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I. ДИАГНОСТИКА И ЛЕЧЕНИЕ
UDC 616.362-003.707:614.253.52
ABOUT THE АUTHORS Abdilova Gulnur Bekmurzaevna
- Head of the CDL, e-mail address: gulnur_abdilova@mail.ru, telephone 87019911346
Nurakhova Alma Dandybaevna
- PhD, doctor-laboratory CDL, e-mail address: nad7788@mai.ru, telephone 87776850298
DIAGNOSIS OF DISEASES OF THE HEPATOBILIARY SYSTEM IN THE PRACTICE OF A LABORATORY ASSISTANT
Abdilova G.B., Nurakhova A.D., Yatsenko S.V.
National Scientific Surgery Center under the name of A.N.Syzganov Kazakh Medical University Continuing Education, Almaty, Kazakhstan
Keywords
liver, hepatobiliary system, biochemical studies.
АВТОРЛАР ТУРАЛЫ Абдилова ^лнур Бекмурзакызы -
А.Н.Сызеанов атындаеы YFXO клиникалыщ-диагностикалыщ зертханасыныц мецгерушю, электрон адреЫ: gulnur_ abdilova@mail.ru, телефон 87019911346
Нурахова Алма Дандыбайкызы - m.f.k, КДЗ лаборант- дэрirерi, электрон адреа: nad7788@mai.ru, телефон 87776850298
Туйш сездер
бауыр, бауыр-етжуйеа, биохимиялыщ зерттеулер.
Abstract
The work analyzes the data of biochemical studies of various parameters of liver function, isolated from the blood serum of patients treated and examined in the National Scientific Surgery Center under the name of A.N.Syzganov in 2017 The article is devoted to the diagnosis of liver pathology, since this is actual for today, which is caused by a large number of people suffering from liver diseases.
Дэр1гер-лаборант тэжрибесшдеп бауыр-ет жуйесшщ ауруылдарын аньщтау
Абдилова Г.Б., Нурахова А.Д., Яценко С.В.
А.Н. Сызганов атында?ы улттык, ?ылыми хирургия орталы^ы
Казак,тьщ медицалык Yздiксiз бшм беру университету Алматы каласы, Казакстан
Ацдатпа
А.Н. Сызганов атындары улттык;гылыми хирургия орталы^ында 2017ж. емдегенжэне щарал€ан наущастардыц биохимиялык зерттеулердыц нэтижелерiне, бауырдын функциялыщ кесеткiштерiне, наущастардыц щанынан белнген сарысуына талдау журпзшген. Макала бауырдыц патологиясын диагностикалау мэселесне арналган, себебi бул бупнп кунге езет жэне бауыры ауыратын адамдардыц саныныц кептше байланысты болып отыр.
ОБ АВТОРАХ Абдилова Гульнур Бекмурзаевна
- Заведующая КДЛ, электронный адрес: gulnur_abdilova@mail.ru, телефон 87019911346
Нурахова Алма Дандыбаевна
- к.м.н., Врач-лаборант КДЛ, электронный адрес: nad7788@mai.
ru, телефон 87776850298
Диагностика заболеваний гепатобилиарной системы в практике врача-лаборанта
Абдилова Г.Б., Нурахова А.Д., Яценко С.В.
ННЦХ им. А.Н. Сызганова
Казахский медицинский университет непрерывного образования, г. Алматы, Казахстан
Ключевые слова
печень, гепатобилиарная система, биохимические исследования.
Аннотация
В работе выполнен анализ данных биохимических исследований различных показателей функции печени, выделенных из сыворотки крови пациентов, лечившихся и обследовавшихся в ННЦХ им. А.Н. Сызганова в 2017 г. Статья посвящена вопросу диагностики патологии печени, так как это является актуальным на сегодняшний день, что обусловлено большим количеством людей, страдающих заболеваниями печени.
According to the latest information of the World Health Organization (WHO), there are more than 2 billion people with liver diseases worldwide, which is 100 times more than the frequency of HIV infection. Over the course of the current 20 years, a marked tendency to an increase in the number of diseases of the hepatobiliary system has been observed worldwide [1, 2]. So, for example, only in the CIS countries is annually fixed from 500 thousand to 1 million patients suffering from a particular hepatic pathology. There is an increase in the frequency of pathology of the hepatobiliary system at a young age, in women 4-7 times more often than in men. According to the WHO experts, every fifth woman and every 10th man in Europe has a pathology of the liver and bile ducts. Accordingly, diagnostics and treatment of diseases of the hepatobiliary system is one of the most urgent problems of modern medicine (1, 2).
