现代妇产科学课件：10妇产科实验诊断

Theexperimentaldiagnostictechnique

ofobstetrics&gynecology2023/4/132ClinicaldemandforexperimentAccurate,timelyPatientrequirementsfortestEconomic,convenient(POCT)InspectionpersonnelrequirementoftechnologyConvenient,goodrepeatability,fastandautomationRequirementsofthemanagersComparable,biologicalsafetyEquipmentstabilitydurability(leadership,equipmentdepartment)

DemandcontributetodevelopmentLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/133Research,manufacturing,andpromotionManufacturerLabClinicianPatientEquipmentdepartmentLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/134BecomeaccurateintheoptimizationAFP：rocketelectrophoresis

qualitativechemiluminescenceCRP：hypersensitivityTSH：HypersensitivityHBsAgqualitativesemi-quantitativeAntibody:PolyclonalmonoclonalLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/135MeaningsofmanyclinicalitemsbecomeclearLargesuspectedpulmonaryembolismordeepvenousthrombosis--thedeterminationofD-dimernegativehelpseliminatebloodclots；Suspectedheartfailure--detectionoftypeBurinesodiumpeptideorB-typenatriureticpeptide(BNP)or(NT-proBNP)contributestodifferentialdiagnosisofcardiacdyspneafromnon-cardiac.。LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/136ThenormallevelofBNPorNT-proBNPspeciallyhelpstoruleoutthediagnosisofleft

ventricular

systolic

dysfunctionSuspectedofmyocardialinjury---althoughmyoglobinisnotinhighspecificinthediagnosisofcardiacdisease,becauseofhighsensitivity,thenegativeresultscanbeusedtoearlyexcludemyocardialinjury.。MeaningsofmanyclinicalitemsbecomeclearLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/137hypersensitivityc-reactiveprotein(hsCRP)isacardiovascularbiomarkerofinflammatorylesionsProstatespecificantigen(PSA)andfreePSAasaspecificityindexinthediagnosisofprostatecancer,etclaboratorydiagnosisisaveryimportantpartofclinicaldiagnosis。MeaningsofmanyclinicalitemsbecomeclearLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/138

AimsofclinicallaboratorytaskbecomemoreprospectiveWiththedevelopmentofmedicine,people’conceptsofhealthcarehavechangedrapidlyThemajorityofpeopleseekformedicaltreatmentsonlywhentheyaresick---mainwayinthepresentMoreandmorepeoplechoosetodophysicalexaminationregularlyandtheconceptofhealthcarehasbeingstrengthened---anewwayAccordingly,applicationsofclinicallaboratorytaskhavebeenchangedLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/139

Aimsofclinicallaboratorytaskbecomemoreprospectivesupplypowerfulhelptothediagnoseandtreatmentofdiseasesandhealthcare---themaintaskofclinicallaboratoryThemaintaskoftraditionalclinicallaboratoryisbasedonthetreatmentofapatient---accessorypartofthestrategyoftreatmentstheconceptofpreventionfirstisstrengthenedandperiodicphysicalexaminationbecomethenecessarypartofhealthcare---clinicallaboratoryitemshasbeenchangedcorrespondinglyinordertomakeearlydetectionandearlytreatment2023/4/1310

AimsofclinicallaboratorytaskbecomemoreprospectiveButitemsneededtomaketherightdiagnosisortodothehealthcare,canonlyreflectthepresentstatusofapatientorthepastconditionofahealth-examinedindividualEventheearlydiagnosisisnotpredictiveLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1311

Aimsofclinicallaboratorytaskbecomemoreprospectivecongenitaldiseases---inevitableafterbirthMulti-areasdocontributionstotheprenatalscreeningandprenataldiagnosisofbirthdefect(structuralgenomics、functionalgenomics、environmentalgenomicsandproteomics)Differentlevels(cytogenetics、moleculargenetics、DNA、RNA、protein）prenataldiagnosis：neuraltubedefects,chromosomaldisease,gonadaldigenesissyndromemonogenicgeneticdisease:PKU,G6PDdificency、Wilson’disease、FragileXsyndrome、Haemophilia、、Hemoglobinopathy,ThalassemiaDMD,etcLvShimingWomen’HospitalSchoolofMedicineZhejiangUniversity2023/4/1312

