임상진단검사 활용 및 해석
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이귀녕 , 문해란
출판사
고려의학
의학 > 내과 > 내과
정가
40,000원
판매가
40,000원
적립금
800원
발행일
2015-11-20
페이지수
974 Pages
ISBN13 9788970438665
배송비
결제금액이 25,000원 이상 무료배송
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최신투석매뉴얼 5판
John T. Daugirdas / Peter G. Blake / Todd S. Ing
45,000 42,750won
우리 몸에 질환이 발생하면 그 병의 진행과 치유상태에 따라 여러 가지 변화가 일어나는데, 그에 따른 생체 내 제반성분을 측정하여 관찰함으로써 질환의 병태를 연구하는 학문이 진단검사의학이며 이 학문의 발전이 의료발전의 큰 원동력이 되었다. 예전에는 모든 의사가 진료과목에 상관없이 진료를 할 때 병력청취와 이학적 검사 후에 의심되는 질환을 확인하기 위한 목적으로 진단검사를 실시해 왔으나 지난 수십 년에 걸친 진단검사의학의 발 전으로, 이제는 일차적인 진료행위에 겸하여 기본적인 진단검사 결과가 있어야만 질환을 추정할 수 있을 정도로 그 활용이 확대되었다. 또한, 확진력이 뛰어난 검사들이 많이 개발되어 활용됨으로써 질병 진단의 정확성이 나날이 높아지고 있다. 그러므로 현재 활용 가능한 검사항목들에 대해, 검사 의의 및 검체채취 방법, 결과 활용 등을 숙지하여 효과적으로 진료에 이용해야 진료수준을 높일 수 있으나, 진료에 활용할 수 있는 검사항목이 특수검사까지 합쳐 2,000여 종이 넘고, 급격하게 발전하 는 검사기법과 새로운 진단마커들의 개발로 인해 의사들은 물론 진단검사의학 전문의조차 그 정보 에 능통하기가 쉽지 않아 불필요한 검사가 남용되거나 꼭 필요한 검사가 누락되어 질병 진단에 차질 이 오기도 한다. 임상의들이 진단검사에 대한 정보를 진료에 활용할 때 도움이 되었으면 하는 마음에서 Lab. Test Directory라는 검사정보 안내서를 1998년과 2013년에 출간한 이래, 그동안 검사항목도 늘어나고 검사기법도 다양화되었기에 새롭게 수정 보완하여 출간하게 되었다. 이 책에는 현재 수탁기관에서 수행하고 있는 검사 대부분이 포함된 최신 검사에 대한 정보가 담 겨 있으며, 각각의 검사항목을 검사 성격으로 분류한 후 찾기 쉽도록 검사명칭의 영어자모순의 찾아 보기를 뒤에 첨부하였다. 각 진단검사항목마다 기준치, 측정법, 검체량, 검사목적, 검체취급(채취, 보존)에 이어 측정치에 따라 추정할 수 있는 질환을 [예상질환], [잠재질환]으로 정리하였으며, 이에 대한 [조치]를 간략하게 설명하였다. 그리고 별도의 소제목으로 이상치를 보이게 되는 기전과 임상적 의의를 기술하고, 검사 치를 해석할 때 주의해야 할 유의사항, 치료약물로 인한 검사치의 영향에 대하여 기술하였다. 또한, 질환과 검사 항에서는 질환을 간단하게 소개하고, 검사소견, 경과관찰을 위한 검사항목과 측정빈도 및 진단 ․ 경과관찰상의 요점을 정리하였다. 책 발간에 도움을 준 Sure Quest Lab 직원들과 고려의학 최병진 사장님께 감사하며, 이 책이 임 상의들의 진료에 활용되어 조금이나마 도움이 되길 진심으로 바란다.
