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1、《黄疸》-09级一系-老年-麻醉-救援-心理-陶小红-12-04-18(1)2.BILIRUBINMETABNISMHemeDegradationHEMEBILIVERDINO2Fe+3NADPHNADP+(openstheporphyrinring)BILIRUBINNADPHNADP+BILIRUBINdiglucuronideBILETheFateofBilirubin…Alb=albuminB=bilirubinGST=glutathione-S-transferaseUDPGA=uridinedip
2、hosphoglucuronicacid;CB=conjugatedbilirubinUGT1A1=UDP-glucuronosyltransferase1A1MRP2=Multi-drugResistanceProtein2AdaptedfromHarrison’s15thEd.“PrinciplesofInternalMedicine”,2001.MRP2B+GSTCBPlasmaHepaticCellBileAlbBAlb?:GSTBsERB+UDPGAUGT1A1BilirubinExcretionI
3、ntestinesLiverBCBCBBUrobilinogenB-glucoronidasebacteriabacteriaBileEnterohepaticcirculationKidneyUrobilinoxUrobilinogenUrobilinStercobilinStercobilingogenfecesUrineoxLiverAlbuninHemeFerrohemetransferaseBilirubinConjugatedbilirubinKidneyUrobilinStercobilinog
4、enUrobilinogenIntestinesAlbuminBilirubinreductaseHemeGlobinHemoglobinoxidaseBiliverdinMarrowInfantilityErythrocyteFerrohemeEnzyme15%~20%Bilirubin
5、AlbuminErythrocyte80%~85%UDPUDPGABilirubinglucuronolactoneurobilinogenEnterohepaticcirculationY/Zproteincatheps
6、inErythrocyteBiochemicalchangeofNormalbilirubinmetabolism3.CLASSFICATION1.DependingonEtiologyHemolyticJaundice（溶血性黄疸）HepatocellularJaundice（肝细胞性黄疸）CholestaticJaundice（胆汁淤积性黄疸）Congenitaljaundice（先天性黄疸）2.DependingonbilirubinUnconjungatedbilirubinincreasedjaun
7、diceConjungatedbilirubinincreasedjaundiceEtiology1.Congenitalhemolyticanemia(thalassemia(海洋性贫血),hereditaryspherocytosis(遗传性球形红细胞增多症)).2.Posteriorityacquiredhemolyticanemia(autoimmunityhemolyticanemia,hemolyticdiseaseofnewborn,posttransfusionhemolytic,Favism
8、(蚕豆病).MechanismAlargenumberoferythrocytedestroyedrapidlyAnemia,hypoxiaandtoxityoferythocytemetabolismproducts3.1.HemolyticJaundiceHemolyticJaundicemechanismClinicalManifestationMildjaundice,lightlemon,noskinitch(痒).Acutehemolysis:fever,chill,headache,vomit,
9、backache,anemia,hemoglobinuria(血红蛋白尿),acuterenalfailure.Chronichemolysis:anemiaandsplenomegaly(脾大).LaboratoryExamination1.SerumTB↑,UCB↑,CBnormal.2.UCB↑→intestinalCB↑→faecalcolordeepen.3.IntestinalUrobi
