Kev Ntsuas Bilirubin (Tag Nrho, Ncaj Qha thiab Tsis Ncaj Qha Bilirubin): Nws Qhia Dab Tsi thiab Dab Tsi Nws Tsis Qhia Tau

Tus yuam sij takeaways

• Qhov kev kuaj bilirubin ntsuas ib qho xim, tsis yog kev puas tsuaj rau daim siab, nws qhia ib qho qauv, tsis yog kev kuaj mob.
• Ib feem pua ​​uas tsis ncaj qha nce siab qhia txog kev puas tsuaj ntawm cov qe ntshav liab, Gilbert syndrome lossis mob daj ntseg rau cov menyuam mos; ib feem pua ​​uas nce siab qhia txog teeb meem ntawm cov qe ntshav siab lossis cov kua tsib.
• Qhov tshwm sim ntawm bilirubin ib txwm muaj tsis suav nrog kab mob siab, suav nrog cirrhosis, kab mob siab lossis kab mob rog siab.
• Qhov kev kuaj bilirubin tsis tuaj yeem qhia qhov twg cov kav dej kua tsib raug thaiv, yuav tsum tau siv duab thaij rau qhov ntawd.
• Hauv cov menyuam mos, cov nqi bilirubin raug txhais raws li cov duab qhia teev thiab hnub nyoog cev xeeb tub, tsis yog raws li cov neeg laus.

Ib nrais muag

Kuj hu ua

• Cov bilirubin hauv cov ntshav; S. bilirubin
• Tag nrho thiab ncaj qha bilirubin; T Bil / D Bil
• Kev kuaj Peelia or kev kuaj mob daj ntseg siv txhua hnub hauv Is Nrias teb
• TSB (tag nrho cov bilirubin hauv cov ntshav) hauv kev saib xyuas menyuam mos; TcB rau kev tshuaj ntsuam bilirubin transcutaneous
• Ib feem ntawm cov LFT or daim siab profile, feem ntau sau nrog SGPT thiab SGOT

Kev kuaj bilirubin yog dab tsi

Cov qe ntshav liab muaj sia nyob li plaub lub hlis. Thaum lawv raug rhuav tshem, cov ntshav hauv lawv yuav hloov mus ua bilirubin. Cov bilirubin tsis sib txuas (tsis ncaj qha) no mus ncig hauv cov ntshav uas khi rau albumin, raug cov qe ntshav siab nqus, koom nrog cov suab thaj kom ua bilirubin sib txuas (ncaj qha), thiab tom qab ntawd dhau mus rau hauv cov kua tsib thiab tawm los ntawm txoj hnyuv.

Lub chaw kuaj ntshav ntsuas tag nrho cov bilirubin thiab cov bilirubin ncaj qha. Cov bilirubin tsis ncaj qha yog suav los ntawm kev rho tawm, tsis yog ntsuas cais. Vim tias nws yog tus lej suav, qhov sib txawv me me ntawm ob tus nqi ntsuas tuaj yeem hloov nws.

Bilirubin nce thaum ib kauj ruam hauv cov saw hlau ntawd raug thauj khoom ntau dhau lossis cuam tshuam: kev tawg ntawm cov qe ntshav liab ntau dhau, txo qis kev nqus lossis sib txuas ntawm daim siab, kev raug mob ntawm daim siab, lossis kev ntws ntawm cov kua tsib.

Vim li cas thiaj ua qhov kev kuaj bilirubin

• Yuav nrhiav kev kho mob qog noj ntshav: qhov muag daj lossis daim tawv nqaij, zis tsaus, quav daj ntseg.
• Yuav ua li cas cais cov mob jaundice: qhov nce ntxiv feem ntau tsis ncaj qha qhia txog kev tawg ntshav lossis teeb meem sib txuas; qhov nce ntxiv feem ntau qhia txog kab mob siab lossis kab mob biliary.
• Yuav saib xyuas cov kab mob siab uas paub lawm: bilirubin yog ib feem ntawm cov qhab nia hnyav uas siv rau hauv kab mob siab ntev thiab hauv kev ntsuam xyuas kev raug mob siab sai.
• Yuav saib xyuas cov menyuam mos uas muaj mob jaundice thiab txiav txim siab seb puas xav tau kev kho mob phototherapy lossis kev kho mob ntxiv.
• Txhawm rau pab soj ntsuam qhov xav tias muaj haemolysisFeem ntau, nws yog txuam nrog cov ntshav haemoglobin, reticulocyte suav thiab LDH.
• Txhawm rau saib xyuas kev nyab xeeb ntawm cov tshuajpiv txwv li thaum lub sijhawm kho mob ntsws, methotrexate lossis qee yam tshuaj chemotherapy, ua ib feem ntawm LFT panel.