목 차 총 론 정상범위 ······················································································································· 3 정상범위의 생리적 변동 ································································································· 7 진단검사의 변동 요인 ··································································································· 14 입원 시의 검사 ············································································································ 20 외래진료 시의 검사 ······································································································ 21 진단검사의학의 Group 검사 ························································································· 24 수혈검사 ····················································································································· 36 진단검사 I. 질소 화합물 ······································································································ 39 Amino acid ················································································································ 39 Analysis of amino acid (tyrosine, phenylalanine) ······················································· 39 Branched chain amino acid/tyrosine molar ratio [BTR] ··············································· 41 Fischer ratio ··············································································································· 42 γ-Aminobutyric acid [GABA] ······················································································ 43 Ammonia [NH3] ·········································································································· 43 Blood urea nitrogen [BUN] ························································································· 44 Urinary urea nitrogen [UUN] ······················································································ 45 BUN/Creatinine ratio ································································································· 46 Creatine, serum ·········································································································· 46 Urinary creatine ········································································································· 47 Creatinine, serum ······································································································· 48 Urinary creatinine ······································································································ 49 Creatinine clearance [Ccr] ···························································································· 50 Inulin clearance [Cin] ·································································································· 52 - vi - Paraaminohippurate clearance [CPAH] ·········································································· 53 Sodium thiosulfate clearance [Cthio] ············································································· 53 Cystatin C [Cys-C] ······································································································· 54 Guanidino compound derivatives ·············································································· 56 Hydroxyproline [Hyp] ································································································ 56 3-Methylhistidine [3-MeHis] ························································································ 57 Uric acid [UA] ············································································································· 58 Urinary uric acid [UUA] ······························································································ 59 Urinary screening test for congenital metabolic disorder ············································ 61 II. 당질검사 ········································································································· 62 Fructose ····················································································································· 62 Galactose [Gal] ··········································································································· 62 Glucose ····················································································································· 63 Glucose tolerance test [GTT] ······················································································ 64 Glycosaminoglycan (acid mucopolysaccharides; AMPS) ············································· 66 Hyaluronic acid [HA] ·································································································· 67 Sialic acid ··················································································································· 68 Urinary myo-inositol [UMI] ························································································· 68 Xylose [Xyl] ················································································································ 69 D-Xylose absorption test ···························································································· 70 III. 지질.유기산 검사 ···························································································· 71 Apolipoprotein fraction ······························································································ 71 Bile acid, total ············································································································ 72 Urinary total sulfated bile acids ·················································································· 73 Cholesterol ester ········································································································ 74 Cholesterol, total ········································································································ 74 Cholesterol ester transfer protein [CETP] ···································································· 76 Free fatty acid [FFA] ··································································································· 76 Glycocholic acid ········································································································ 77 HDL-Cholesterol [high density lipoprotein cholesterol] ··············································· 78 LDL-Cholesterol [low density lipoprotein cholesterol] ················································· 78 Lipoprotein lipase [LPL] ······························································································ 80 Lecithin-cholesterol acyltransferase [LCAT] ································································· 80 - vii - Lipid peroxide ··········································································································· 81 Lipoprotein fraction ··································································································· 82 Lipoprotein(a) [Lp(a)] ································································································· 83 Malondialdehyde-modified low density lipoprotein [MDA-LDL] ·································· 83 Phospholipids ············································································································ 84 Remnant like particle cholesterol [RLP-C] ··································································· 85 Triglyceride [TG] ········································································································ 85 Ketone bodies ············································································································ 87 Ketone body fractionation ························································································· 88 Acetone ····················································································································· 89 Lactic acid ·················································································································· 90 Pyruvic acid ··············································································································· 91 Urinary organic acid analysis for congenital metabolic disorder ································· 91 IV. 단백 검사 ······································································································· 94 α1-Acid glycoprotein [α1-AG; AAG] ··········································································· 94 α1-Antichymotrypsin [ACT] ························································································· 94 α1-Antitrypsin [α1-AT] ································································································· 95 Acute phase reactants score [APR score] ····································································· 96 Albumin ····················································································································· 96 Albumin/Globulin ratio [A/G ratio] ············································································· 97 Ceruloplasmin ··········································································································· 97 Cryoglobulin ·············································································································· 98 Serum amyloid A protein [SAA] ·················································································· 99 Bence Jones protein [BJP] ·························································································· 99 C-reactive protein [CRP] ···························································································· 100 Type IV collagen ······································································································ 102 Type IV collagen 7S ································································································· 