LABORATORY DIAGNOSIS OF MYOCARDIAL INFARCTION：心肌梗死的实验室诊断.ppt

LABORATORY EVALUATION OF THEROSCLEROSIS AND ACUTE CORONARY SYNDROME CORONARY HEART DISEASE CORONARY ARTERY OBSTRUCTION MAIN COMPONENTS OFVASCULAR WALL INTIMAL THICKENING MAJOR COMPONENETS OF ATHEROMATOUS PLAQUE PATHOGENESIS OF ATHERSCLEROSIS CELLULAR EVENTS CELLULAR INTERACTIONS RISK FACTORS FOR CHD Clinical Risk Factors Laboratory Risk Factors CLINICAL RISK FACTORS LABORATORY RISK FACTORS Common Lipid Markers Including TC, HDL-C, LDL-C TG Uncommon Lipid Markers Including Lp(a), beta-VLDL, Apo A-I Apo B-100 Nonlipid Markers Including Homocysteine hsCRP SOURCES OF RESULT VARIABILITY IN LIPID MEASURMENT Analytical Error Physiologic Variation Fasting Diseases Drugs Posture Venous vs. Capilary Samples Plasma vs. Serum Storage ANALYTICAL ERROR %Total Error = % Bias + 1.96 (%CV) BIOLOGICAL VARIATIONS Due to Age, Gender, Diet, Season FASTING Fasting for at Least 9 Hours Is Necessary for TG Fasting Is Not Necessary for TC Slight Decrease of LDL-C HDL-C After Eating DIEASES Myocardial Infarction Shock Trauma Surgery Weight lose Fever Thyroid Disease Liver Disease Kidney Disease DRUGS Oral Contraceptive Increases VLDL Anabolic steroids Increase VLDL Decrease HDL POSTURE OCCLUSION TG, TC Lipoproteins Increase in Standing Position Prolonged Venous Occlusion Has Similar Effect Venous vs. Capilary Measurements in Capilary Blood Sample Seem to Be a Little Lower Than Venous Sample PLASMA vs SERUM Serum Plasma Can be Used Plasma Is Preferred for Electrophoresis Ultracentrifugation EDTA Is Preferred, But the Results Are Lower Heparin Can Also Be Used Protein Aggregation Occurs In Plasma STORAGE It Is Recommended to Analyze at Day of Sample Collection Samples Can Be Stored in Refrigerator or Freezer ANALYTICAL APPROACHIN LIPIDS ABNORMALITIES 1) LIPIDS DETERMINATIONS 2) LIPO