Leej twg yuav tsum tau txais qhov kev xeem no

• Cov neeg uas muaj qhov muag lossis daim tawv nqaij daj, khaus tsis muaj pob khaus, zis tsaus (xim tshuaj yej) lossis quav xim av nplaum.
• Cov neeg uas xav tias muaj tus kab mob siab, suav nrog tus kab mob siab A thiab tus kab mob siab E, uas tseem muaj ntau hauv Is Nrias teb.
• Cov neeg noj tshuaj uas paub tias muaj teebmeem rau lub siab, suav nrog cov tshuaj tiv thaiv kab mob ntsws, thiab cov neeg noj tshuaj ntsuab, AYUSH lossis cov chaw dhia ua si lossis cov tshuaj pab kom poob phaus, uas yog ib qho ua rau lub siab raug mob los ntawm tshuaj.
• Cov menyuam mos uas muaj qhov mob daj ntseg pom tseeb, qhov mob daj ntseg tshwm sim hauv 24 teev thawj zaug, yug tsis tau sijhawm, pawg ntshav tsis sib haum nrog leej niam, noj tsis txaus lossis tsaug zog ntau dhau.
• Cov neeg uas paub lossis xav tias muaj cov mob haemolytic, thalassemia, kab mob sickle cell, G6PD deficiency, autoimmune haemolysis.
• Cov neeg uas muaj pob zeb hauv lub zais zis, tau phais mob biliary yav dhau los, mob plab nrog rau kub taub hau, lossis poob phaus yam tsis paub meej.
• Cov neeg uas muaj kab mob siab ntev, rau kev saib xyuas raws sijhawm raws li lawv tus kws kho mob qhia.

Kev kuaj bilirubin tsis yog kev kuaj mob dav dav rau ib tus neeg uas tsis muaj tsos mob lossis muaj feem yuav ua rau muaj kev pheej hmoo. Feem ntau nws raug thov kom ua ib feem ntawm pawg neeg LFT es tsis yog ib leeg xwb.

Qhov kev kuaj bilirubin tsis tuaj yeem pom lossis tsis suav nrog

• Nws tsis tuaj yeem zam tau kab mob siab. Feem ntau bilirubin yog ib txwm muaj nyob rau hauv cov kab mob cirrhosis uas raug kho dua tshiab, kab mob siab B lossis C ntev, thiab hauv cov kab mob siab steatotic (MASLD, yav tas los hu ua NAFLD). Yog bilirubin ib txwm muaj tsis tau txhais hais tias lub siab noj qab nyob zoo.
• Nws tsis tuaj yeem nrhiav tau qhov chaw uas muaj kev thaiv. Qhov bilirubin uas nce siab tsis qhia tias yog pob zeb hauv cov hlab ntsha hauv lub cev, qhov nqaim lossis yog qog. Yuav tsum tau siv ultrasound, MRCP, CT lossis endoscopic imaging.
• Nws tsis tuaj yeem ntsuas tau fibrosis lossis cirrhosis. Siv cov elastography, imaging, fibrosis scores lossis biopsy rau qhov ntawd.
• Nws tsis tuaj yeem txheeb xyuas qhov ua rau mob siab. Xav tau kev kuaj mob viral serology, cov cim qhia txog kev tiv thaiv kab mob autoimmune, kev tshawb nrhiav hlau thiab tooj liab, keeb kwm tshuaj thiab kev thaij duab.
• Nws tsis tuaj yeem lees paub qhov tseeb ntawm cov ntshav txhaws ntawm nws tus kheej. Yuav tsum tau kuaj ntshav hemoglobin, suav cov reticulocyte, LDH, haptoglobin thiab peripheral smear.
• Nws tsis tuaj yeem kuaj mob Gilbert syndrome los ntawm nws tus kheej, txawm hais tias qhov nce me me tsis ncaj qha nrog rau lwm yam kev kuaj mob ib txwm yog tus qauv ib txwm muaj.
• Nws tsis tuaj yeem ntsuas seb tus menyuam mos mob npaum li cas tsis muaj kev siv rau hnub nyoog hauv teev, cev xeeb tub thiab cov yam ntxwv pheej hmoo.

Tus nqi uas qhia tias zoo li qub lossis "tsis nce" piav qhia txog yam uas cov qauv qhia thaum lub sijhawm ntawd. Yog tias cov tsos mob tseem muaj txawm tias qhov tshwm sim zoo li qub, rov qab mus ntsib koj tus kws kho mob dua li xav tias qhov teeb meem tau raug tshem tawm lawm.