102 Urinary type IV collagen ·························································································· 103 Ferritin ····················································································································· 103 Fructosamine ··········································································································· 104 Glycoalbumin ·········································································································· 105 Haptoglobin [Hp] ····································································································· 106 α2-Heat stable glycoprotein [α2-HS] ··········································································· 107 Heart type fatty acid-binding protein [H-FABP] ························································· 108 Hemoglobin A1c [HbA1c] (glycated hemoglobin) ······················································· 109 - viii - Hemopexin ·············································································································· 109 Immune complex [IC] ······························································································· 110 Immunoelectrophoresis [IEP] ···················································································· 111 Immunofixation electrophoresis ··············································································· 111 Immunoglobulin A [IgA] ··························································································· 112 Immunoglobulin D [IgD] ·························································································· 113 Immunoglobulin E [IgE] ··························································································· 113 High sensitive immunoglobulin E ············································································· 114 Immunoglobulin G [IgG] ·························································································· 115 Immunoglobulin M [IgM] ·························································································· 116 Immunoglobulin free light chain κ/λ ratio ······························································· 116 α2-Macroglobulin ····································································································· 118 β2-Microglobulin [β2-mG], serum ·············································································· 118 β2-Microglobulin [β2-mG], urine ··············································································· 119 Mucoprotein (acid soluble glycoprotein) ·································································· 120 Mucoprotein fraction ································································································ 121 Myoglobin [Mb] ········································································································ 122 Pancreatitis-associated protein [PAP] ········································································ 122 Pentosidine ·············································································································· 123 Prealbumin [PA] ······································································································· 124 Surfactant protein A [SP-A] ······················································································· 124 Surfactant protein D [SP-D] ······················································································· 125 Total iron binding capacity [TIBC], Unsaturated iron binding capacity [UIBC] ··········· 126 Total protein [TP] ····································································································· 127 Serum protein fractionation ······················································································ 128 Transferrin [Tf] ········································································································· 129 Urinary transferrin ···································································································· 129 Urinary α1-microglobulin [α1-mG] ············································································· 130 Urinary liver type fatty acid binding protein [L-FABP] ··············································· 131 Urinary microalbumin ······························································································ 132 V. 효소 활성 검사 ······························································································ 133 Acid phosphatase [ACP] ··························································································· 133 Tartrate-resistant acid phosphatase 5 b ····································································· 133 Adenosine deaminase [ADA] ···················································································· 134 Adenosine diphosphate [ADP] ·················································································· 135 - ix - Adenosine triphosphate [ATP] ·················································································· 135 Alanine aminotransferase [ALT] ················································································ 137 Aldolase ··················································································································· 138 Aldolase isoenzyme ································································································· 139 Alkaline phosphatase [ALP] ······················································································ 140 Alkaline phosphatase isoenzymes ············································································ 141 Bone specific alkaline phosphatase [BAP, bs-ALP] ···················································· 143 Amylase ··················································································································· 144 Amylase isoenzyme ·································································································· 144 Pancreas type amylase ····························································································· 145 Urinary amylase ······································································································· 146 Angiotensin converting enzyme [ACE] ······································································ 148 Aspartate aminotransferase [AST] ·············································································· 148 Mitochondria-AST [m-AST] ······················································································· 150 AST/ALT ratio ·········································································································· 150 Catalase ··················································································································· 151 Cholinesterase [ChE] ································································································· 152 Creatine kinase [CK] ································································································· 153 Creatine kinase isoenzyme ······················································································· 154 Creatine kinase-MB [CK-MB] ···················································································· 155 Deoxythymidine kinase ···························································································· 156 2,3-Diphosphoglyceric acid [2,3-DPG] ······································································ 156 Elastase 1 ················································································································· 157 Glucose-6-phosphate dehydrogenase [G-6-PD] ························································ 158 Glutamate dehydrogenase [GLDH] ··········································································· 159 γ-Glutamyl transferase [γ-GT] ················································································ 159 Guanase ··················································································································· 160 Isocitrate dehydrogenase [ICDH] ·············································································· 161 Lactate dehydrogenase [LD] ······················································································ 162 Lactate dehydrogenase isoenzyme ··········································································· 163 LD isoenzyme & LD/AST ratio ·················································································· 163 Leucine aminopeptidase [LAP] ·················································································· 164 Lipase ······················································································································ 165 Monoamine oxidase [MAO] ······················································································ 165 Myosin light chain ···································································································· 166 5.