{"id":1189,"date":"2016-12-11T18:08:02","date_gmt":"2016-12-11T17:08:02","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/11\/biochemicke-vysetrenia-pri-ochoreniach-pecene\/"},"modified":"2017-10-04T14:34:11","modified_gmt":"2017-10-04T12:34:11","slug":"biochemical-examinations-in-liver-diseases","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/biochemical-examinations-in-liver-diseases\/","title":{"rendered":"Biochemical Examinations in Liver Diseases"},"content":{"rendered":"<pre><span style=\"color: #ff0000;\"><strong>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf\u00a0\r\nattachment at the end of the paper.\r\n\r\n\r\n<\/strong><\/span><\/pre>\n<p><strong>Kli<\/strong><strong>ni<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00fd v\u00fdznam<\/strong><\/p>\n<p>Pe\u010de\u0148 m\u00e1 \u00fastredn\u00fa \u00falohu v rade \u017eivotne d\u00f4le\u017eit\u00fdch pochodov. Prebieha tu metabolizmus sacharidov, lipidov a plazmatick\u00fdch lipoprote\u00ednov, synt\u00e9za prote\u00ednov, ako aj likvid\u00e1cia metabolicky zmenen\u00fdch molek\u00fal prote\u00ednov. \u010eal\u0161ou funkciou pe\u010dene je vychyt\u00e1vanie, detoxik\u00e1cia a vylu\u010dovanie cudzorod\u00fdch \u00a0l\u00e1tok (1).<\/p>\n<p><em>Pri diagnostike\u00a0 ochoren\u00ed \u00a0pe\u010dene m\u00f4\u017eeme biochemick\u00e9 vy\u0161etrenia rozdeli\u0165 na:<\/em><\/p>\n<ol>\n<li>testy odr\u00e1\u017eaj\u00face po\u0161kodenie hepatocytov \u2013 AST, ALT<\/li>\n<li>testy odr\u00e1\u017eaj\u00face poruchy na \u00farovni \u017el\u010dovodov a kanalikul\u00e1rneho p\u00f3lu pe\u010de\u0148ovej bunky \u2013 ALP, GMT<\/li>\n<li>testy na syntetick\u00fa \u010dinnos\u0165 pe\u010dene \u2013 album\u00edn, prealbum\u00edn, chol\u00ednester\u00e1za, koagula\u010dn\u00e9 \u00a0faktory<\/li>\n<li>testy meraj\u00face kapacitu odstra\u0148ovania endog\u00e9nnych \u00a0a exog\u00e9nnych l\u00e1tok z cirkul\u00e1cie \u2013 bilirub\u00edn, amoniak<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><strong>A<\/strong><strong>L<\/strong><strong>T<\/strong><strong>, AST<\/strong><\/p>\n<p>ALT je enz\u00fdm prim\u00e1rne lokalizovan\u00fd v pe\u010deni. AST je enz\u00fdm pr\u00edtomn\u00fd vo viacer\u00fdch tkaniv\u00e1ch \u2013 srdce, kostrov\u00e9 svaly, obli\u010dky, mozog, pe\u010de\u0148, pankreas. K\u00fdm ALT je pr\u00edtomn\u00fd len v cytozole, AST sa nach\u00e1dza v dvoch izoform\u00e1ch \u2013 mitochondri\u00e1lnej a cytozolovej. Preto zv\u00fd\u0161enie AST je prognosticky z\u00e1va\u017enej\u0161ie. S\u00e9rov\u00e9 aktivity AST a ALT s\u00fa zv\u00fd\u0161en\u00e9 pri v\u00e4\u010d\u0161ine pe\u010de\u0148ov\u00fdch chor\u00f4b a pri v\u00e4\u010d\u0161ine s v\u00fdnimkou alkoholick\u00e9ho pe\u010de\u0148ov\u00e9ho po\u0161kodenia a Reyovho syndr\u00f3mu je aktivita ALT vy\u0161\u0161ia ako AST. Najvy\u0161\u0161ie hodnoty \u00a0s\u00fa pri v\u00edrusov\u00fdch hepatit\u00eddach a poliekovom toxickom po\u0161koden\u00ed pe\u010dene (1).<br \/>\nPomer AST\/ALT sa ozna\u010duje ako Ritisov index, a ak je &gt; 2, je pokladan\u00fd za \u0161pecifick\u00fd pre alkoholick\u00e9 po\u0161kodenie pe\u010dene. Pri v\u00edrusovej hepatit\u00edde je pomer AST\/ALT &lt; 1.<\/p>\n<p><em>Zv\u00fd\u0161en\u00e1 aktivita AST, ALT:<br \/>\n<\/em>chronick\u00e9 hepatit\u00eddy<\/p>\n<ul>\n<li>pe\u010de\u0148ov\u00e1 cirh\u00f3za, cholestatick\u00e9 ochorenia pe\u010dene, pe\u010de\u0148ov\u00e9 neopl\u00e1zie, intenz\u00edvne cvi\u010denie<\/li>\n<li>A \u00a0ST \u2013 ochorenie myokardu, myopatie, \u0165a\u017ek\u00e9 infek\u010dn\u00e9 ochorenia<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>A<\/strong><strong>L<\/strong><strong>T<\/strong><strong>, AST<\/strong><\/p>\n<p>ALT je enz\u00fdm prim\u00e1rne lokalizovan\u00fd v pe\u010deni. AST je enz\u00fdm pr\u00edtomn\u00fd vo viacer\u00fdch tkaniv\u00e1ch \u2013 srdce, kostrov\u00e9 svaly, obli\u010dky, mozog, pe\u010de\u0148, pankreas. K\u00fdm ALT je pr\u00edtomn\u00fd len v cytozole, AST sa nach\u00e1dza v dvoch izoform\u00e1ch \u2013 mitochondri\u00e1lnej a cytozolovej. Preto zv\u00fd\u0161enie AST je prognosticky z\u00e1va\u017enej\u0161ie. S\u00e9rov\u00e9 aktivity AST a ALT s\u00fa zv\u00fd\u0161en\u00e9 pri v\u00e4\u010d\u0161ine pe\u010de\u0148ov\u00fdch chor\u00f4b a pri v\u00e4\u010d\u0161ine s v\u00fdnimkou alkoholick\u00e9ho pe\u010de\u0148ov\u00e9ho po\u0161kodenia a Reyovho \u00a0syndr\u00f3mu \u00a0je aktivita ALT vy\u0161\u0161ia ako AST. Najvy\u0161\u0161ie hodnoty \u00a0s\u00fa pri v\u00edrusov\u00fdch hepatit\u00eddach a poliekovom toxickom po\u0161koden\u00ed pe\u010dene (1). Pomer AST\/ALT sa ozna\u010duje ako Ritisov index, a ak je &gt; 2, je pokladan\u00fd za \u0161pecifick\u00fd pre alkoholick\u00e9 po\u0161kodenie pe\u010dene. Pri v\u00edrusovej hepatit\u00edde je pomer AST\/ALT &lt; 1.