兽医临床病理学-第6讲血清生物化学检测

1、李英 讲师华南农业大学兽医学院血清生物化学检测 Serum proteins 血清蛋白 Total protein（TP) 总蛋白、 albumin(ALb)白蛋白、 Globulins(GLB)球蛋白Lipid metabolism Cholesterol（CHO)胆固醇、Triglycerides (TG)甘油三脂Carbohydrate metabolism Glucose（Glu)血糖、 Fructosamine 果糖胺Electrolytes Sodium(Na)钠; Potassium(K)钾; Chloride(Cl)氯 Magnesium（Mg)镁; Calcium(Ca)钙;

2、 Phosphorus(P)磷 临床生化检测项目 Muscle enzymes Creatine kinase（CK）肌酸激酶 Aspartate aminotransferase （AST)谷草转氨酸Indicators of renal function Blood Urea nitrogen（BUN)尿素氮、Creatinine （CREA)肌酐Pancreatic disease Amylase（AMY)淀粉酶、Lipase（LPS)脂肪酶临床生化检测项目 Markers of hepatic disease Alanine aminotransferase（ALT)谷丙转氨酶 Asp

3、artate aminotransferase(AST)谷草转氨酶 Alkaline phosphatase(ALP)碱性磷酸酶 Gamma-glutamyi transferase (-GT)-谷氨酰转移酶 lactate dehydrogenase（LDH)乳酸脱氢酶 Bilirubin（BiL)胆红素 Bile acids胆汁酸 Ammonia 氨临床生化检测项目血清、血浆血清：血液离体后自然凝固，分离的淡黄色透明液体，缺少某些凝血因子，如纤维蛋白原（凝血因子）。血浆：血液加抗凝剂后分离出来的淡黄色液体，含有纤维蛋白原。血清样品的制备采集血液，置不含抗凝剂的试管内。室温下自然凝集2030

4、min沿试管壁分离血凝块20003000rpm离心10min移液管将血清移出，标记。脂血、溶血样品对结果的影响在高度溶血程度下, AST、ALT、ALP、LDH、CK、CK-MB、- GT 和羟丁酸脱氢酶(HBDH) 活性均明显升高。脂血时TG、CHO、T.BiL、D.BiL、UA 有显著差异火焰光度法测定的血清钠和钾离子假性降低，折射仪测定血浆蛋白假性升高。各种血清酶的贮藏稳定性 温度酶254-25ALT2天1周不稳定AST3天1周1月ALP2-3天2-3天1月LDH1周1-3天1-3天CK2天1周1月AMY1月7月2月LPS7天21天-GT2天1周1月在已定时间内，酶活性不低于原有活性90

5、%.血液标本长时间放置后 ，其结果偏高的是: TP、ALB、CHO、K 、Na 。其结果偏低的是：GLU、T.BiL、Cl 。血液标本放置时间对结果影响差异无显著性的是：D.BiL、TG。生化室的大多数标本可放置 24 h，但应尽可能在 4 h内完成 ，理想情况是1h。标本的存放时间对结果的影响 总蛋白（Total protein，TP）分类：白蛋白、球蛋白；功能分类：转运物质、免疫、凝血、补体、蛋白类激素功能 维持血浆渗透压、营养作用、运载、pH缓冲、抑制组织蛋白酶、是血浆中起催化作用酶的组成成分、参与凝血和免疫防御系统。 白蛋白 （albumin，ALB） 简述 是小的球形蛋白，血浆中含量

6、最多的蛋白质（3550%）。主要由肝实质细胞合成。具有维持血浆胶体渗透压、重要营养蛋白、血浆中主要的载体蛋白、缓冲酸碱的能力。新生和幼畜和孕期血清蛋白生理性偏低。腹水和组织水肿时出现明显低白蛋白血症(1.0); 牛猪和猫的白蛋白浓度等于或低于球蛋白浓度（A/G1.0)1.“Belinda” is a 6-year-old spayed female German Shepherd dog with a history of unilateral hip replacement for hip dysplasia. 2.Belinda has presented three times with

7、in the last year for vomiting and diarrhea related to dietary indiscretion. 3.She presented again today for vomiting associated with getting into the garbage last night. 4.On physical examination, Belinda is quiet and alert. She is very thin with a dull haircoat. No abnormalities or pain are noted o

8、n abdominal palpation. Mucous membranes are slightly tacky but pink.（P152，case1）Manual of Veterinary Clinical Chemistry:A Case Study ApproachLeslie C. Sharkey, DVM, PhD, DACVP M. Judith Radin, DVM, PhD, DACVP“Princess” is a 6-year-old intact female German Shepherd that was hit by a car. She presents

