nAmniotic：羊膜的 electrolyte 电解质，电解液 creatinine Myeloma pleural synovial dehydration vomit therapeutic interstitial n sodium钠 potassium 钾 chloride 氯化物 ndioxide 二氧化物 electrophoresis 电泳Lesson 3 Clinical ChemistryIn the clinical chemistry section, clinical laboratory practitioners perform biochemical analyses of body fluids using highly complex, most often fully automated instrumentation. 在临床生化科室，临床检验人员利用高端复杂，通常是全自动的仪器对体液进行生化分析。nBody fluids tested in this area include serum, urine, CSF, amniotic fluid, pleural fluid and synovial fluid. Common tests performed on serum, urine and CSF include serum glucose and total protein concentrations. 生化科室检测的体液包括血清，尿样，脑脊液，羊水，胸腔积液和关节腔液。在血清，尿样和脑脊液常规检测的项目有血清葡萄糖，总蛋白浓度。n Other analytes tested for in the serum are electrolytes such as sodium ( Na+), potassium ( K+), chloride ( Cl-) and carbon dioxide (CO2). Blood urea nitrogen, creatinine, liver enzyme and cardiac enzyme levels are also commonly requested tests.血清中其他检测项目还包括电解质，例如钠，钾氯和二氧化碳。血尿素氮，肌酐，肝酶，心肌酶水平也是经常被要求检测的项目。nSerum glucose level is determined to diagnose and monior diabetes. Elevated levels as well as low levels of glucose are life threateriing if the patient does not receive the appropriate intervetion. The presence of glucose in urine provides a similar diagnostic and monitoring tool.nappropriate interverition：适宜的介入治疗n Proteins serve numerous bodily functions. Exploring each function in detail is beyond the scope of this chapter. Table 3-2 lists the major functions of proteins. Measuring total serum protein concentrations provides valuable information regarding disease processes in major organ systems.蛋白质在体内承担多种功能。对每种功能进行详细的探讨超出这章范围。表格2-3列出体内蛋白质的主要功能。测定总血清蛋白浓度可以为主要器官的疾病进展提供有用的信息。nLow levels (hypoproteinemia) as well as high levels (hyperproteinemia) are indicative of pathologic conditions, some of which can be serious. An example of a decreased level of proteins is found in renal disease, in which proteins are lost by excretion through the kidneys.低蛋白血症或高蛋白血症都是病理变化的指标，有些状态下病人是非常严重的。例如，在肾病中蛋白降低，主要由于通过肾脏排泄而丢失。Proteins are not usually detected in the urine; therefore, loss of plasma proteins through the kidneys results in proteinuria(proteins in the urine) . Dehydration that results from excessive vomiting and diarrhea may produce an increased level of plasma proteins. Conditions such as multiple myeloma produce highly elevated protein concentrations.肾脏机能正常情况下，尿中出现蛋白量低，且常为阴性。当血浆蛋白通过肾脏排泄时最终会产生蛋白尿。由于过度的呕吐与腹泻所引起的脱水也会造成血浆蛋白水平增加。多发性骨髓瘤会产生蛋白浓度急剧升高。An increase in total protein in the CSF indicates the presence of inflammatory cells such as PMNs and debris of damaged tissue commonly associated with bacterial meningitis. In this type of infection, the total protein level in the CSF is elevated while the glucose level is usually decreased as a result of the bacterial utilization of glucose in the fluid.脑脊液中总蛋白浓度升高揭示炎性细胞的存在；例如多形核白细胞和受损的组织碎片常与细菌性脑膜炎有关。在这类感染中，脑脊液的总蛋白水平升高，葡萄糖水平则因细菌的使用消耗而降低。Chemical analyses of body fluids in the clinical chemistry laboratory have been performed routinely by automated analyzers since 1957. The first autoanalyzer, developed by Technicon, dominated the market during the early years of automated instrumentation in the clinical laboratory. 在临床检验操作仪自动化早期，由Technicon开发的第一台自动分析仪曾一度控制了市场。nSeveral decades later, one could visit a clinical chemistry section and find a wide variety of analyzers manufactured by numerous companies. Today, fully automated computerized instruments are used to analyze hundreds of tests on clinical samples.There are areas in the clinical chemistry laboratory that perform special procedures, such as toxicology and electrophoresis. The toxicology section is the area where samples are tested either for the presence of drugs of abuse or to monitor levels of therapeutic drugs.