<\/p>\n<p><em><br \/>\nZv\u00fd\u0161en\u00e1 aktivita AST, ALT:<\/em><\/p>\n<ul>\n<li><em>3\u00a0 &#8211; a\u017e 20-kr\u00e1t \u2013 ak\u00fatne, chronick\u00e9 hepatit\u00eddy, toxick\u00e9 po\u0161kodenie pe<\/em>\u010dene, ak\u00fatne pravostrann\u00e9 srdcov\u00e9 zlyhanie s venost\u00e1zou v pe\u010deni, \u0165a\u017ek\u00e1 bili\u00e1rna kolika<\/li>\n<li>3-kr\u00e1t \u2013 pe\u010de\u0148ov\u00e1 steat\u00f3za, nealkoholick\u00e1 pe\u010de\u0148ov\u00e1 steatofibr\u00f3za, chronick\u00e9 hepatit\u00eddy<\/li>\n<li>pe\u010de\u0148ov\u00e1 cirh\u00f3za, cholestatick\u00e9 ochorenia pe\u010dene, pe\u010de\u0148ov\u00e9 neopl\u00e1zie, intenz\u00edvne cvi\u010denie<\/li>\n<li>A \u00a0ST \u2013 ochorenie myokardu, myopatie, \u0165a\u017ek\u00e9 infek\u010dn\u00e9 ochorenia<\/li>\n<\/ul>\n<p><em>\u00a0<\/em><\/p>\n<p><strong>A<\/strong><strong>L<\/strong><strong>P<\/strong><strong>, GMT<\/strong><\/p>\n<p>ALP je enz\u00fdm nach\u00e1dzaj\u00faci sa v kostiach, \u010dreve, obli\u010dk\u00e1ch, placente a leukocytoch. U zdrav\u00fdch je preva\u017en\u00e1 \u010das\u0165 v s\u00e9re tvoren\u00e1 kostnou a pe\u010de\u0148ovou zlo\u017ekou. V gravidite sa v\u00fdrazne zvy\u0161uje aktivita placent\u00e1rnej \u00a0zlo\u017eky. Hodnoty ALP s\u00fa zv\u00fd\u0161en\u00e9 u det\u00ed a v puberte po\u010das rastu. Pri pe\u010de\u0148ov\u00fdch ochoreniach sa s najvy\u0161\u0161\u00edmi hodnotami stret\u00e1vame pri cholestatick\u00fdch ochoreniach \u00a0pe\u010dene (1).<\/p>\n<p><em>Zv\u00fd\u0161en\u00e1 aktivita ALP:<\/em><\/p>\n<ul>\n<li>chronick\u00e9 pe\u010de\u0148ov\u00e9 choroby spojen\u00e9 s cholest\u00e1zou (prim\u00e1rna bili\u00e1rna cirh\u00f3za, chronick\u00e1 hepatit\u00edda alebo cirh\u00f3za s cholestatick\u00fdmi \u010drtami)<\/li>\n<li>toxick\u00e9 pe\u010de\u0148ov\u00e9 l\u00e9zie<\/li>\n<li>lo\u017eiskov\u00e9 pe\u010de\u0148ov\u00e9 procesy (cysty, abscesy, tumory, metast\u00e1zy)<\/li>\n<li>pe\u010de\u0148ov\u00e1 cirh\u00f3za<\/li>\n<\/ul>\n<p>GMT je pr\u00edtomn\u00e1 v membr\u00e1nach \u00a0mnoh\u00fdch \u00a0tkan\u00edv s exkretorickou alebo absorp\u010dnou funkciou \u2013 obli\u010dky, pankreas, pe\u010de\u0148, ale aj srdce, slezina a mozog. Nach\u00e1dza sa v prostate a semin\u00e1lnych va\u010dkoch. Aktivita GMT st\u00fapa s vekom. V pe\u010deni sa nach\u00e1dza v \u017el\u010dov\u00fdch cest\u00e1ch, hepatocytoch, v tkaniv\u00e1ch pankreatick\u00fdch v\u00fdvodov. Pri pe\u010de\u0148ov\u00fdch \u00a0ochoreniach koreluje hodnota GMT s hodnotou ALP, pri\u010dom je pova\u017eovan\u00e1\u00a0 za citlivej\u0161\u00ed ukazovate\u013e hepatobili\u00e1rneho ochorenia ako ALP. Pri cholest\u00e1ze je vzostup a\u017e 12-n\u00e1sobn\u00fd, pri\u010dom vzostup ALP len 3-n\u00e1sobn\u00fd. Len v\u00fdnimo\u010dne je GMT norm\u00e1lne pri hepatobili\u00e1rnych ochoreniach det\u00ed (1).<\/p>\n<p><em>Zv\u00fd\u0161en\u00e1 aktivita GMT:<\/em><\/p>\n<ul>\n<li>cholest\u00e1za<\/li>\n<li>chronick\u00fd alkoholizmus<\/li>\n<li>mimope\u010de\u0148ov\u00e9 ochorenia \u2013 infarkt myokardu, ren\u00e1lna insuficiencia,\u00a0ob\u0161truk\u010dn\u00e1 choroba p\u013e\u00fac, DM, ochorenia pankreasu<\/li>\n<li>liekov\u00e9 po\u0161kodenie<\/li>\n<\/ul>\n<p><strong>A<\/strong><strong>l<\/strong><strong>b<\/strong><strong>um\u00edn<\/strong><strong>, prealbum\u00edn, chol\u00ednester\u00e1za<\/strong><\/p>\n<p>Album\u00edn \u2013 sledovanie s\u00e9rovej koncentr\u00e1cie album\u00ednu je jednoduch\u00e9 vy\u0161etrenie, ktor\u00e9 posudzuje syntetick\u00fa \u010dinnos\u0165 pe\u010dene. Denne sa v pe\u010deni vytvor\u00ed 12 \u2013 15 g album\u00ednu. Ke\u010f\u017ee m\u00e1 album\u00edn pol\u010das 19 \u2013 21 dn\u00ed, nie je vhodn\u00fdm parametrom na pos\u00fadenie \u00a0prote\u00ednovej synt\u00e9zy pri ak\u00fatnych pe\u010de\u0148ov\u00fdch ochoreniach (1).