Kev ntsuam xyuas sib txuas tab sis sib txawv

Qhov kev kuaj twg yuav ua ntej nyob ntawm seb qhov teeb meem kev kho mob yog dab tsi. Hauv cov mob daj ntseg uas tsis mob thiab muaj qhov nce siab ncaj qha, kev thaij duab ntawm tsob ntoo biliary feem ntau ua raws li sai sai. Hauv ib tug tub hluas uas muaj mob bilirubin ntau dhau thiab tsis muaj tsos mob, kev kuaj dua thiab keeb kwm zoo yuav yog txhua yam uas xav tau. Hauv ib tug menyuam mos, kev ntsuas bilirubin raws li teev yuav tsum muaj qhov tseem ceeb dua txhua yam.

Yuav npaj li cas

Cov lus qhia npaj ua haujlwm tau thiab sib txawv ntawm cov chaw kuaj mob thiab cov tsev kho mob. Cov lus qhia sau ntawm koj chav kuaj mob muaj qhov tseem ceeb dua txhua yam ntawm nplooj ntawv no.

• Kev yoo mov: Feem ntau tsis tas yuav yoo mov vim tias kev kuaj bilirubin muaj nrog rau kev kuaj lipid lossis glucose. Kev yoo mov ntev tuaj yeem ua rau bilirubin tsis ncaj nce ntxiv, tshwj xeeb tshaj yog hauv Gilbert syndrome.
• Tshuaj thiab tshuaj ntxiv: Qhia rau lub chaw kuaj mob thiab koj tus kws kho mob txog txhua yam koj noj, suav nrog cov tshuaj tua kab mob, tshuaj tua kab mob ntsws, tshuaj tiv thaiv kev xeeb tub, hmoov protein, thiab AYUSH lossis cov tshuaj ntsuab. Tsis txhob tsum cov tshuaj uas tau muab rau koj kom "tau txais txiaj ntsig zoo dua", nrog tus kws kho mob tham ua ntej.
• Dej Cawv: qhia rau koj tus kws kho mob txog kev haus dej cawv tsis ntev los no kom nyeem tau qhov tshwm sim kom raug.
• Kev co: kev haus dej li qub ua rau cov ntshav nqus tau yooj yim dua, tshwj tsis yog tias koj tau txwv tsis pub haus dej ntau.
• Kev ua qauv: bilirubin rhiab heev rau lub teeb, yog li ntawd, cov chaw kuaj mob tiv thaiv cov qauv ntawm lub teeb. Qhov no yog lub luag haujlwm ntawm lub chaw kuaj mob, tsis yog koj li.

Yog koj xeeb tub

Mob daj ntseg lossis khaus thaum cev xeeb tub yuav tsum tau mus soj ntsuam mob sai sai dua li kev saib xyuas tus kheej. Feem ntau yuav tsum ntxiv cov kua qaub hauv cov zis thiab lwm yam kev kuaj mob. Tsis txhob yoo mov ntev thaum cev xeeb tub tshwj tsis yog tias tau qhia tshwj xeeb.

Yog koj muaj mob ntshav qab zib uas tab tom kho mob kom txo cov piam thaj (glycolysis)

Kev yoo mov ntev ntev muaj feem yuav ua rau muaj ntshav qab zib tsawg thaum noj tshuaj insulin lossis sulfonylurea. Nug koj tus kws kho mob seb yuav ua li cas thiaj teem sijhawm kuaj thiab noj tshuaj. Feem ntau, kev teem sijhawm thaum sawv ntxov yog qhov zoo dua.

Yog tias koj muaj kab mob raum ntev, lub plawv tsis ua haujlwm lossis kev txwv dej

Tsis txhob haus dej ntau dhau qhov koj tau teem tseg rau kev kuaj ntshav. Ua raws li qhov koj pab neeg kho mob tau teev tseg.

Me nyuam mos thiab me nyuam

Cov menyuam yaus tsis tau yoo mov tas li rau kev kuaj bilirubin. Kev kuaj menyuam mos yog lub sijhawm raws li hnub nyoog hauv cov teev, tsis yog los ntawm kev pub mis. Kev pub mis tuaj yeem txuas ntxiv mus raws li pab pawg menyuam mos qhia.

Cov laus

Cov leeg ntshav yuav tsis khov thiab yuav muaj qhov mob ntau dua. Hais txog cov tshuaj anticoagulants lossis cov tshuaj antiplatelet ua ntej kos duab kom thiaj li siv zog tau ntev dua.

