocortical hormone.

Decrease: Insufficient alkali reserves.

(1) Metabolic acidosis: diabetic ketoacidosis, renal failure, uremia, septic shock, severe dehydration, epidemic hemorrhagic fever (hypotensive period and oliguria period), chronic adrenal cortex hypofunction, and taking too many acidic drugs.

(2) Respiratory alkalosis: excitement of respiratory center (accelerated breathing, hyperventilation, excessive inhalation of carbon dioxide).

(3) Renal diseases: glomerulonephritis, renal tubular acidosis, pyelonephritis and renal tuberculosis.

Mild acidosis: Co2cp23-18mmol/l/l.

Moderate acidosis: Co2cp18-14mmol/L.

Severe acidosis: carbon dioxide

Extreme acidosis: carbon dioxide

3 1. Clinical significance of serum calcium determination;

Elevated: common in bone tumors, hyperparathyroidism, acute bone atrophy, adrenal seborrhea and excessive vitamin D intake.

Decrease: it is common in vitamin D deficiency, rickets, rickets, hand and foot convulsions in children, senile osteoporosis, hypoparathyroidism, chronic nephritis, uremia, low calcium diet and malabsorption.

32. The clinical significance of serum magnesium determination:

Elevated: common in acute and chronic renal insufficiency, hypothyroidism, Addison's illness, multiple myeloma, severe dehydration and diabetic coma.

Decrease: It is common in congenital familial hypomagnesemia, hyperthyroidism, long-term diarrhea, vomiting, malabsorption, diabetic acidosis, primary aldosteronism, and after long-term treatment with corticosteroids.

33. The clinical significance of serum phosphorus determination:

Elevated: common in hypoparathyroidism, acute and chronic renal insufficiency, uremia, myeloma and fracture healing.

Decrease: It is common in hyperthyroidism, metabolic acidosis, rickets, renal failure, long-term diarrhea and malabsorption.

34. The clinical significance of serum lactate dehydrogenase determination:

Elevated: Acute myocarditis starts to increase 2-48 hours after onset, reaches its peak in 2-4 days, and returns to normal in 8-9 days. In addition, liver diseases and malignant tumors can also lead to the increase of LDH.

35. Serum AFU (? Clinical significance of -L- fucosidase)

Serum AFU can be used as a good supplementary means of serum AFP and become a sensitive and specific marker for diagnosis, curative effect observation and postoperative follow-up of primary liver cancer.

The serum AFU activity of patients with primary liver cancer is not only significantly higher than that of healthy people, but also significantly higher than that of benign liver occupying lesions such as metastatic liver cancer, cholangiocarcinoma, malignant hemangioendothelioma, malignant mesothelioma, cirrhosis and congenital liver cyst. The positive rate of diagnosis of primary liver cancer ranged from 64-8 1%, and the specificity was about 90%. The difference of positive rate may be related to the research object, the number of samples, the control of diagnostic criteria and the determination of diagnostic critical value.

Serum AFU activity has nothing to do with sex, age and liver function test results (such as ALT, AST, AKP, 5'-NT, GGT, TB, PT, GGP and ALB). Serum AFU activity in patients with primary liver cancer has nothing to do with tumor metastasis and differentiation. Dynamic follow-up of serum AFU activity after surgical resection or chemotherapy of primary liver cancer showed that AFU activity showed a downward trend, and AFU activity rose again, suggesting cancer recurrence. At the same time, the increase of serum AFU has obvious qualitative diagnostic significance for hepatocellular carcinoma with AFP positive or negative serum, especially for early diagnosis of hepatocellular carcinoma. The dynamic observation of serum AFU activity after hand resection of liver cancer also shows that measuring this index is helpful to observe the curative effect of liver cancer and monitor the postoperative recurrence.

36.？ Clinical significance of 2- microglobulin;

? 2- microglobulin (? 2-MG): a classic renal tubular marker protein, which can directly reflect renal tubular function.

Blood? 2- microglobulin elevation: glomerular filtration function is poor, which is found in patients with early glomerular lesions, acute and chronic nephritis, chronic renal insufficiency and long-term hemodialysis; It can also be seen in lymphocytic leukemia, gastric lymphoma, angionasal lymphoma, melanoma and other tumor diseases.

37. The clinical significance of homocysteine

The clinical application of Hcy is mainly used as a risk indicator of cardiovascular diseases, especially coronary atherosclerosis and myocardial infarction, and its concentration is directly proportional to the risk of the disease. The increase of Hcy level is considered as an independent progressive pathogenic factor of atherosclerosis, and the content of homocysteine in plasma is related to genetic factors, nutritional factors, estrogen level and age.

Homocysteine is closely related to cardiovascular diseases. The increase of homocysteine concentration damages coronary arteries and other blood vessels, which eventually leads to cardiovascular diseases such as atherosclerosis. Vitamin B6, B 12 and folic acid can regulate and reduce homocysteine by participating in homocysteine metabolism, thus reducing the risk of cardiovascular diseases. If the results exceed the standard, homocysteine is an independent risk factor for cerebrovascular disease, which is mostly caused by smoking and drinking.