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Pokles album\u00ednu:<\/strong><\/p>\n<ul>\n<li>alkoholick\u00e1 pe\u010de\u0148ov\u00e1 cirh\u00f3za s ascitom<\/li>\n<li>nefrotick\u00fd syndr\u00f3m<\/li>\n<li>prote\u00edny str\u00e1caj\u00face enteropatie<\/li>\n<li>pop\u00e1leniny<\/li>\n<li>katabolick\u00e9 stavy<\/li>\n<li>lie\u010dba kortikosteroidmi<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Vzostup album\u00ednu:<\/strong><\/p>\n<ul>\n<li>hemokoncentr\u00e1cia \u00a0pri dehydrat\u00e1cii<\/li>\n<li>pri terapii diuretikami<\/li>\n<\/ul>\n<p>Prealbum\u00edn \u2013 m\u00e1 pol\u010das \u00a0rozpadu \u00a0len 1,9 d\u0148a, preto sa jeho koncentr\u00e1cia pou\u017e\u00edva na hodnotenie stavu proteosynt\u00e9zy pe\u010de\u0148ov\u00fdmi bunkami pri ak\u00fatnych pe\u010de\u0148ov\u00fdch \u00a0l\u00e9zi\u00e1ch (1).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Pokles prealbum\u00ednu:<\/strong><\/p>\n<ul>\n<li>\u0165a\u017ek\u00e9 hepatopatie<\/li>\n<li>prote\u00ednov\u00e9 malnutr\u00edcie<\/li>\n<\/ul>\n<p>Chol\u00ednester\u00e1za, spr\u00e1vnej\u0161ie pseudochol\u00ednester\u00e1za, je enz\u00fdm \u00a0syntetizovan\u00fd v hepatocytoch secernovan\u00fd do krvnej plazmy \u00a0(2). M\u00e1 pol\u010das rozpadu \u00a0asi 10 dn\u00ed. Postihnutie pe\u010de\u0148ov\u00e9ho \u00a0parench\u00fdmu sa prejavuje zn\u00ed\u017een\u00edm synt\u00e9zy CHE.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Zn\u00ed\u017een\u00e1 aktivita v s\u00e9re:<\/strong><\/p>\n<ul>\n<li>porucha proteosynt\u00e9zy pri \u0165a\u017ekej hepatopatii, prote\u00ednovej malnutr\u00edcii<\/li>\n<li>intoxik\u00e1cia organofosf\u00e1tmi<\/li>\n<li>famili\u00e1rna idiopatick\u00e1 acholinesteraz\u00e9mia \u2013 dedi\u010dn\u00fd defekt synt\u00e9zy, je klinicky nem\u00fd, po podan\u00ed sukcinylchol\u00ednu hroz\u00ed apnoick\u00e1 pauza<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>K<\/strong><strong>oag<\/strong><strong>ul<\/strong><strong>a<\/strong><strong>\u010d<\/strong><strong>n<\/strong><strong>\u00e9 faktory<\/strong><\/p>\n<p>V pe\u010deni s\u00fa syntetizovan\u00e9 koagula\u010dn\u00e9 \u00a0faktory I\u00a0 (fibrinog\u00e9n), \u00a0II (protromb\u00edn), V, VII, IX, X. V\u00e4\u010d\u0161ina \u00a0t\u00fdchto faktorov je v s\u00e9re v nadbytku a pokles nast\u00e1va\u00a0 pri v\u00fdznamnej poruche proteosynt\u00e9zy v pe\u010deni. Pri pe\u010de\u0148ov\u00fdch ochoreniach \u010dasto doch\u00e1dza ku koagula\u010dn\u00fdm poruch\u00e1m.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>A<\/strong><strong>m<\/strong><strong>on<\/strong><strong>i<\/strong><strong>ak<\/strong><\/p>\n<p>Amoniak vznik\u00e1 pri degrad\u00e1cii \u00a0dus\u00edka aminokysel\u00edn v pe\u010deni. Preto\u017ee ide o toxick\u00fa l\u00e1tku, v pe\u010deni sa premen\u00ed na mo\u010dovinu. \u010eal\u0161\u00edm miestom tvorby amoniaku \u00a0je proxim\u00e1lny tubulus \u00a0obli\u010diek. \u00a0Amoniak neutralizuje vod\u00edkov\u00e9 i\u00f3ny v mo\u010di a umo\u017e\u0148uje ich vylu\u010dovanie. Pri pe\u010de\u0148ov\u00fdch chorob\u00e1ch \u00a0doch\u00e1dza \u00a0k vzostupu hodn\u00f4t, najm\u00e4 pri pe\u010de\u0148ovej insuficiencii. Zv\u00fd\u0161enie koncentr\u00e1cie amoniaku v\u00e4\u010d\u0161inou koreluje so z\u00e1va\u017enos\u0165ou pe\u010de\u0148ovej encefalopatie, aj ke\u010f amoniak je len jednou z jej pr\u00ed\u010din (3).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Vzostup amoniaku:<\/strong><\/p>\n<ul>\n<li>pe\u010de\u0148ov\u00e1 insuficiencia<\/li>\n<li>Reyov syndr\u00f3m<\/li>\n<li>ak\u00fatna a chronick\u00e1 pe\u010de\u0148ov\u00e1 encefalopatia<\/li>\n<li>nepe\u010de\u0148ov\u00e9 ochorenia \u2013 ak\u00fatna leuk\u00e9mia, krv\u00e1canie do tr\u00e1viaceho traktu, po krvnej transf\u00fazii<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Bili<\/strong><strong>r<\/strong><strong>ub\u00ed<\/strong><strong>n<\/strong><\/p>\n<p>Bilirub\u00edn je hlavn\u00fd metabolit hemu. Vznik\u00e1 po rozpade erytrocytov a pri degrad\u00e1cii hemoglob\u00ednu. Naviazan\u00fd na album\u00edn je krvou transportovan\u00fd do pe\u010dene. V\u00e4zba na album\u00edn neumo\u017e\u0148uje jeho prienik glomerulom do mo\u010du. Takto viazan\u00fd na album\u00edn sa naz\u00fdva nekonjugovan\u00fd. V pe\u010deni prebieha konjug\u00e1cia bilirub\u00ednu s kyselinou glukuronovou a vznik\u00e1 konjugovan\u00fd bilirub\u00edn. Konjugovan\u00fd bilirub\u00edn prech\u00e1dza z pe\u010de\u0148ov\u00fdch \u00a0buniek do \u017el\u010dovodov a \u017el\u010dou sa dost\u00e1va do tenk\u00e9ho \u010dreva. Pri zv\u00fd\u0161enej koncentr\u00e1cii v plazme prenik\u00e1 do mo\u010du. Bilirub\u00edn je v\u00fdznamn\u00fd diagnostick\u00fd test pri chronick\u00fdch pe\u010de\u0148ov\u00fdch chorob\u00e1ch, predov\u0161etk\u00fdm sprev\u00e1dzan\u00fdch cholest\u00e1zou. S\u00e9rov\u00e1 koncentr\u00e1cia z\u00e1vis\u00ed aj od pe\u010de\u0148ovej perf\u00fazie a rozpadu hemoglob\u00ednu (3).