The aim of the work was the analysis of biochemical studies of various indicators of liver function performed in 2017 in diagnostic laboratory of National Scientific Surgery Center under the name of A.N. Syzganov.
Material and methods
In the work, biochemical studies of various parameters of liver function, isolated from serum of 430 (225 women, 205 men), patients aged 18 to 78 years, treated and examined in the National Scientific Surgery Center under the name of A.N.Syzganov in 2017.
In total, the following number of parameters was studied: bilirubin total - 430; bilirubin straight - 430; asparagine aminotransferase (AST) - 430; alanine aminotransferase (ALT) - 430; alkaline phosphatase (APP) - 430; gamma-gamma-glutyl-transferase (GGTP) - 430; lactate dehydrogenase (LDH) - 430; cholesterol - 430; albumin - 430; ammonia - 430. The analyzes were carried out on the device «COBAS INTEGRA 400/400 plus» company
«Roche» (Germany), which is an automatic analyzer intended for the quantitative determination of various parameters in serum and blood plasma.
Results
In this article, we present the results of biochemical studies of various parameters of liver function, isolated from blood serum 430 (225 women, 205 men) from 18 to 78 years old, treated and examined at the National Scientific Surgery Center under the name of A.N.Syzganov in 2017 (Table 1).
Discussion
The term «liver» originates from the word «oven», since the highest temperature of all organs is characteristic for the oven. This is due to the fact that in the liver per unit mass, the greatest number of energy production is observed. Up to 20% of the mass of the hepatic cell is in the mitochondria -«power stations» cells, which constantly synthesize ATP, which spreads throughout the body.
The liver is the largest organ in the human body and animals; in an adult it weighs 1.2-1.5 kg. Its weight varies with age - about 50 years, the liver begins to atrophy, and by the old age its weight is only 0.8-1 kg. Despite the fact that the liver is 2-3% of body weight, it takes away 20 to 30% of the oxygen consumed by the body (4).
The structural-functional unit of the liver is a lobe of the liver. The area located between the hepatic cells is the bile ducts. On the central part of the lobule passes the vein, in the interlobular tissue - vessels and nerves. In the human liver there are about 500 thousand hepatic lobules. The liver has about 300 billion cells, 80% of which are hepatocytes.
The liver is a significant gland that maintains the constancy of the internal environment of the body. It is a unique and complex organ that takes a central place in the metabolism of proteins, carbohydrates, fats and plays a significant role in the metabolism of drugs.
Biochemical indicator of blood Patients (n=430)
Total bilirubin, ^mol / l 294,0 (7,1 - 581,0)
Direct bilirubin, ^mol / l 226,6 (1,2 - 485,0)
Aspartate aminotransferase, U / l 541,0 (10,0 - 1072,0)
Alanine aminotransferase, U / l 359,3 (7,6 - 711,0)
Alkaline phosphatase, U / l 240,5 (34,0 447,0)
Gamma-glutamyltransferase, U / l 451,5 (6,0 - 897,0)
Lactate dehydrogenase, U / L 2069,5 (17,0 - 4122,0)
Total cholesterol, mmol / l 3,91 (0,82 - 7,0)
Albumins, g / l 31,5 (16,0 - 47,0)
Ammonia, ^mol / l 59,0 (10,0 - 108,0)
Table 1.
Features of biochemical parameters in liver pathology
The liver provides the following functions. 1. Bile and biliary excretory functions. Liver cells release bile, which includes water, electrolytes, organic substances (bile acids and salts, cholesterol, conjugated bilirubin, cytokines, etc.) and heavy metals, in particular copper. The total amount of bile produced by the liver is an average of 600 ml / day. The physiological significance of bile includes the removal of lipophilic components from the body, which can not be disposed of and excreted in the urine; and also - the release of bile acids, which take part in the digestion of fat of food products and the absorption of products of its hydrolysis (1, 4).