Muaj dab tsi tshwm sim thaum lub sijhawm xeem

Tus kws kho mob ntshav ntxuav daim tawv nqaij, muab ib txoj hlab ntshav thiab rub cov ntshav los ntawm cov leeg ntshav, feem ntau yog nyob rau hauv caj npab lossis tom qab tes. Tom qab ntawd lawv nias. Rau cov menyuam mos, lawv siv ib rab koob chob pob taws, lossis ib lub cuab yeej ntsuas ntshav uas siv rau ntawm lub hauv pliaj lossis hauv siab ua ib lub cuab yeej ntsuas.

Yuav siv sijhawm ntev npaum li cas: kev kuaj nws tus kheej feem ntau yog 2-5 feeb. Kev mus ntsib kws kho mob sab nraud tag nrho feem ntau yog 15-30 feeb. Kev kuaj mob ntawm cov menyuam mos uas raug khawb ntawm pob taws yuav siv sijhawm ob peb feeb; kev kuaj mob transcutaneous siv sijhawm tsawg dua ib feeb. Lub sijhawm tshaj tawm txawv ntawm chaw kuaj mob thiab seb qhov kev kuaj mob puas yog ib txwm lossis ceev, nug koj lub chaw kuaj mob.

To taub koj daim ntawv qhia txog bilirubin

Cov sijhawm siv sib txawv ntawm cov chaw kuaj mob vim tias cov txheej txheem thiab cov khoom siv tshuaj ntsuam sib txawv. Ib txwm nyeem koj tus nqi tawm tsam qhov ntau thiab tsawg uas luam tawm ntawm koj daim ntawv qhia, tsis yog tawm tsam qhov ntau thiab tsawg los ntawm lwm lub chaw kuaj mob lossis lub vev xaib. Cov chav nyob hauv Is Nrias teb feem ntau yog mg / dL; qee lub chaw kuaj mob tshaj tawm 祄ol / L.

Qhov tseem ceeb tshaj ib tus lej yog tus qauv :

• Kev nce ntxiv tsis ncaj qha, SGPT/SGOT thiab ALP ib txwm muaj: feem ntau yog Gilbert syndrome, haemolysis, daws cov haematoma, lossis tsis muaj peev xwm tsim cov qe ntshav liab. Tus cwj pwm Thalassemia, G6PD deficiency thiab kab mob sickle cell yog qhov tseem ceeb rau cov pej xeem Is Nrias teb.
• Kev nce siab ncaj qha nrog ALP thiab GGT siab: tus qauv cholestatic, pob zeb hauv cov kav dej kua tsib, kev nruj, cholestasis ua rau muaj tshuaj, lossis ib qho pob zeb nias cov kav dej.
• bilirubin nce nrog SGPT/SGOT nce siab heev: tus qauv hepatocellular, kab mob siab viral suav nrog kab mob siab A thiab E, kev raug mob los ntawm tshuaj lossis tshuaj ntxiv, kab mob siab ntsig txog cawv, ischemia.
• bilirubin nce nrog INR ntev, albumin qis lossis tsis meej pem: qhia tias lub siab ua haujlwm tsis zoo thiab xav tau kev kuaj mob sai.
• Bilirubin qis: tsis yog kab mob thiab tsis yog qhov tsis txaus. Nws tsis tas yuav kho.

Feem ntau qhov mob daj ntseg uas pom tseeb tsuas yog tshwm sim thaum bilirubin siab dua qhov ntsuas siab dua, yog li ntawd qhov nce me ntsis feem ntau tsis ua rau muaj qhov daj ntseg li. Qhov bilirubin siab tsis yog kev kuaj mob, thiab tib tus lej tuaj yeem txhais tau tias muaj ntau yam sib txawv rau cov neeg sib txawv. Tsuas yog tus kws kho mob uas tau thov kom kuaj thiaj li txhais tau nws nrog koj keeb kwm, kev kuaj mob thiab lwm yam txiaj ntsig.

Cov ntawv qhia txog cov menyuam yug tshiab

Cov nqi bilirubin ntawm cov menyuam mos tau muab tso rau ntawm daim ntawv qhia teev sijhawm uas suav nrog lub hnub nyoog cev xeeb tub thiab cov yam ntxwv txaus ntshai xws li haemolysis. Tus nqi uas lees txais tau tag nrho thaum 72 teev yuav xav tau kev kho mob thaum 24 teev. Tsis txhob piv tus nqi ntawm tus menyuam mos nrog cov neeg laus lossis nrog lwm tus menyuam daim ntawv qhia.