（治疗药物浓度监测） toxicology and electrophoresis：毒理学与电泳drugs of abuse：药物滥用In electrophoresis, serum samples are placed on a special gel medium. An electrical current is passed through the gel to separate the different serum protein components. These special tests are usually available in large institutions; in smaller hospital laboratories, these tests are frequently sent to a reference laboratory.在电泳操作中，血清标本加入特定的凝胶介质中，通以电流来分离不同血清蛋白成分。这些特殊的检测在大医疗机构都有开展。在小型医院，这些检测通常送至参考实验室完成检测。n羊水 电解质 多发性骨髓瘤 脱水n呕吐 腹泻 止血 凝血 肌酐n高蛋白血症 低蛋白血症 血尿素氮n血糖水平 电泳 细菌性脑膜炎n大夫：请进。你哪里不舒服？ Doctor: Please come in. What seems to be the trouble? n病人：肚子不舒服。我想可能是昨晚吃得太多了。 Patient: Its my stomach. I think probably I had too much at supper yesterday evening.大夫：你昨晚吃了些什么，能告诉我吗？ Doctor: Can you tell me what you had for supper yesterday evening?n病人：海鲜，烤鸭。种类很多，有的我叫不出名儿。 Patient: Seafood, roastduck. Oh, a great variety of things, I cant name them exactly.n大夫：你呕吐过没有？ Doctor: Have you vomitted?n病人：呕吐过。昨晚吐了三次，还上了好几趟厕所。 Patient: Yes, I have vomitted three times and made several trips to the bathroom last night.n大夫：我明白了。你得做一个大便检查。我给你开一张化验单。你带着化验单到化验室去。检查完后，请把化验报告给我送过来。 Doctor: I see. Now you have to get your stools tested. Ill write out a slip and you can take it to the laboratory. Wait for a while and pick up the report, and then bring it back to me.n病人：好吧。待会儿见，大夫。Patient: All right, doctor. Ill see you later.n（实验室人员告诉病人怎么做，而病人拿到报告后咨询化验项目内容）nHow Long It Takes nA few minutes Discomfort/Pain None. nSpecial Equipment Sterile collection cup Direct and/or microscopic examination of a stool sample detects the presence of parasites or their ova (eggs). Test procedure: nYou will receive one sterile containers in which to collect your stool sample. nYou defecate directly into the container and seal it. You do not need to handle the stool, and it need not be refrigerated. You deliver the stool sample to laboratory. nThe sample is observed for evidence of parasites. A slide may be prepared for microscopic examination.nAfter the test:（Interpretation） And if a stool test finds blood in stools, patients should get a colonoscopy.nA positive test means that a particular parasite or its ova are present.n病人：大夫，这是我的化验报告。 Patient: Here my report, Doctor.n大夫：请坐。让我看看。没什么大问题。只是你吃了过多的油腻食物，导致消化不良。我给你开点药。吃了这些药你会感觉好多了。接下来的几天，你的饮食要尽量清淡一点。 Doctor: Take your seat, and let me have a look. Its nothing serious, only indigestion due to too much oily food. I will prescribe you some medicine for it to make you feel better. I do advise you to avoid oily food for the next few days.n病人：我会照你说的去做。谢谢您，大夫。 Patient: I will follow your advice. Thanks a lot.n大夫：不客气。 Doctor: You are welcome.Two Cases with Unusual Vancomycin MeasurementsnCASE Patient A was a 68-year-old woman with a history of lymphoplasmacytic lymphoma who presented after several weeks of mucosal bleeding. On admission, her cancer involved 95% of bone marrow cells. She was pancytopenic and febrile (38.3 C). Leukocyte count was 0.39 x 103/L (neutrophils, 0.03 x 103/L), hematocrit 25%, platelet count 21 x 103/L, relative serum viscosity 2.3 (reference interval, 1.41.8), blood urea nitrogen 6.4 mmol/L (18 mg/dL), creatinine 62 mol/L (0.7 mg/dL).and estimated glomerular filtration rate 60 mL/min/1.73 m2. She had an IgM monoclonal component of 42.8g/L. This patient was started on vancomycin 1 g intravenously (IV) every 12 h,n and a course of chemotherapy. On day 3 after the beginning of antibiotic treatment, a trough specimen was collected for measurement of vancomycin. The concentration, measured with a Beckman Coulter Synchron competitive turbidimetric immunoassay, was 0.1 mg/L.