38. Clinical significance of cystatin

The concentration of Cys C in serum and plasma was 0.5 1- 1.09mg/L (reference range). When renal function is damaged, the concentration of Cys C in blood changes with the change of glomerular filtration rate. When renal failure occurs, the glomerular filtration rate decreases, and the concentration of Cys C in blood can increase by more than 10 times. If the glomerular filtration rate is normal and the renal tubular function is abnormal, it will hinder the absorption and rapid decomposition of Cys C in the renal tubular, and increase the urine concentration by more than 100 times.

39. Clinical significance of fructosamine determination

Fructosamine can reflect the average blood sugar level of diabetic patients before the trial 1 ~ 3 weeks. To some extent, it makes up for the deficiency that glycosylated hemoglobin can not reflect the change of blood sugar concentration in a short time. The determination of fructosamine is rapid and cheap (chemical method), which is a good index to evaluate the control of diabetes, especially for brittle diabetes and gestational diabetes with large blood sugar fluctuation, and it is of practical significance to know its average blood sugar level. However, fructosamine does not affect every meal, so it cannot be used to directly guide the daily dose of insulin and oral hypoglycemic agents. The normal value of serum fructosamine was 1.64 ~ 2.64 mmol/L, and the plasma fructosamine was 0.3mmol/L lower than that of serum.

40. Clinical significance of IgG determination

Physiological changes: IgG can be obtained from the mother before the fetus is born. During the 22-28 weeks of pregnancy, the IgG concentration in fetal blood is equal to that in maternal blood. After birth, the maternal IgG gradually decreased, reaching the lowest level in the third and fourth months, and then the fetus gradually began to synthesize IgG, and the serum IgG gradually increased, reaching the adult level before the age of 65,438+06.

(1)IgG elevation: IgG elevation is a sign of re-immunization. Common in various chronic infections, chronic liver diseases, collagen angiopathy, lymphoma, systemic lupus erythematosus, rheumatoid arthritis and other autoimmune diseases; Simple IgG elevation is mainly seen in immune proliferative diseases, such as IgG secretory multiple myeloma.

(2) Decrease (2)IgG: It is found in patients with various congenital and acquired humoral immunodeficiency diseases, combined immunodeficiency diseases, heavy chain diseases, light chain diseases, nephrotic syndrome, viral infections and taking immunosuppressants. It can also be seen in metabolic diseases, such as hyperthyroidism and muscular dystrophy, and the concentration of IgG in blood can also be reduced.

Clinical significance of 4 1. IgA determination

Physiological changes: Children's IgA level is lower than that of adults, and increases with age, reaching human level before 16 years old.

(1)IgA increase: seen in IgA multiple myeloma, systemic lupus erythematosus, rheumatoid arthritis, liver cirrhosis, eczema and kidney diseases; In toxic liver injury, IgA concentration is related to the degree of inflammation.

(2) Decreased IgA: seen in repeated respiratory tract infections, non-IgA multiple myeloma, heavy chain diseases, light chain diseases, primary and secondary immunodeficiency diseases, autoimmune diseases and metabolic diseases (such as hyperthyroidism and muscular dystrophy).

42. Clinical significance of IgM determination

Physiological changes: From the 20th week of pregnancy, the fetus can synthesize IgM. The IgM concentration of fetus and newborn is 65,438+00% of the adult level, which increases with age and reaches the human level before the age of 8-65,438+06.

(1)IgM increase: it is found in early viral hepatitis, liver cirrhosis, rheumatoid arthritis, systemic lupus erythematosus, etc. Because IgM is the Ig in the initial immunity, the simple increase of IgM often indicates the primary infection caused by pathogens. Intrauterine infection can cause a sharp increase in IgM concentration, if IgM >1; 0.2g/L indicates intrauterine infection. In addition, in primary macroglobulinemia, IgM is monoclonal and obviously increased.

(2) Decrease (2)IgM: It is found in IgG heavy chain disease, IgA multiple myeloma, congenital immunodeficiency disease, lymphatic tumor after immunosuppressant treatment, nephrotic syndrome and metabolic diseases (such as hyperthyroidism and muscular dystrophy).

43. Clinical significance of determination of anti-streptolysin O.

Adult ASO & gt500 unit has diagnostic significance. Patients with active rheumatic fever generally exceed 400 units.

ASO positive is common in group A hemolytic streptococcus infection. Patients with active rheumatism not only have increased ASO, but also have the characteristics of increased ESR, CRP positive and leukocytosis. Acute glomerulonephritis also increased.

44. Clinical significance of rheumatoid factor

RF is an autoantibody with denatured IgG as the target antigen.

RF positive is very common in patients with rheumatoid arthritis and autoimmune diseases. A few healthy people will also have positive results.

45. Determination of C-reactive protein (CRP)

CRP is an acute phase protein. In all kinds of acute and chronic infections, tissue injuries, malignant tumors, myocardial infarction, surgical trauma, radiation injuries, etc. CRP increased rapidly within a few hours after illness, and then returned to normal quickly when the lesion improved. This reaction is not affected by radiotherapy, chemotherapy and corticosteroid therapy.