Thaum cov txiaj ntsig bilirubin tuaj yeem ua rau neeg tsis meej pem

Tsa siab dhau los yog siab dhau lawm

• Kev rhuav tshem cov ntshav ntawm cov qauv thaum lub sijhawm rub nyuaj lossis kev thauj mus los tsis zoo tuaj yeem cuam tshuam kev ntsuas bilirubin.
• Kev yoo mov ntev, kev qhuav dej, kev tawm dag zog hnyav lossis kev mob nkeeg sai tuaj yeem ua rau bilirubin tsis ncaj nce ntxiv, tshwj xeeb tshaj yog hauv Gilbert syndrome.
• Qee cov tshuaj cuam ​​tshuam rau kev nqus ntawm daim siab lossis nrog qhov kev ntsuam xyuas nws tus kheej, ua rau tus nqi tshaj tawm tsis muaj kev raug mob rau daim siab. Atazanavir, rifampicin thiab qee yam tshuaj yog cov piv txwv lees paub.
• Cov qauv lipaemic (rog) lossis turbid tuaj yeem cuam tshuam nrog qee txoj kev spectrophotometric.
• Kev daws cov qhov txhab loj lossis tom qab hloov ntshav, kev tawg ntawm cov qe ntshav liab ntxiv ua rau bilirubin tsis ncaj nce ib ntus.

Qis dua lossis yuam kev li qub

• Teeb pom kev zoo rhuav tshem cov bilirubin hauv cov qauv, txo qhov ntsuas.
• Kev ua tiav qeeb tuaj yeem txo tus nqi.
• Kev tsim cov cirrhosis tuaj yeem muaj nyob nrog bilirubin ib txwm muaj kom txog thaum decompensation, qhov kev ntseeg siab cuav feem ntau los ntawm qhov kev xeem no.
• Kev nyeem ntawv transcutaneous hauv cov menyuam mos feem ntau tsis txhim khu kev qha tom qab kev kho mob phototherapy tau pib thiab rau cov menyuam mos uas muaj daim tawv nqaij muaj xim tob; kev ntsuas serum yog siv thaum kev txiav txim siab nyob ntawm tus lej.
• Kev thaiv tsis tu ncua, xws li lub pob zeb uas txav mus los, tuaj yeem muab bilirubin ib txwm muaj ntawm cov ntu.

Kev Pheej Hmoo thiab Kev Nyab Xeeb

Kev kuaj ntshav venous hauv cov neeg laus thiab cov menyuam yaus loj dua

Me me thiab tsis tshua muaj: mob qhov muag, mob ib ntus, qaug zog taub hau, thiab tsis tshua muaj cov ntshav me me lossis kev kis kab mob hauv zos. Kev los ntshav yuav kav ntev dua yog tias koj noj tshuaj anticoagulants. Qhia rau tus kws kho mob ntshav yog tias koj tau tsaus muag thaum lub sijhawm kuaj ntshav yav dhau los.

Khaus pob taws rau cov menyuam mos

Qhov mob me ntsis thiab qhov mob me me yog ib txwm muaj; kev kis kab mob hauv zos tsis tshua muaj. Kev kuaj ntau zaus ntau hnub tuaj yeem ua rau mob, yog vim li cas cov chaw zov menyuam thiaj li muab cov qauv kuaj raws li qhov xav tau ntawm kev kho mob.

Kev kuaj mob bilirubin transcutaneous

Tsis muaj koob txhaj tshuaj thiab tsis muaj daim tawv nqaij raug mob, yog li ntawd, kev pheej hmoo ntawm lub cev tsis tseem ceeb. Qhov sib pauv yog qhov tseeb dua li kev nyab xeeb, cov nyeem ze ntawm qhov ntsuas kev kho mob tau lees paub los ntawm cov qauv ntshav.

Cov txiaj ntsig sib txawv nyob ntawm tus kheej qhov xwm txheej kho mob.

Cov xwm txheej tshwj xeeb

Cev xeeb tub

Qhov mob daj ntseg lossis khaus heev thaum cev xeeb tub yeej tsis raug tso tseg. Cov ua rau muaj xws li mob cholestasis hauv lub siab thaum cev xeeb tub mus rau mob siab viral, mob siab E tuaj yeem mob hnyav heev thaum cev xeeb tub hauv Is Nrias teb, thiab rau HELLP syndrome lossis mob siab rog thaum cev xeeb tub. Bilirubin raug txhais nrog cov kua qaub bile, cov enzymes hauv siab, cov platelet suav thiab cov ntshav siab.

