Measurement of serum bilirubin and its mono- and diconjugates: application to patients with hepatobiliary disease.
Measurement of serum bilirubin and its mono- and diconjugates: application to patients with hepatobiliary disease.
复制标题
血清胆红素及其单结合物和双结合物的测量：在肝胆疾病患者中的应用。
作者：
Scharschmidt,BF;Blanckaert,N;Farina,FA;Kabra,PM;Stafford,BE;Weisiger,RA
Blanckaert和他的同事最近描述了一种技术，可以特异性和准确地定量非结合胆红素、双结合胆红素以及单结合胆红素的C-8和C-12异构体。本文应用该技术测定了65例肝胆疾病患者91份血清中胆红素及其酯结合物的分布模式，并与两种常规的重氮法进行了比较。这两种重氮测定产生的总胆红素浓度值显着和不可预测的高于通过新技术获得的值，和直接反应馏分重氮测定显示很少或没有协议的总酯共轭物的馏分确定的新方法。以前使用新方法的研究表明，胆红素结合物在健康成人或吉尔伯特综合征患者的血清中检测不到，但在91例患者血清中的89例中发现了它们。由C-8单缀合物、C-12单缀合物、双缀合物和总酯缀合物代表的血清总胆红素的分数在胆道梗阻患者中高于实质性肝病患者，但组间的广泛重叠阻止了这些缀合物的测定在诊断上有用。总体而言，血清中的胆红素酯结合物由30%的C-8单结合物、37%的C-12单结合物和33%的双结合物组成，而尿液中主要含有双结合物。
A technique has recently been described by Blanckaert and his colleagues that specifically and accurately quantifies unconjugated bilirubin, diconjugated bilirubin, and the C-8 and C-12 isomers of monoconjugated bilirubin. This technique has now been used to determine the distribution pattern of bilirubin and its ester conjugates in 91 sera from 65 patients with hepatobiliary disease, and the results were compared with two conventional diazo assays. Both diazo assays yielded values for total bilirubin concentration that were markedly and unpredictably higher than those obtained by the new technique, and the direct-reacting fraction by diazo assay showed little or no agreement with the fraction of total ester conjugates determined by the new method. Previous studies using the new method had shown that bilirubin conjugates are undetectable in sera from healthy adults or individuals with Gilbert's syndrome, but they were found in 89 of the 91 present patient sera. The fraction of total serum bilirubin represented by C-8 monoconjugates, C-12 monoconjugates, diconjugates, and total ester conjugates was higher in patients with biliary obstruction than in those with parenchymal liver disease, but extensive overlap between groups prevented determination of these conjugated species from being diagnostically useful. Overall, bilirubin ester conjugates in serum consisted of 30% C-8 monoconjugates, 37% C-12 monoconjugates, and 33% diconjugates, while urine contained predominantly diconjugates.