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>H<\/strong><strong>yp<\/strong><strong>e<\/strong><strong>r<\/strong><strong>bili<\/strong><strong>r<\/strong><strong>ubi<\/strong><strong>n<\/strong><strong>\u00e9<\/strong><strong>m<\/strong><strong>i<\/strong><strong>e nekonjugovan\u00e9<\/strong><\/p>\n<p>Pri nadmernom \u00a0vzniku bilirub\u00ednu:<\/p>\n<ul>\n<li>zv\u00fd\u0161en\u00fd rozpad hemoglob\u00ednu \u00a0\u2013 hemolytick\u00e9 an\u00e9mie<\/li>\n<li>fyziologick\u00fd ikterus novorodencov<\/li>\n<li>prim\u00e1rna skratov\u00e1 hyperbilirubin\u00e9mia \u2013 vznik bilirub\u00ednu v kostnej dreni n\u00e1sledkom defektnej erytropo\u00e9zy<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Porucha vychyt\u00e1vania, respekt\u00edve konjug\u00e1cie:<\/strong><\/p>\n<ul>\n<li>fyziologick\u00fd ikterus novorodencov<\/li>\n<li>Gilbertov syndr\u00f3m<\/li>\n<li>Criglerov-Najjarov syndr\u00f3m<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>H<\/strong><strong>yp<\/strong><strong>e<\/strong><strong>r<\/strong><strong>bili<\/strong><strong>r<\/strong><strong>ubi<\/strong><strong>n<\/strong><strong>\u00e9<\/strong><strong>m<\/strong><strong>i<\/strong><strong>e zmie\u0161an\u00e9<\/strong><\/p>\n<p>Po\u0161kodenie hepatocytov a n\u00e1sledn\u00e1 porucha vychyt\u00e1vania a konjug\u00e1cie bilirub\u00ednu, exkr\u00e9cie konjugovan\u00e9ho bilirub\u00ednu do \u017el\u010de:<\/p>\n<ul>\n<li>v\u00edrusov\u00e1 hepatit\u00edda<\/li>\n<li>toxick\u00e9 po\u0161kodenie pe\u010dene<\/li>\n<li>dekompenzovan\u00e1 pe\u010de\u0148ov\u00e1 cirh\u00f3za<\/li>\n<li>ak\u00fatne zlyhanie pe\u010dene<\/li>\n<li>dlhotrvaj\u00faca ob\u0161trukcia, cholangit\u00eddy<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>H<\/strong><strong>yp<\/strong><strong>e<\/strong><strong>r<\/strong><strong>bili<\/strong><strong>r<\/strong><strong>ubi<\/strong><strong>n<\/strong><strong>\u00e9<\/strong><strong>m<\/strong><strong>i<\/strong><strong>e konjugovan\u00e9<\/strong><\/p>\n<ul>\n<li>ob\u0161trukcia \u017el\u010dov\u00fdch ciest<\/li>\n<li>bez ob\u0161trukcie:<\/li>\n<\/ul>\n<ol>\n<li>\u2013\u00a0\u00a0\u00a0 \u00a0poliekov\u00e1 cholest\u00e1za<\/li>\n<li>\u2013\u00a0\u00a0\u00a0 \u00a0prim\u00e1rna bili\u00e1rna cirh\u00f3za<\/li>\n<li>\u2013\u00a0\u00a0\u00a0 \u00a0Dubinov-Johnsonov syndr\u00f3m \u2013 porucha exkr\u00e9cie konjugovan\u00e9ho bilirub\u00ednu pe\u010de\u0148ovou bunkou<\/li>\n<li>\u2013\u00a0\u00a0\u00a0 \u00a0Rotorov syndr\u00f3m \u2013 porucha exkr\u00e9cie konjugovan\u00e9ho bilirub\u00ednu pe\u010de\u0148ovou bunkou<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><strong>\u017d<\/strong><strong>l<\/strong><strong>\u010d<\/strong><strong>ov\u00e9 kyseliny<\/strong><\/p>\n<p>\u017dl\u010dov\u00e9 kyseliny sa syntetizuj\u00fa v pe\u010deni z cholesterolu, predstavuj\u00fa jedin\u00fa v\u00fdznamn\u00fa cestu jeho elimin\u00e1cie. V podobe \u00a0svojich sodn\u00fdch a draseln\u00fdch sol\u00ed s\u00fa d\u00f4le\u017eitou s\u00fa\u010das\u0165ou \u017el\u010de, maj\u00fa siln\u00fd emulzifika\u010dn\u00fd \u00fa\u010dinok na tuky a aktiv\u00e1ciou pankreatickej lip\u00e1zy sa v\u00fdznamnou mierou podie\u013eaj\u00fa na tr\u00e1ven\u00ed a resorpcii tukov. Najd\u00f4le\u017eitej\u0161ou \u017el\u010dovou kyselinou je kyselina cholov\u00e1, druh\u00e1 v porad\u00ed je kyselina chenodeoxycholov\u00e1. Spolu sa ozna\u010duj\u00fa ako prim\u00e1rne \u017el\u010dov\u00e9 kyseliny. Denne sa v pe\u010deni syntetizuje 200 \u2013 500 mg \u017el\u010dov\u00fdch kysel\u00edn.