Cov menyuam mos thiab cov menyuam mos

Feem ntau cov menyuam mos uas muaj mob ntshav qab zib yog los ntawm lub cev thiab nws nyob ruaj khov. Kev txiav txim siab txog kev kho mob yog nyob ntawm qhov ntsuas bilirubin raws li lub sijhawm, hnub nyoog cev xeeb tub thiab cov yam ntxwv uas ua rau muaj kev pheej hmoo, tsis yog nyob ntawm qhov tsos xwb. Mob ntshav qab zib uas muaj feem ntau nce siab, lossis mob ntshav qab zib uas kav ntev tshaj ob lub lis piam, yuav tsum tau tshawb xyuas seb puas muaj laj thawj xws li biliary atresia, qhov twg kev kuaj mob thaum ntxov tseem ceeb. Kev pub niam mis tsuas yog yuav tsum txuas ntxiv mus tshwj tsis yog tias pab pawg menyuam mos qhia lwm yam.

Cov me nyuam

Mob daj ntseg hauv ib tug menyuam loj dua ua rau muaj lus nug txog kab mob siab viral hepatitis, haemolysis, cov teebmeem ntawm tshuaj thiab kab mob siab uas tau txais los ntawm noob caj noob ces. Cov ntim kuaj raug kho kom haum rau qhov loj me.

Cov laus

Cov neeg laus uas muaj mob ntshav qab zib uas tsis mob thiab poob phaus yuav tsum tau kuaj mob sai sai. Muaj ntau yam tshuaj ua rau muaj feem yuav mob cholestasis vim yog tshuaj.

Cov neeg uas muaj cov kab mob hemoglobinopathy

Thalassemia, kab mob sickle cell thiab G6PD deficiency ua rau muaj kev nce bilirubinemia tsis ncaj qha thiab muaj kev pheej hmoo ntawm cov pob zeb hauv lub zais zis. Daim ntawv qhia txog "bilirubin siab" ntawm cov neeg no yuav tsum tau muab piv rau lawv cov nqi yav dhau los.

Cov neeg uas muaj kab mob raum lossis lub plawv tsis ua haujlwm ntev

Tsis txhob yoo mov ntev thiab tsis txhob haus dej ntau tshaj qhov tau teev tseg. Thaum lub plawv tsis ua haujlwm zoo, kev txhaws ntawm lub siab tuaj yeem ua rau bilirubin nce ntxiv yam tsis muaj kab mob siab thawj zaug.

Kev kuaj bilirubin hauv Is Nrias teb

• Lub Npe: Feem ntau qhov kev kuaj bilirubin tshwm sim hauv LFT uas qhia SGPT (ALT) thiab SGOT (AST). Ntau daim ntawv qhia siv ob pawg npe.
• Kab mob siab A thiab E yog cov ua rau mob daj ntseg hauv Is Nrias teb, feem ntau cuam tshuam nrog dej lossis zaub mov uas muaj kuab paug. Kab mob siab E thaum cev xeeb tub yuav tsum tau soj ntsuam zoo tshwj xeeb.
• Kev kho mob ntsws siv dav dav, thiab kev raug mob siab los ntawm tshuaj yog ib qho teeb meem uas paub zoo. Kev mob daj ntseg thaum kho mob yuav tsum tau kuaj xyuas los ntawm tus kws kho mob dua li kev hloov kho cov tshuaj.
• Cov tshuaj ntsuab, AYUSH thiab cov tshuaj pab kom poob phaus hauv chaw dhia ua si yog ib qho ua rau lub siab raug mob uas tsis tau tshaj tawm txaus. Nqa cov pob khoom tiag tiag tuaj rau kev sab laj.
• Haemoglobinopathies suav nrog tus cwj pwm beta-thalassaemia thiab kab mob sickle cell yog qhov tshwm sim hauv ntau thaj chaw thiab hloov qhov feem tsis ncaj qha mus rau sab saud.
• Kab mob siab metabolic thaum BMI qis dua: Cov neeg Esxias Qab Teb muaj tus kab mob siab steatotic (MASLD) thaum lawv qhov hnyav qis dua li lwm cov pej xeem. Feem ntau bilirubin yog ib txwm muaj thaum ntxov MASLD, yog li ntawd, tsis txhob xav tias bilirubin ib txwm muaj yog qhov ua rau lawv ntseeg siab.
• Kev hloov tshiab ntawm cov lus: NAFLD tam sim no yog MASLD thiab NASH yog MASH, nrog rau kab mob siab steatotic ua lub ntsiab lus dav dav thiab MetALD piav qhia txog kab mob metabolic thiab cawv uas muaj nyob ua ke (multi-society Delphi consensus, Rinella et al., 2023).
• Cov khoom noj uas muaj turmeric, beetroot thiab carotene ntau tuaj yeem ua rau daim tawv nqaij xim av tab sis tsis ua rau lub qhov muag dawb daj thiab tsis ua rau bilirubin nce. Qhov muag daj yuav tsum tau kuaj xyuas.