9、 in lateral recumbancy with thready pulses. She has at least eight broken ribs and is extremely painful. A quick PCV and total protein are with in reference intervals at presentation. After fluid therapy and medication for pain, samples are drawn for CBC and serum biochemical profile.（P156，case3)“Su

10、sannah” is a 2-year-old spayed female domestic short haired cat who was adopted 3 months ago after being held as a stray in a veterinary clinic. Her physical examination and blood work were unremarkable prior to adoption. For the last week, Susannah has had dark stool and a decreased appetite. She h

11、as become progressively more lethargic for the past Three days, and she may be drinking more than usual lately. On physical examination, Susannah is thin and has an unkempt hair coat. She has lost one pound of body weight, has icteric mucous membranes, and is febrile. Susannahs abdomen is distended

12、and the kidneys feel enlarged on palpation. She is feline leukemia virus negative. （P165，case7)“Slurpee”is a 9-year old spayed female Golden Retriever presenting for an orexia, lethargy, and increased urinations. On presentation, she is bright and alert, in good body condition, But slightly dehydrat

13、ed. （P169，case8)血糖（Glucose, GLU) 生理 糖是哺乳动物主要的能量来源，由饮食和肝的糖原异生而来。血糖浓度由胰岛素、胰高血糖素、肾上腺素、 皮质醇、生长激素、甲状腺素来调节。肾重吸收阈值为10-12 mmol/1，当高于此值时会导致糖尿。 检测适应症 糖尿病 (多饮、多尿、体重减轻、白内障)、酮血症 (呕吐、腹泻、厌食) ；低血糖 (虚弱、癫痫、失明、定向性差, 沉郁)；体检；另外在一些其它疾病 (肾上腺皮质功能亢进, 肝病)，血糖数据提供参考 ，糖尿病治疗中胰岛素的量和合理的饮食。 注意：正常，3.0 mmol/l 虚脱, 癫痫；0.5 mmol/l 昏迷。 但慢

14、性病，3 seconds.Immune-mediated thrombocytopenia was presumptively diagnosed based on the marked thrombocytopenia and the absence of other causes of decreased platelets. Serologic tests for tick borne diseases such as Rocky Mountain Spotted Fever and Ehrlichial organisms were negative. Salvatore was tr

15、eated with immunosuppressive doses of corticosteroids. His clinical condition improved, and subsequent blood samples were collected 14 days after initiation of therapy.尿素氮 (Urea nitrogen,BUN)Physiology 食物中蛋白在肠道中降解为氨基酸，部分被肠道菌转化为氨，氨基酸和氨被转运到肝，被鸟氨酸循环利用后在肝细胞中形成尿素氮，由肾排出。尿素氮和氯化钠在肾髓质为水的重吸收形成渗透梯度。Indications

16、 for assay 尿素氮浓度是反应肾脏功能的一个指标，适合于临床表现呕吐、厌食、体重减轻、多饮、脱水的病例。 尿素氮 (Urea nitrogen,BUN)减少 食入蛋白减少、肝脏疾病、病理性的多尿，如：肾上腺皮质机能亢进、糖尿病。增多 食入蛋白增多，禁食12小时 肾前性（灌注量不足、脱水、肠道出血等）、 肾实质疾病、 肾后性（尿道阻塞、尿腹症）肌酐(Creatinine,CREA)生理 肌酐由肌肉中贮能的磷酸肌酸进行非酸性转化而来，肌酐不能再利用。每天机休内的肌酐量由食物和肌肉活动量的大小和肌肉疾病及其程度而定。尿素和肌酐自由滤过肾小球，但尿素被重吸收，所以肌酐是最好反应肾小球滤过率（G

17、FR）的指标。临床意义减少 弱动物增多 活动量大的动物。肾小球滤过率减少。血清肌酐浓度不受体内水分和分解代谢因素的影响，肌酐清除较尿素快，故肌酐含量增加出现在尿素增高之后，又由于影响肌酐的非肾性因素少，所以在评价肾病的临床意义比BUN大。“Marsali” is a 10-year old Paint mare that presents for evaluation after being seized for Mistreatment by law enforce mentagents. She is extremely thin with a poor haircoat。She appe

18、ars bright and alert with pale mucous membranes.“Marklar” is a7-year-old castrated male, domestic short hair cat that has been missing for4 days. Marklar normally is an exclusively indoor cat. Here turned home with some weight loss, although his body condition is still good. He is obviously hungry a

19、nd thirsty. His owners request a health check and blood work. Marklar has tacky mucus membranes and a slightly prolonged capillary refill time, but he other wise appears healthy.其它正常“Sherpa” is a 10-year-old castrated male Collie presenting with a 5 month history of hematuria and stranguria血尿、小便涩痛. He now re