-Nucleotidase ········································································································· 167 - x - Pancreatic phospholipase A2 [PLA2] ·········································································· 168 Pancreatic secretory trypsin inhibitor [PSTI] ······························································ 168 Pepsinogen I ············································································································ 169 Pepsinogen II ··········································································································· 170 Pepsinogen I/II ratio ································································································ 171 Procollagen III peptide [P-III-P] ················································································ 171 Prolyl hydroxylase [PH] ···························································································· 172 Pyruvate kinase [PK] ································································································· 172 Superoxide dismutase [SOD] ···················································································· 173 Troponin I [TnI] ······································································································· 174 Troponin T [TnT] ······································································································ 175 Trypsin (immunoreactive trypsin; IRT) ····································································· 175 Urinary N-acetyl-β-D-glucosaminidase [NAG] ·························································· 176 VI. 전해질.혈액가스.중금속 ··············································································· 178 Anion gap [AG] ········································································································ 178 Arterial carbon dioxide tension [PaCO2] ···································································· 179 Arterial oxygen tension [PaO2] ·················································································· 181 Arterial pH ··············································································································· 183 Base excess [BE] ······································································································· 184 Plasma bicarbonate concentration [HCO3 -] ······························································ 186 Calcium [Ca] ············································································································· 187 Chloride(chlorine) [Cl] ······························································································ 190 Iodine [I] ·················································································································· 192 Inorganic phosphorus [IP], Phosphorus [P] ······························································· 192 Magnesium [Mg] ······································································································· 194 Plasma osmolality [Posm] ························································································· 195 Urine osmolality [Uosm] ··························································································· 197 Potassium [K] ··········································································································· 198 Sodium [Na] ············································································································· 200 Aluminum [Al] ·········································································································· 202 Arsenic [As] ·············································································································· 203 Copper [Cu] ·············································································································· 204 Gold [Au] ················································································································· 206 Iron [Fe] ··················································································································· 207 - xi - Lead [Pb] ·················································································································· 208 Lithium [Li] ··············································································································· 209 Manganese [Mn] ······································································································· 210 Mercury [Hg] ············································································································ 211 Zinc [Zn] ·················································································································· 213 VII. 색소관련 물질 ······························································································ 216 Bilirubin, total ·········································································································· 216 Direct bilirubin ········································································································· 216 Indirect bilirubin ······································································································ 217 Direct bilirubin & indirect bilirubin ··········································································· 218 Bromosulfophthalein test [BSP test] ·········································································· 218 Indocyanine green test [ICG test] ·············································································· 218 Phenolsulfonphthalein test [PSP test] ········································································ 219 Porphobilinogen [PBG] ···························································································· 220 Porphyrin bodies and their precursors in urine Porphyrin body : [UP], [CP], [PP] Precursor : [ALA], [PBG] ··················································································· 220 VIII. 뇌하수체 호르몬 ·························································································· 223 Adrenocorticotropic hormone [ACTH] ······································································ 223 Arginine loading test ································································································ 225 Bromocriptine test ···································································································· 226 Corticotropin releasing hormone (factor) test [CRH (CRF) test] ·································· 226 Dexamethazone suppression test ············································································· 228 L-Dopa test ·············································································································· 230 β-Endorphin ············································································································ 231 Follicle stimulating hormone [FSH] ·········································································· 232 Glucagon test ··········································································································· 233 Growth hormone [GH] ····························································································· 234 Urinary growth hormone growth hormone-releasing hormone test [GH-RH test] ······ 236 Insulin loading test ··································································································· 237 Insulin-like growth factor-I [IGF-I], (Somatomedin C) ··············································· 239 Insulin-like growth factor-II [IGF-II] ·········································································· 240 Insulin-like growth factor binding protein-3 [IGFBP-3] ············································· 241 - xii - Luteinizing hormone [LH] ························································································· 242 Luteinizing hormone-releasing hormone test [LH-RH test] ········································· 243 α-Melanocyte stimulating hormone [α-MSH] ··························································· 245 Oxytocin ·················································································································· 245 Prolactin [PRL] ·········································································································· 246 Thyroid stimulating hormone [TSH] (thyrotropin) ····················································· 248 Thyrotropin-releasing hormone test [TRH test] ·························································· 250 Vasopressin [antidiuretic hormone (ADH)] ······························································· 251 IX. 갑상선 호르몬 ······························································································ 254 Anti-thyroid peroxidase antibody (anti-microsomal antibody) ·································· 254 Thyroxine [T4] ·········································································································· 255 Free thyroxine [FT4] ·································································································· 256 Thyroxine-binding globulin [TBG] ············································································ 257 Triiodothyronine [T3] ································································································ 257 Free triiodothyronine [FT3] ······················································································· 258 Reverse triiodothyronine [rT3] ··················································································· 259 Thyroglobulin [Tg] ··································································································· 260 Anti-thyroglobulin antibody [TgAb] ·········································································· 261 Thyroid stimulating antibody [TSAb] ········································································· 262 Thyroid-stimulation blocking antibody [TSBAb] ························································ 263 Thyroid stimulating hormone (thyrotropin) receptor antibody [TRAb] (TSH-binding inhibiting immunoglobulin; TBII) ·············································· 264 X. 부갑상선 호르몬 ···························································································· 265 Calcitonin ···························································
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