Tus nqi thiab kev pov hwm hauv Is Nrias teb

Cov nqi sib txawv ntawm cov chaw ua haujlwm ntawm tsoomfwv, cov chaw kuaj mob uas tsis yog chaw ua haujlwm thiab cov tsev kho mob ntawm cov tuam txhab, yog li thov kom muaj daim ntawv sau nqi ua ntej kuaj es tsis txhob cia siab rau cov lej tshaj tawm.

Dab tsi cuam tshuam tus nqi:

• Seb tsuas yog kuaj bilirubin xwb los yog LFT tag nrho lossis daim ntawv ntsuam xyuas siab.
• Lub nroog thiab hom chaw; kev sau nyiaj hauv tsev thiab cov nqi phlebotomy.
• Kev ua haujlwm ceev lossis tom qab sijhawm ua haujlwm, thiab rov kuaj dua rau kev saib xyuas.
• Txawm qhov kev kuaj mob no yog ib feem ntawm pob khoom, kev kuaj mob lossis kev npaj yug menyuam.
• Feem ntau yuav tsum tau kuaj ntxiv rau mob jaundice, viral serology, ultrasound, thiab coagulation profile.

Kev Pov Hwm: kev kuaj mob sab nraud feem ntau raug tshem tawm ntawm cov cai them nqi yooj yim tab sis tej zaum yuav raug them rau hauv OPD cov neeg caij tsheb lossis cov txiaj ntsig kev noj qab haus huv. Thaum lub sijhawm nyob hauv tsev kho mob, kev tshawb nrhiav feem ntau yog ib feem ntawm qhov kev thov. Cov phiaj xwm tsoomfwv yuav them rau kev kuaj mob ntawm cov chaw empaneled. Paub meej nrog koj tus neeg pov hwm ua ntej. Raws li Txoj Cai Tiv Thaiv Cov Ntaub Ntawv Tus Kheej Digital 2023, cov chaw soj nstuam yuav tsum tswj hwm koj cov ntaub ntawv kev noj qab haus huv thiab kev pom zoo kom raug, nug seb koj daim ntawv qhia yuav raug sib qhia thiab khaws cia li cas.

Cov lus dab neeg thiab qhov tseeb

Lus nug cov lus nug

Kuv cov bilirubin puas tuaj yeem siab txawm tias kuv tsis zoo li daj?

Yog. Qhov muag daj feem ntau tsuas pom thaum bilirubin nce siab tshaj qhov txwv siab tshaj plaws. Qhov nce me me, xws li cov neeg mob Gilbert syndrome, feem ntau tsis pom kev hloov pauv li thiab pom tau los ntawm kev siv LFT ib txwm.

Qhov txawv ntawm bilirubin ncaj qha thiab tsis ncaj qha ntawm kuv daim ntawv qhia yog dab tsi?

Cov bilirubin ncaj qha (conjugated) twb tau raug ua tiav los ntawm cov qe ntshav siab lawm, yog li qhov nce siab ncaj qha qhia txog teeb meem ntawm cov qe ntshav siab lossis cov kua tsib. Cov bilirubin tsis ncaj qha (unconjugated) tsis tau raug ua tiav, yog li qhov nce siab tsis ncaj qha qhia txog kev tawg ntawm cov qe ntshav liab ntau ntxiv lossis teeb meem conjugation xws li Gilbert syndrome.

Puas yog bilirubin siab tas li txhais tau tias kuv yuav tsum tau kuaj daim siab?

Tsis yog. Feem ntau cov txiaj ntsig ntawm bilirubin uas nce siab yuav raug tshuaj xyuas ua ntej nrog LFT tag nrho, kev kuaj mob siab rau tus kab mob viral hepatitis, kev suav cov ntshav thiab USG plab. Kev kuaj biopsy tsuas yog siv rau cov xwm txheej tshwj xeeb uas kev kuaj mob tsis tshua muaj kev cuam tshuam tsis tau teb cov lus nug. Koj tus kws kho mob txiav txim siab raws li daim duab tag nrho.

Puas tsim nyog yoo mov ua ntej kuaj bilirubin?

Feem ntau tsis yog rau bilirubin xwb. Feem ntau yuav tsum tau yoo mov vim tias qhov kev kuaj no muaj nrog rau kev kuaj lipid lossis glucose. Kev yoo mov ntev ntev tuaj yeem ua rau bilirubin tsis ncaj nce. Ua raws li cov lus qhia uas koj lub chaw kuaj mob muab, thiab nrog koj tus kws kho mob tham yog tias koj noj insulin lossis sulfonylureas.