<\/p>\n<p>\u017dl\u010dov\u00e9 kyseliny sa usklad\u0148uj\u00fa a zahus\u0165uj\u00fa v \u017el\u010dn\u00edku, zo \u017el\u010dn\u00edka je \u017el\u010d vylu\u010dovan\u00e1 do tenk\u00e9ho \u010dreva pri pr\u00edjme potravy a vplyvom cholecystokin\u00ednu. V termin\u00e1lnom ileu sa akt\u00edvnym transportn\u00fdm syst\u00e9mom sp\u00e4tne resorbuje a\u017e 95 % \u017el\u010dov\u00fdch \u00a0kysel\u00edn, tieto sa port\u00e1lnym syst\u00e9mom \u00a0vracaj\u00fa sp\u00e4\u0165 do pe\u010dene \u2013 hovor\u00edme o enterohepat\u00e1lnom obehu \u017el\u010dov\u00fdch kysel\u00edn. Len mal\u00e1 \u010das\u0165 sa neresorbuje (asi 500 mg denne) a vyl\u00fa\u010di sa stolicou von z tela. T\u00e1to \u010das\u0165 predstavuje hlavn\u00fa cestu elimin\u00e1cie cholesterolu. V \u010dreve \u010dinnos\u0165ou bakteri\u00e1lnej fl\u00f3ry doch\u00e1dza \u00a0k zmene \u00a0\u0161trukt\u00fary \u017el\u010dov\u00fdch \u00a0kysel\u00edn, vznikaj\u00fa sekund\u00e1rne a terci\u00e1rne \u017el\u010dov\u00e9 kyseliny, ktor\u00e9 sa v\u00fdrazne hor\u0161ie resorbuj\u00fa.<\/p>\n<p>Hlavnou fyziologickou \u00falohou \u017el\u010dov\u00fdch kysel\u00edn je pom\u00e1ha\u0165 pri tr\u00e1ven\u00ed, resorpcii lipidov a exkr\u00e9cii cholesterolu. Pri nedostato\u010dnom \u00a0pr\u00edsune \u017el\u010dov\u00fdch kysel\u00edn do \u010dreva vznik\u00e1 porucha tr\u00e1venia a resorpcie tukov (steatorea, hna\u010dky) a vitam\u00ednov rozpustn\u00fdch v tukoch.<\/p>\n<p>Stanovenie \u00a0\u017el\u010dov\u00fdch \u00a0kysel\u00edn u pacientov \u00a0nala\u010dno \u00a0je ve\u013emi citliv\u00fdm ukazovate\u013eom poruchy portobili\u00e1rnej funkcie alebo zn\u00ed\u017een\u00e9ho prietoku krvi pe\u010de\u0148ou. Je senzit\u00edvnej\u0161\u00edm testom pe\u010de\u0148ov\u00e9ho po\u0161kodenia ako sta- novenie bilirub\u00ednu, AST alebo ALP. Vzostup koncentr\u00e1cie \u00a0\u017el\u010dov\u00fdch\u00a0 kysel\u00edn je najcitlivej\u0161\u00edm indik\u00e1torom cholest\u00e1zy. Jeho nev\u00fdhodou \u00a0je n\u00edzka \u0161pecifickos\u0165 \u2013 koncentr\u00e1cia \u017el\u010dov\u00fdch kysel\u00edn sa zvy\u0161uje aj pri in\u00fdch prim\u00e1rnych poruch\u00e1ch pe\u010dene, pri ktor\u00fdch je cholest\u00e1za sekund\u00e1rna a klinicky m\u00e1lo v\u00fdznamn\u00e1. N\u00e1lez norm\u00e1lnej koncentr\u00e1cie \u00a0\u017el\u010dov\u00fdch kysel\u00edn v\u0161ak, prakticky s ur\u010ditos\u0165ou, cholest\u00e1zu \u00a0vylu\u010duje (2, 4, 5).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Zv\u00fd\u0161en\u00e9 hodnoty:<\/strong><\/p>\n<ul>\n<li>prim\u00e1rna bili\u00e1rna cirh\u00f3za<\/li>\n<li>prim\u00e1rna sklerotizuj\u00faca cholangit\u00edda<\/li>\n<li>ak\u00fatna a chronick\u00e1 hepatit\u00edda<\/li>\n<li>alkoholick\u00e9 po\u0161kodenie pe\u010dene<\/li>\n<li>cirh\u00f3za<\/li>\n<li>extra- a intrahepat\u00e1lna cholest\u00e1za<\/li>\n<li>intrahepat\u00e1lna cholest\u00e1za gravidn\u00fdch (ICP)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>C<\/strong><strong>D<\/strong><strong>T \u2013 Karbohydr\u00e1t-deficientn\u00fd transfer\u00edn<\/strong><\/p>\n<p>CDT je v s\u00fa\u010dasnosti pova\u017eovan\u00fd za naj\u0161pecifickej\u0161\u00ed marker chronick\u00e9ho ab\u00fazu alkoholu. Transfer\u00edn je najd\u00f4le\u017eitej\u0161\u00ed transportn\u00fd prote\u00edn \u017eeleza. Je syntetizovan\u00fd v hepatocytoch. Transfer\u00edn sa nepova\u017euje za homog\u00e9nnu molekulu, ale predstavuje skupinu transfer\u00ednov\u00fdch izoforiem, ktor\u00e9 sa navz\u00e1jom odli\u0161uj\u00fa po\u010dtom naviazan\u00fdch \u00a0i\u00f3nov \u017eeleza (Fe0-Trf, Fe1-Trf, Fe2-Trf ), substit\u00faciou aminokysel\u00edn v polypeptidovom re\u0165azci a stup\u0148om vetvenia oligosacharidov\u00fdch komplexov.<br \/>\nV z\u00e1vislosti od \u0161trukt\u00fary oligosacharidov\u00fdch \u00a0re\u0165azcov je mo\u017en\u00e1 v\u00e4zba a\u017e 8 molek\u00fal kyseliny sialovej. Za karbohydr\u00e1t-deficientn\u00fd transfer\u00edn (CDT) sa pova\u017euj\u00fa tri izoformy transfer\u00ednu \u2013 asialo, monosialo, disialotransfer\u00edn. Denn\u00fd pr\u00edjem etanolu v mno\u017estve 50 \u2013 80 g (pribli\u017ene 0,75 l v\u00edna alebo 1,5 l piva) po obdobie \u00a01 \u2013 2 t\u00fd\u017ed\u0148ov vedie k zv\u00fd\u0161eniu koncentr\u00e1cie izoforiem transfer\u00ednu, ktor\u00e9 maj\u00fa naviazan\u00e9 dve, jednu alebo \u017eiadnu kyselinu sialov\u00fa (CDT). Naopak, pri abstinencii trvaj\u00facej aspo\u0148 2 \u2013 3 t\u00fd\u017edne sa hladina CDT zni\u017euje. CDT je teda mo\u017en\u00e9 vyu\u017ei\u0165 ako marker na kontrolu abstinen\u010dnej terapie.