2016 đhqg ts kinh mien dich phong xa 72016 new

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  • TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • MC CHnh lng cc hormone v cc cht c trong huyt thanh, huyt tng, dch sinh hc Nghin cu bnh min dch Nghin cu nh gi tnh trng dinh dng Nghin cu ung th TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NGUYN LK thut min dch: Da mi tng tc c hiu thun- nghch gia khng nguyn (Ag) vi khng th (Ab).+ Nhm k thut min dch quan st trc tip (ln bng, kt ta, ngng kt, c nh b th, trung ha)+ Nhm k thut min dch dng cht nh duBin phn ng khng quan st c thnh mt phn ng c th quan st & nhn nh kt qu.Tng nhy, c hiu, chnh xc.Tng kh nng t ng haC th p dng trn c th sng TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NGUYN L Cht nh du c 2 loi:

    Cht nh du khng phi phng x ( Enzym, Ferritin, luciferin) K thut min dch Enzyme (immunoenzymometric assay:IEMA) Min dch hunh quang (immunofluorometric assay) Min dch ha pht quang ( immunochemiluminometric assay)2. Cht nh du l ng v phng xng v phng x (RIA, IRMA: Radioimmunoassay., Immunoradiometric assay.)TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NGUYN L NH LNG MDPX nh ngha: MDPX l k thut vi phn tch trong cc ng v phng x c dng vo XN xc nh nng cc cht trn cc mu l dch sinh hcRosalyn S. Yalow & SolomonA. Berson dng ng v phng x nh du trn Insuline nghin cu thi gian tn lu ca Insulin tun hon trong mu; Vitamin B12 c gii Nobel nm 1977 u im: n gin c th trin khai cc c s, gi thnh r, c hiu & nhy rt cao, c th xc nh c cc cht c nng cc thp trong huyt thanh, dch sinh hc, huyt tng (10-17 10-18 ) Tiu chun vng nh gi cc k thut khc

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • THNH PHN C BN CA XN MDPXKhng th (Ab) c hiu vi cht cn nh lng c sn xut bng gy min dch cho ng vt or cng ngh sinh hc. Khng nguyn (Ag - cht cn nh lng) c trong dch sinh hcCht nh du (Tracer) l ng v gn vo khng nguyn (Ag*) ( RIA); hoc vo khng th Ab* (IRMA); n l thnh phn cu trc nn cht gn Cht phng x c hot tnh ring cao, gn c hiu vo phn t Ab or Ag, thi gian bn r khng ngn, pht ra bc x gamma n thun nh125I. H thng tch: Tch ring cc phc hp v cht t do bng cht hp th phase rn:Than hot

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • Bng cht kt ta ha hc: PEG 6000; Kt ta min dch: thm Ab th hai lm tng trng lng Ag-Ab c dng nhiu v rt ngn thi gian, khng b nh hng nng mu th, dng c cho Ab c i lc thp or Ag c hiu thp. H thng pha rn: Ab th nht bt gi gn sn thnh ng or gn nn b mt ht nh cellulose, sepharose or ht cellulose t ( ly tm). Cht nh du, Khng th, PH v nhit phn ng l hng nh, cht cn nh lng l thay i. Cc ng huyt thanh chun (Std), huyt thanh gim st (CS).1. Nguyn L chung: RIA AgAg*+ Ab Ag Ab, Ag*- Ab, Ag* or AgTS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NGUYN L NH LNG MDPXAg trong cht cn nh lng cao th Ag*- Ab thp, ngc li Ag thp th Ag*- Ab s cao.Mu th thc hin trong iu kin nh nhau ( thi gian , khi lng mu, nhit , thi gian, tc quay ly tm v PH) th chun:

    TS. Nguyn vn Knh*

    B/TCpm0CxNng B/T%Cpm

    TS. Nguyn vn Knh

  • Thit b: Micropipet (100 1000l), my lc (200-350 RPm), my trn, gi ng nghim, my m gammacounter.VD. Quy trnh FT4 : Thuc th & mu bnh phm nhit phng 20, nh s ng, trn thuc th TS. Nguyn vn Knh*

    ng Toatal (T)S1-S6P1-PnCSStandard100lMu B/n100lcontrol100lm 1000l1000l1000lLc u trong 30 pht nhit phngGn nc, p ngc 2 pht trn giy thm125I-Tracer1000l1000l1000l1000lLc ngang 60 pht 200-350 v/p nhit phngGn nc, p ngc 2 pht trn giy thmo hot phng x 60 s/ng