2. Metabolic function. In the liver, the compounds necessary for the operation of other organs of the digestive system (stomach, pancreas and small intestine) are formed. The products of nutrient cleavage go to the liver from the gastrointestinal tract through the portal vein. In the liver, the exchange of proteins and amino acids, lipids, carbohydrates, biologically active substances (hormones, biogenic amines and vitamins), microelements, and regulation of water metabolism is observed. The liver promotes the synthesis of proteins, including blood plasma proteins, their accumulation; reamination and deamination of amino acids; urea formation and synthesis of creatinine; the synthesis of glycogen from monosaccharides and non-carbohydrate products; oxidation of fatty acids; the formation of ketone bodies and the synthesis of cholesterol. The main way of catabolism of cholesterol in the liver is the synthesis of bile acids; also on the basis of cholesterol all steroid hormones are formed: glucocorticoids, mineralocor-ticoids and sex hormones (estrogens, androgens and progesterone); vitamin D3, blood plasma lipids. To all steroid hormones, only 3% of cholesterol is consumed (1, 4).
3. Deposition function. In the liver, the carbohydrate is deposited in the form of glycogen; proteins, fats, hormones, vitamins (A, D, K, C, PP, B12) and minerals (iron, copper, manganese, cobalt, molybdenum) (1, 4).
4. Barrier function. The liver performs neutralization (biochemical transformation) of foreign and toxic substances coming with food or arising in the intestine, as well as toxic compounds of exogenous nature. Microorganisms are rendered harmless by macrophages (Kupffer cells) by phagocytosis and lysis. An increase in the level of environmental pollution, increased consumption of various preservatives, alcohol, uncontrolled use of drugs significantly increase the metabolic burden on the liver (1, 4).
5. Excretory function. From the liver, various compounds of endogenous and exogenous origin (more than 40 compounds) are sent to the bile
ducts and are excreted with bile or enter the blood, where they are excreted by the kidneys. One of the characteristic features of the excretory function of bile is that it is able to remove from the body such substances that can not be isolated from the body in any other way.
6. Homeostatic function. The liver provides a constant composition of blood (homeostasis), performing the synthesis, accumulation and secretion into the blood of various metabolites, as well as carrying out the absorption, transformation and excretion of plasma components.
That is, the liver performs three main types of life: digestion, metabolism (energy supply, metabolism of proteins, fats, carbohydrates, hormones, vitamins, enzymes, water, electrolytes, trace elements, pigments) and detoxification, as well as blood circulation.
The hepatobiliary system, to which the liver itself belongs, the bile ducts and the gallbladder, is involved in many vital processes of the body. Its damage is determined by significant damage to metabolism, immune response, detoxification and antimicrobial protection (1, 2).
Quite often liver cells are disrupted under the influence of aggressive compounds - poisons, free radicals, bacterial and viral infections. In addition, damaging effects on the liver show stress, hormonal and metabolic disorders, poor-quality food, excessive enthusiasm for medicines and alcohol. Liver disorders are carried out through chemical and immunological mechanisms (3).
However, the liver refers to organs capable of regeneration after damage due to cellular cooperation, the presence of molecular mechanisms of the reaction of the acute phase and the synthesis of a number of substances of a protective nature (4).
Almost in all cases, regardless of the etiology of the disease, oxidative stress is the common patho-genetic link (5).
According to the results of experimental works, the dosage forms of antioxidants help suppress inflammatory necrotic reaction in the liver, inhibit the development of fibrosis, stimulate regeneration processes and reduce the risk of malignant transformation of hepatocytes. Based on these experiments, the use of antioxidants (including plant origin) in the treatment of various chronic liver diseases, taking into account the common pathogenetic features of their development (5) was suggested.
Conclusions
1. Leading syndrome with liver lesions is cytolytic, with laboratory criteria being the increase in ACAT activity and, to a greater extent, ALT, an increase in serum iron content, and in massive cytolysis with hepatocellular insufficiency, the
decline in the synthesis of prothrombin, other coagulation factors and albumin, and cholesterol esters. Cytolysis is caused by a change in the permeability of hepatocyte membranes and the release of intracellular contents into the intercellular matrix and blood.
2. Mesenchymal inflammatory syndrome is manifested by an increase in the levels of a2-, p- and y-globulins, immunoglobulins of all classes, changes in colloidal samples (decrease in the sulfate titer and increase in timolveronal test).
References
3. With cholestatic syndrome, blood levels of bound bilirubin, bile acids, cholesterol, copper, alkaline phosphatase activity, 5-nucleo-tidase (5-NAA), gamma-glutamyltranspepti-dase (GGTP) increase; bilirubinuria is noted. Thus, the examined patients had biochemical signs of all the above syndromes, which determine the development of the pathology of the hepatobiliary system, which, in turn, is a predictor of the progression of other diseases.
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