<br \/>\nHodnota CDT je z\u00e1visl\u00e1 od stavu metabolizmu \u017eeleza a hladiny transfer\u00ednu, preto sa odpor\u00fa\u010da \u00a0prepo\u010det na celkov\u00fd transfer\u00edn. Falo\u0161ne pozit\u00edvny v\u00fdsledok m\u00f4\u017ee by\u0165 u pacientov s hepat\u00e1lnou cirh\u00f3zou v\u00edrusovej etiol\u00f3gie (40 %), prim\u00e1rnou \u00a0bili\u00e1rnou cirh\u00f3zou (46 %), hepatocelul\u00e1rnym karcin\u00f3mom, v tehotenstve, pri u\u017e\u00edvan\u00ed estrog\u00e9nov, po kombinova- nej transplant\u00e1cii obli\u010diek a pankreasu, pri hemochromat\u00f3ze \u00a0(6, 7).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>N<\/strong><strong>\u00e1do<\/strong><strong>r<\/strong><strong>ov\u00e9 postihnutie pe\u010dene<\/strong><\/p>\n<p>Sekund\u00e1rne n\u00e1dorov\u00e9 postihnutie pe\u010dene \u00a0je \u010dast\u00e9, do pe\u010dene metast\u00e1zuj\u00fa predov\u0161etk\u00fdm \u00a0karcin\u00f3my tr\u00e1viaceho \u00a0traktu a pankreasu, ale aj in\u00fdch org\u00e1nov. Metast\u00e1zy oby\u010dajne sp\u00f4sobuj\u00fa lok\u00e1lnu cholest\u00e1zu so zv\u00fd\u0161en\u00edm aktivity ALP, GMT.<\/p>\n<p>Prim\u00e1rny karcin\u00f3m pe\u010dene \u00a0vznik\u00e1 naj\u010dastej\u0161ie na podklade cirh\u00f3zy. Za prekancer\u00f3zu sa pova\u017euje najm\u00e4 chronick\u00e1 v\u00edrusov\u00e1 hepatit\u00edda B a C. U v\u00e4\u010d\u0161iny pacientov s prim\u00e1rnym karcin\u00f3mom pe\u010dene nach\u00e1dzame v s\u00e9re zv\u00fd\u0161en\u00fa koncentr\u00e1ciu \u00a0AFP, ktor\u00fd je produkovan\u00fd \u00a0n\u00e1dorov\u00fdmi \u00a0bunkami (3).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>B<\/strong><strong>io<\/strong><strong>c<\/strong><strong>h<\/strong><strong>e<\/strong><strong>m<\/strong><strong>i<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00e9 vy\u0161etrenia pri zriedkav\u00fdch pe\u010de\u0148ov\u00fdch ochoreniach<\/strong><\/p>\n<p><strong>Hemochromat\u00f3za<\/strong><\/p>\n<p>Je dedi\u010dn\u00e9 ochorenie sp\u00f4soben\u00e9 ch\u00fdban\u00edm regul\u00e1cie absorpcie \u017eeleza v tenkom \u010dreve. N\u00e1sledkom je nadmern\u00e9\u00a0 ukladanie \u017eeleza v pe\u010deni (vyv\u00edja sa cirh\u00f3za), myokarde (kardiomyopatia), pankrease a ko\u017ei (vznik\u00e1 tzv. bronzov\u00fd \u00a0diabetes)\u00a0 (3).<\/p>\n<p><strong>Laborat\u00f3rny n\u00e1lez:<\/strong><\/p>\n<ul>\n<li>vysok\u00e1 satur\u00e1cia transfer\u00ednu \u2013 viac ako 60 % u mu\u017eov, viac ako 50 % u \u017eien<\/li>\n<li>zv\u00fd\u0161en\u00e1 koncentr\u00e1cia plazmatick\u00e9ho \u017eeleza<\/li>\n<li>zv\u00fd\u0161en\u00e1 koncentr\u00e1cia ferit\u00ednu<\/li>\n<li>zn\u00ed\u017een\u00e1 v\u00e4zbov\u00e1 kapacita \u017eeleza<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Wilsonova choroba<\/strong><\/p>\n<p>Je dedi\u010dn\u00e9 ochorenie prejavuj\u00face sa nedostato\u010dnou tvorbou ceruloplazm\u00ednu, celkov\u00e1 koncentr\u00e1cia medi v s\u00e9re je zn\u00ed\u017een\u00e1, vy\u0161\u0161ia je v\u0161ak vo\u013en\u00e1 frakcia Cu. T\u00e1 prenik\u00e1 do pe\u010dene, mozgu a obli\u010diek a sp\u00f4sobuje cirh\u00f3zu a neurologick\u00e9 poruchy (3).<\/p>\n<p><strong>Laborat\u00f3rny n\u00e1lez:<\/strong><\/p>\n<ul>\n<li>zn\u00ed\u017een\u00e1 koncentr\u00e1cia ceruloplazm\u00ednu pod 0,2 g\/l<\/li>\n<li>zn\u00ed\u017een\u00e1 s\u00e9rov\u00e1 koncentr\u00e1cia medi<\/li>\n<li>zv\u00fd\u0161en\u00e9 vylu\u010dovanie medi mo\u010dom nad 1,5 \u00b5mol\/de\u0148<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Porf\u00fdrie<\/strong><\/p>\n<p>Porf\u00fdrie predstavuj\u00fa skupinu chor\u00f4b sp\u00f4soben\u00fdch \u00a0poruchou meta- bolizmu hemu, ktor\u00e1 m\u00e1 za n\u00e1sledok hromadenie a zv\u00fd\u0161en\u00e9 vylu\u010dovanie niektorej zlo\u017eky porfyr\u00ednov\u00e9ho \u00a0metabolizmu \u00a0mo\u010dom alebo stolicou. Z klinick\u00e9ho poh\u013eadu ich del\u00edme na ak\u00fatne a chronick\u00e9. Naj\u010dastej\u0161ou chronickou porf\u00fdriou je porfyria cutanea tarda. Naj\u010dastej\u0161ou \u00a0ak\u00fatnou porf\u00fdriou je ak\u00fatna intermitentn\u00e1 \u00a0porf\u00fdria (1). Diagnostika porf\u00fdri\u00ed je v\u0161ak zlo\u017eit\u00e1 a presahuje r\u00e1mec tohto preh\u013eadu.