    TS. Nguyn vn Knh

  • 2. NGUYN L IRMA: Ab* + Ag Ab* - Ag, Ab*Ab* - Ag t l thun vi nng cht cn nh lng Ab n dng lm pha rn bt gi, Ab* , hai Ab & Ab* quyt nh trn v tr gn ca Ag. Ab - Ag Ab* , hn ch phn ng cho, c nhy cao & hn ch sn xut Ag tinh khit gi thnh cao to Ab. Nhng cht cn nh lng phi c trng lng phn t ln c hai v tr gn ca hai Ab, Ab* , Cc huyt thanh chun v HT gim st. TS. Nguyn vn Knh*Nng 0

    B/TCpmCxB/T%Cpm

    TS. Nguyn vn Knh

  • TS. Nguyn vn Knh*Quy trnh thc hin chun Thyroglobuline IRMA

    ng nghimMu chun & bnh phmmLc ngang 400 v/ ph, 3 gi nhit phng 18 25 0c ,ra 2 ln vi m125I - tracer 16 20 gi nhit phng 18 -25 0C, ra 2 ln vi mm trn my gammacounterT--400S0 S6100300400CS1 CS2100300400P1 - Pn100300400

    TS. Nguyn vn Knh

  • 3. K thut MDPX khng th kp* Nguyn l: U Ag trong bnh phm vi Ab n dng; Ab gn vi 1 v tr c hiu ca Ag thnh phc hp Ab Ag ; ra loi b nhng Ag & Ab t do. Gn Ab* vi phc hp Ab Ag to phc hp: Ab*- Ag Ab .Loi b nhng Ab* or Ab Ag t do ng nghim con: Ab*- Ag Ab.m hot tnh phng xHot phng x t l thun vi nng Ag trong mu th.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • Hiu ng mc p ng hai pha (Hook Effect Biphasic Response)Hiu ng mc thng xy ra XN bnh kp Gy nhm ln nhn nh kt qu v:

    Trong XN ny Ab c hn so Ag d tha nn Ab Ag khng tng thch vi nng Ag Xut hin khng p ng phase hai: Phc hp Ab Ag c hn gn Ab* xc nh, phc hp Ab Ag - Ab* khng tng thch vi Ag trong mu c nng cao qu Kt qu Cpm trong mu khng phn nh ng c nng cht cn nh lng, kt qu thc s cao b nhn nh sai lm l thp. Khc phc: Pha long mu th XN nng khc nhau.Lm mu th theo hai giai on: phase bt gi, phn ng vi Ab*.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NH GI TIN CY CA PHNG PHPSai s:

    - Ch quan- Khch quan: Ha cht, thit bKim tra: tnh CV% ca hai ng, Standard ca ln XN. Cc ln XN khc nhauKm tra ni b: huyt thanh ngi bnh thng, huyt thanh bnh nhn, phn 3 loi : thp, trung bnh, cao.Lm n= 10 mean 2SD

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • KHC NHAU GiA RIA & IRMARIA: Cnh tranh gia Ag cn inh lng vi Ag* vi Ab (lng nht nh thiu). Cht nh du l Ag.IRMA: Khng co cnh tranh, Ag cn inh lng gn vi Ab d tha xc nh. Cht nh du l Ab*. nhy: IRMA 10 -34 mol/l > RIA 10 -17 mol/l. c hiu: IRMA > RIA vi dung Ab n dong.C th nh lng c cc phn t sinh hc min nng rt thp pgK thut n gin, kt qu n nh t b chi phi v nhit .Cn Lab thch hp, c hi phng x cng tng ng nh c hi ca ha cht.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • NG DNGnh lng cc ni tit t lin quan n tuyn gipBnh tuyn giap: lm sang & XN phong phu, nhiu phng phap chn oan, theo doi & tin lng bnh tuyn giap trong o MDPX la c bit quan trong vi inh lng c nng hormone tuyn giap, ni tit t lin quan (Thyroid related hormones). Bnh cng giap (Hyperthyroidism) hu ht T3, T4 or FT3, FT4 , TRAb (TSH receptor antibody) tng & TSH giam.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • Nhim c giap do T3 or do T4 hai hormone nay khng tng song hanh.Suy giap a s T3 ,T4 thp do lin bao t/g giam or mt kha nng tng hp va TSH tng cao.Mt s yu t anh hng n T3 ,T4 nh bnh gan, thn, thai nghen & mt s thuc tranh thai, an thnMt s hi chng quan trong thng gp

