关于胆红素升高的实验室检测与临床

Detection of bilirubin： from laboratory to clinical practice

黄疸即胆红素异常升高在临床上很常见。目前医院检测胆红素通常测定血中的总胆红素和直接胆红素，而以总胆红素减去直接胆红素得到间接胆红素的数值。直接胆红素主要反映结合胆红素，但二者并不完全等同。与此类似，间接胆红素主要反映非结合胆红素。在临床上，对黄疸的诊断和鉴别诊断，直接胆红素（或间接胆红素）占总胆红素的比例较之胆红素升高的幅度更有意义。通过分析直接或间接胆红素的比例，往往可以对黄疸的原因做出大致的诊断和鉴别诊断。但目前各家医院检测胆红素的方法和水平差别较大，不同疾病状态下所测出的直接或间接胆红素的比例也大不相同，给黄疸的临床诊断和鉴别诊断带来很大困惑。建议医院临检部门加强对胆红素检测的质控工作，在严格质控的基础上，适当调整各种疾病状态下胆红素的比例使之符合临床实际情况，并长期稳定。如此将对黄疸的临床诊断工作起到至关重要的作用。

Jaundice （abnormal elevation of bilirubin ） is common in clinical practice. At present bilirubin is detected by measuring total bilirubin （TB） and direct bilirubin （DB） in hospital. Indirect bilirubin （IB） is the difference of TB and DB. Direct bilirubin reflects mainly the conjugated bilirubin but they are not all equivalent. Indirect bilirubin and unconjugated bilirubin are the same condition. In clinical practice, the proportion of DB （or IB ） in TB is more significant than their level of elevation. The cause of jaundice could be roughly determined by analyzing the proportion of DB （or IB） in TB. The methodology and quality of bilirubin detection are quite different in hospitals in our country. The proportion of DB and IB in TB in detection of bilirubin is also quite different in hospitals. It leads to a big puzzle to the diagnosis and differential diagnosis of jaundice for clinical doctors. It is suggested that the quality control of bilirubin detection should be strengthened in laboratory in hospital. On the bases of strict quality control of bilirubin detection, proper adjustment of the proportion of DB and IB as to make it consisting with clinical practice and pathogenesis of diseases, and making the proportion stable for long time are also suggested.