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>P<\/strong><strong>r<\/strong><strong>e<\/strong><strong>d<\/strong><strong>an<\/strong><strong>a<\/strong><strong>l<\/strong><strong>y<\/strong><strong>t<\/strong><strong>i<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00e9 inform\u00e1cie<\/strong><\/p>\n<p>AST, ALT, ALP, GMT, BILK, BILC, Album\u00edn, Prealbum\u00edn, CHE, CDT, \u017el\u010dov\u00e9 kyseliny, AFP, Cu, Cpl \u2013 odber do \u0161tandardnej biochemickej sk\u00fa- mavky so separa\u010dn\u00fdm g\u00e9lom. Po odbere \u010do najsk\u00f4r doru\u010di\u0165 do laborat\u00f3ria.<\/p>\n<p>NH3 \u00a0\u2013 odber do sk\u00famavky s K-EDTA (ako na KO), ihne\u010f \u00a0po odbere doru\u010di\u0165 do laborat\u00f3ria na \u013eade.<\/p>\n<p>dUCu \u2013 24-hodinov\u00fd zber do \u0161peci\u00e1lne \u00a0umytej plastovej n\u00e1doby (poskytneme v laborat\u00f3riu), mo\u010d nesmie pr\u00eds\u0165 do kontaktu so sklom.<\/p>\n<p>Porfyr\u00edny \u2013 jednorazov\u00fd mo\u010d \u2013 uchov\u00e1va\u0165 v sk\u00famavke zabalenej do alobalu, mo\u010d nesmie by\u0165 na svetle; 24-hodinov\u00fd mo\u010d, zber do tmavej n\u00e1doby s Na2CO3.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>I<\/strong><strong>n<\/strong><strong>t<\/strong><strong>e<\/strong><strong>r<\/strong><strong>f<\/strong><strong>e<\/strong><strong>r<\/strong><strong>e<\/strong><strong>n<\/strong><strong>c<\/strong><strong>i<\/strong><strong>a<\/strong><\/p>\n<p>AST \u2013 slab\u00e1 hemol\u00fdza, siln\u00fd z\u00e1kal ALT, GMT \u2013 hemol\u00fdza \u00a0, siln\u00fd z\u00e1kal ALP \u2013 siln\u00e1 hemol\u00fdza, siln\u00fd z\u00e1kal Album\u00edn \u2013 siln\u00e1 hemol\u00fdza Bilirub\u00edn \u2013 slab\u00e1 hemol\u00fdza, z\u00e1kal<br \/>\n\u017dl\u010dov\u00e9 kyseliny \u2013 siln\u00e1 hemol\u00fdza, chylozita s\u00e9ra<br \/>\nCu \u2013 hemol\u00fdza s\u00e9ra<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Me<\/strong><strong>t<\/strong><strong>\u00f3d<\/strong><strong>a<\/strong><\/p>\n<p>AST, ALT, GMT, ALP, bilirub\u00edn, album\u00edn, CHE \u2013 fotometrick\u00e1 met\u00f3da<br \/>\nPrealbum\u00edn \u2013 imunoturbidimetria<br \/>\nAmoniak \u2013 reflekta\u010dn\u00e1 fotometria<\/p>\n<p>&nbsp;<\/p>\n<p><strong>CDT \u2013 HPLC<\/strong><\/p>\n<p>\u017dl\u010dov\u00e9 kyseliny \u2013 enzymatick\u00e1 kolorimetria<br \/>\nAFP \u2013 imunochemick\u00e1 met\u00f3da na princ\u00edpe elektrochemiluminiscencie<br \/>\nCu, dUCu \u2013 at\u00f3mov\u00e1 absorp\u010dn\u00e1 spektrofotometria<\/p>\n<p>&nbsp;<\/p>\n<p><strong>K<\/strong><strong>\u00f3<\/strong><strong>d vy\u0161etrenia<\/strong><\/p>\n<p>ALT \u2013 3692, AST \u2013 3691, GMT \u2013 3693, ALP \u2013 3690, BILK \u2013 3673, BILC \u2013 3672, Album\u00edn \u20133681, Prealbum\u00edn \u2013 4538, Amoniak \u2013 4069, CHE \u2013 3701, CDT \u2013 4238, \u017el\u010dov\u00e9 kyseliny \u2013 4458, AFP \u2013 4361, Cu, dU Cu 4113, Ceruloplazm\u00edn \u2013 4543.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Dos<\/strong><strong>t<\/strong><strong>up<\/strong><strong>nos<\/strong><strong>\u0165 vy\u0161etrenia<\/strong><\/p>\n<p>Centr\u00e1lne laborat\u00f3rium Bratislava \u2013 \u017el\u010dov\u00e9 kyseliny len Bratislava<\/p>\n<p>Centr\u00e1lne laborat\u00f3rium Ko\u0161ice<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>it<\/strong><strong>e<\/strong><strong>ra<\/strong><strong>t<\/strong><strong>\u00fa<\/strong><strong>ra<\/strong><\/p>\n<ol>\n<li>Zima T. <em>Laborat\u00f3rn\u00ed diagnostika. <\/em>Praha: Gal\u00e9n; 2007: 97\u2013108, 110\u2013111.<\/li>\n<li>Masopust J. <em>K<\/em><em>li<\/em><em>nick\u00e1 biochemie. Po\u017eadov\u00e1n\u00ed <\/em><em>a hodnocen\u00ed biochemick\u00fdch vy\u0161et\u0159en\u00ed<\/em>. \u010c\u00e1st I. 1. vyd. Praha: Karolinum; 1998: 165, 190.<\/li>\n<li>Racek J. <em>K<\/em><em>li<\/em><em>nick\u00e1 biochemie<\/em>. Praha: Gal\u00e9n; 1999: 73, 129, 204, 207\u2013209.<\/li>\n<li>Tureck\u00fd L. Lek\u00e1rska bioch\u00e9mia II. Bratislava: Asklepios; 2008: 216.<\/li>\n<li>Ku\u017eela L. <em>Choroby pe\u010dene. <\/em>Bratislava: Univerzita Komensk\u00e9ho; 2013: 65.<\/li>\n<li>Arndt T. Carbohydrate-deficient transferin as a marker of chronic accohol abuse: A critical review of preanalysis, analysis and interpretation. <em>Clin Chem. <\/em>2001;47(1):13\u20132<\/li>\n<li>Martiakov\u00e1 K, Galajda P, Mok\u00e1\u0148 M. Diagnostika chronick\u00e9ho ab\u00fazu alkoholu \u2013 v\u00fdznam CDT transfer\u00ednu. <em>S\u00fa\u010dasn\u00e1 klinick\u00e1 prax. <\/em>2007;3: 14\u201317.