Kev kuaj bilirubin txawv ntawm LFT li cas?

Bilirubin yog ib feem ntawm LFT. Lub vaj huam sib luag LFT ntxiv SGPT/ALT thiab SGOT/AST rau kev raug mob ntawm lub siab, ALP thiab GGT rau tus qauv biliary, thiab albumin thiab protein rau kev ua haujlwm tsim. Bilirubin ib leeg muab ib daim duab nqaim thiab tsis tshua muaj kev txhais lus cais.

Kuv tus menyuam cov bilirubin siab dua li tus neeg laus uas tau teev nyob rau hauv daim ntawv qhia. Qhov ntawd puas txaus ntshai?

Cov lej siv rau cov neeg laus tsis siv rau cov menyuam mos tshiab. Cov nqi rau cov menyuam mos tshiab raug teeb tsa raws li hnub nyoog hauv teev, hnub nyoog cev xeeb tub thiab cov yam ntxwv uas ua rau muaj kev pheej hmoo. Tus lej uas xav tau kev kho mob phototherapy rau hnub thawj zaug yuav raug lees txais rau hnub plaub. Qhov tseem ceeb yog pab pawg menyuam mos tshiab qhov kev ntsuam xyuas.

Cov tshuaj lossis cov tshuaj ntxiv puas tuaj yeem ua rau bilirubin nce ntxiv?

Yog. Qee cov tshuaj cuam tshuam rau kev nqus bilirubin lossis kev kuaj, thiab lwm tus ua rau lub siab raug mob tiag tiag lossis cholestasis. Cov tshuaj tiv thaiv kab mob ntsws, qee cov tshuaj tua kab mob, thiab cov tshuaj ntsuab, AYUSH thiab cov tshuaj ntxiv rau hauv chaw dhia ua si yog cov piv txwv tseem ceeb. Sau txhua yam koj noj, thiab tsis txhob tsum cov tshuaj uas tau sau tseg yam tsis tau nrog tus kws sau ntawv sau ntawv tham.

Kuv puas yuav tsum tau rov ua qhov kev xeem yog tias kuv cov txiaj ntsig tsis zoo?

Feem ntau yog. Bilirubin hloov pauv thaum yoo mov, mob thiab haus dej ntau, yog li ntawd ib qho nqi ntawm cov ntshav ib zaug xwb yuav tsis muaj txiaj ntsig ntau. Koj tus kws kho mob yuav rov ua dua nrog LFT tag nrho tom qab ob peb lub lis piam, lossis tshawb xyuas sai dua yog tias koj muaj cov tsos mob lossis lwm yam tshwm sim tsis zoo.

Ntev npaum li cas ntawm tag nrho cov txheej txheem coj mus ntev?

Qhov kev rho ntshav nws tus kheej siv sijhawm li 2-5 feeb, thiab kev mus ntsib kws kho mob sab nraud feem ntau siv sijhawm li 15-30 feeb suav nrog kev sau npe. Kev kuaj ntshav ntawm cov menyuam mos uas raug khawb ntawm pob taws siv sijhawm ob peb feeb thiab kev kuaj mob transcutaneous siv sijhawm tsawg dua ib feeb. Lub sijhawm tshaj tawm nyob ntawm koj lub chaw kuaj mob thiab seb cov qauv ntshav puas raug cim tias yog qhov ceev.

Qhov chaw

• Rinella ME et al. Ib daim ntawv tshaj tawm kev pom zoo ntawm ntau lub koom haum Delphi txog kev muab lub npe kab mob siab rog tshiab, 2023.
• American Academy of Pediatrics, cov lus qhia txog kev kho mob rau kev tswj hwm hyperbilirubinaemia hauv cov menyuam mos uas muaj hnub nyoog 35 lossis ntau dua lub lis piam ntawm kev xeeb tub.
• Lub Koom Haum Hauv Tebchaws rau Kev Noj Qab Haus Huv thiab Kev Saib Xyuas Zoo Tshaj Plaws, mob daj ntseg hauv cov menyuam mos uas yug tshiab hnub nyoog qis dua 28 hnub.
• Lub Koom Haum Kev Noj Qab Haus Huv Ntiaj Teb, cov ntawv qhia txog kab mob siab A thiab kab mob siab E.
• Tsoom Fwv Tebchaws Is Nrias teb, Txoj Cai Tiv Thaiv Cov Ntaub Ntawv Tus Kheej Digital, 2023; Txoj Cai Tshuaj thiab Tshuaj Kho Mob (Kev Tshaj Tawm Tsis Zoo), 1954.