    Cng giap( Hyperthyroidism), Graves Basedow: T3 ,T4 , FT3, FT4, TSH, TRAb.Hi chng binh giap bnh ly + T4 binh thng, T3 giam do bnh ly khac + T4 thp do suy giap, giam tit ch TSH tuyn yn

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • + T4 tng: phu n nhiu tui, dung thuc cha iot, tm thn+ Bt thng v lin kt hormone: T3, T4 giam iu tri hormone khng hiu quaSuy giap: Hu ht FT3, FT4 giam TSH tngBu c ia phng T3, T4 binh thng or tng nhe Tom lai: Bnh ly tuyn giap nn chi inh it nht 2 XN, chu y n TSH (IRMA)+ inh lng khang th khang receptor cua TSH. TRAb y nghia trong theo doi iu triTS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • + inh lng mt s loai hormone: GH: theo di bnh to u chi, ln do tuyn yn, chng khng l. PTH: hormone tuyn cn gip. Chuyn ha calci, Cortisol, Insuline, Calcitonin, Plolactin, ACTH.Cc cht du n ung th: l i phn t, s c mt ca chng lin quan n s c mt hoc pht trin ca khi u c tnh. Chng hnh thnh t trong or trn t bo K or kch thch TB phn chia khng kim sot.Du n ung th tit vo mu ngoi vi nng c th pht hin c khi TB chuyn thnh c tnh.Cho php kt lun v tr xut pht ca khi U.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • K thut IRMA s dng trong XN theo di din tin, nh gi hiu qu & tin lng. AFP: Glycoprotein , W= 70.000 daltons, hinh thanh trong gan, da day, rut bao thai. AFP at inh tun 12 16 cua thai ky va giam khi sinh. Chm sc tin sn. Gim st K gan nguyn pht, nh gi p ng iu tr. CEA: Glycoprotein , W= 180.000 daltons, la KN ung th phi thai c san xut trong i sng phi va bao thai. CEA kim ham sau sinh, khng thy trong huyt thanh ngi ln binh thng, KN giai toa cac t bao mt s K ang phat trin . Cao trong ung th biu m tuyn i trc trng. Gim st tin trin & p ng iu tr b/n K i trc trng.

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • PSA: Glycoprotein , W= 34.000 daltons. Co trong ng ngoai tit cua tin lit tuyn. Gim st din tin & p ng iu tr K TLT. Gim st B/N ph i TLT c hiu 90%. L ch tiu XN sng lc K TLT nam tui > 50Tg: Glycoprotein cua tuyn giap.Trong K gip bit ha Tg la cht chi im s tn tai cua m giap. Tg + WBS c gi tr sau iu tr K gip. 80 85 % Tg + WBS ph hp LS. Sau iu tri I-131 Tg < 2 ng/ml. 15 20% Tg & WBS khng tng ng. Tg > 5 - 10ng/ml l iu tr. Nng Tg tng cao khi co di cn xa

    TS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • CU HI.

    Nguyn l ca phng php min dch phng xu im ca k thut RIA & IRMAS ging nhau & khc nhau gia RIA & IRMANhng yu t lm nh hng n kt qu XNNu ng dng ca phng php min dch phng x trong chn on bnh tuyn gip & cc du n ch im khi u trong mt s bnh ung th thng gpTS. Nguyn vn Knh*

    TS. Nguyn vn Knh

  • TS. Nguyn vn Knh*TRN TRNG CM N

    TS. Nguyn vn Knh