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf\u00a0 attachment at the end of the paper. Klinick\u00fd v\u00fdznam Pe\u010de\u0148 m\u00e1 \u00fastredn\u00fa \u00falohu v rade \u017eivotne d\u00f4le\u017eit\u00fdch pochodov. Prebieha tu metabolizmus sacharidov, lipidov a plazmatick\u00fdch lipoprote\u00ednov, synt\u00e9za prote\u00ednov, ako aj likvid\u00e1cia metabolicky zmenen\u00fdch molek\u00fal prote\u00ednov. \u010eal\u0161ou funkciou<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[289],"tags":[784,782,783,781,779,780,778],"class_list":["post-1189","post","type-post","status-publish","format-standard","hentry","category-biochemistry","tag-alcoholism","tag-cholestasis","tag-cirrhosis","tag-hepatitis","tag-hepatocytes","tag-hepatopathy","tag-liver","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Liver plays a central role in energy and intermediary metabolism. Moreover, it plays an important role in excretion (endogenous substances) and detoxication (exogenous substances). To establish diagnosis of a liver disease, tests and examinations focus on determining hepatocyte damage, defects of proteosynthesis, defects of excretion of foreign and toxic substances as well as testing to detect cholestasis.<\/p>\n<p><strong>Key words: <\/strong>liver, hepatocytes, hepatopathy, hepatitis, cholestasis, cirrhosis, alcoholism<\/p>\n","casopis":[{"ID":995,"post_author":"7","post_date":"2016-11-16 12:14:30","post_date_gmt":"2016-11-16 11:14:30","post_content":"<h4><strong>Biochemistry <\/strong><\/h4>\r\n<ul>\r\n \t<li>Biochemical inflammation markers<\/li>\r\n \t<li>Biochemical examinations in liver diseases<\/li>\r\n \t<li>Biochemical diagnosis in diseases of GIT<\/li>\r\n \t<li>Hypoglycemia<\/li>\r\n \t<li>Urolithiasis as a result of metabolic diseases<\/li>\r\n \t<li>Indication and application of tumor markers in clinical practice<\/li>\r\n \t<li>Monoclonal gammopathies \u2013 laboratory examinations in diagnosis and monitoring<\/li>\r\n \t<li>Hormones in diagnosis of reproductive function disorders<\/li>\r\n \t<li>Cerebrospinal fluid diagnosis of diseases affecting the nervous system<\/li>\r\n \t<li>Determining trace elements in blood serum<\/li>\r\n<\/ul>\r\n<h4><strong>Genetics<\/strong><\/h4>\r\n<ul>\r\n \t<li>Assessing the therapeutic response in patients with chronic myelocyte leukemia treated with tyrosine kinase inhibitors<\/li>\r\n \t<li>Hormones in diagnosis of reproductive functions\u2019 disorders<\/li>\r\n<\/ul>\r\n<h4><strong>Hematology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Anemias \u2013 laboratory diagnosis of the most frequently prevalent types of anemia<\/li>\r\n \t<li>Laboratory and hematological technical equipment<\/li>\r\n<\/ul>\r\n<h4><strong>Immunology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Paraneoplastic neurological syndromes and in vitro diagnosis of onconeural antibodies<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab","to_ping":"","pinged":"","post_modified":"2017-08-16 21:40:20","post_modified_gmt":"2017-08-16 19:40:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"57","upload_clanok":{"ID":1190,"id":1190,"title":"vlnieskova_biochemicka_diagnostika_pri_ochoreniach_pecene","filename":"Vlnie\u0161kov\u00e1_Biochemick\u00e1_diagnostika_pri_ochoreniach_Pe\u010dene.pdf","filesize":135756,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/Vlnie\u0161kov\u00e1_Biochemick\u00e1_diagnostika_pri_ochoreniach_Pe\u010dene.pdf","link":"https:\/\/www.newslab.sk\/en\/biochemical-examinations-in-liver-diseases\/vlnieskova_biochemicka_diagnostika_pri_ochoreniach_pecene\/","alt":"","author":"7","description":"","caption":"","name":"vlnieskova_biochemicka_diagnostika_pri_ochoreniach_pecene","status":"inherit","uploaded_to":1189,"date":"2016-12-11 16:39:20","modified":"2016-12-11 16:39:20","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1189","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1189"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1189\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1189"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1189"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1189"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}