AimsofclinicallaboratorytaskbecomemoreprospectiveManydiseasesarecausedbytheinteractionfunctionbetweenindividualsusceptibilityandtheenvironmentSusceptibilityisrelatedtopolygenicinheritance,moreandmoreattentionarepaidtothediagnosisofpolygenicinheritancePolygenicinheritanceisacommonandfrequently-occurringdisease,suchasmalignanttumorcardiovasculardisease(atherosclerosis、hypertensionetc.)、diabete、Nervoussystemdisease(Alzheimer’sDisease)、Psychosis(Schizophrenia)、Asthma、Autoimmunedisease(SLE、RA)、Myopia

andsoon.Thepathogenesisofthesediseasesareverycomplex,molecularbiotechnology,suchasarrayCGH,isusedtoanalysisindividualsusceptibilitytofindthecandidateswithhighrisktomaketheproperpredictionand,asaresult,tohelpdoctorstomaketherighttreatmentLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1313“Chemiluminescentmicroparticleimmunoassay”2023/4/1314microspheresforimmobilizationofbiomoleculeLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1315BroadmeasuringrangeRocheGroup2023/4/1316ExcellentlinerRocheGroup2023/4/1317AutomationinthewholelabRepeatabilityandComparableThecharacteristicsoflabdiagnosisingynecologyandobstetricsTheinspectionitemsparticularityinthefemalesexAgeandtheperiodicinfluencelabtestingPhysiologicalparticularityofthepregnancyPrenataldiagnosisofbirth

defect2023/4/1318LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityAgeandtheperiodicinfluencereproductivetractinfection:

PH、samplingpoint……Determinationofreproductivehormones2023/4/1319ThecharacteristicsoflabdiagnosisingynecologyandobstetricsLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1320LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity21Themainreproductiveendocrinehormonepituitarygonodotropinghormone：luteinizinghormone（LH）follicle-stimulatinghormone（FSH）

Sexhormone:Estrogen,progesteroneandandrogenPituitaryprolactinLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity22Thehypothalamus-pituitarygonadaxis

pituitaryhypothalamus

Gonadotropin-releasinghormoneLH,FSHfeedbackregulationsteroidhormones,

Inhibin

stimulating

gonad

SteroidhormonesTargetorganLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity23

生殖内分泌激素2006.02.20浙江大学医学院附属妇产科医院检验报告单姓名：孙茜性别：女年龄：37岁门诊号：00552465科别：妇科专家临床诊断：标本种类：血清标本编号：L062718865送检医生：流水号：2247采样时间：10.22.15：22末次月经：2005.07.15No

项目结果参考值单位1黄体生成素（LH）34.43.8-20.0中期峰值可5倍于基础值青春期前<5绝经后>25IU/L2卵泡刺激素（FSH）67.13.8-17.2中期峰值可2倍于基础值青春期前<5绝经后>40IU/L3睾酮（TTE）0.90.3-3.0nmol/L4雌二醇（E2）156.2卵泡期：92-275中期峰：734-2200黄体期：367-1100绝经后：<100pmol/L5垂体泌乳素（PRL）13.33-30ng/ml检验起始时间：2006.02.2009：04报告时间：2006.02.2013：17检验者：审核者：24

生殖内分泌激素2006.02.20浙江大学医学院附属妇产科医院检验报告单姓名：徐性别：女年龄：21岁门诊号：002472833科别：妇科专家临床诊断：标本种类：血清标本编号：L062718865送检医生：流水号：2247采样时间：02.18.15：22末次月经：2006.02.15No

项目结果参考值单位1黄体生成素（LH）1.43.8-20.0中期峰值可5倍于基础值青春期前<5绝经后>25IU/L2卵泡刺激素（FSH）2.13.8-17.2中期峰值可2倍于基础值青春期前<5绝经后>40IU/L3睾酮（TTE）0.90.3-3.0nmol/L4雌二醇（E2）56.2卵泡期：92-275中期峰：734-2200黄体期：367-1100绝经后：<100pmol/L5垂体泌乳素（PRL）13.33-30ng/ml检验起始时间：2006.02.2009：04报告时间：2006.02.2013：17检验者：审核者：25

生殖内分泌激素2006.02.20浙江大学医学院附属妇产科医院检验报告单姓名：张三性别：女年龄：51岁门诊号：00001049科别：妇科专家临床诊断：标本种类：血清标本编号：L062718865送检医生：流水号：2247采样时间：02.19.15：22末次月经：2005.12.15No

项目结果参考值单位1黄体生成素（LH）54.43.8-20.0中期峰值可5倍于基础值青春期前<5绝经后>25IU/L2卵泡刺激素（FSH）58.13.8-17.2中期峰值可2倍于基础值青春期前<5绝经后>40IU/L3睾酮（TTE）0.90.3-3.0nmol/L4雌二醇（E2）112.2卵泡期：92-275中期峰：734-2200黄体期：367-1100绝经后：<100pmol/L5孕酮（P）0.9卵泡期：0.3-4.8黄体期：8-89.0绝经后：<2.2nmol/L6垂体泌乳素（PRL）13.33-30ng/ml检验起始时间：2006.02.2009：04报告时间：2006.02.2013：17检验者：审核者：26

生殖内分泌激素2006.02.20浙江大学医学院附属妇产科医院检验报告单姓名：孙茜性别：女年龄：37岁门诊号：00552465科别：妇科专家临床诊断：标本种类：血清标本编号：L062718865送检医生：流水号：2247采样时间：10.22.15：22末次月经：2005.07.15No

项目结果参考值单位1黄体生成素（LH）34.43.8-20.0中期峰值可5倍于基础值青春期前<5绝经后>25IU/L2卵泡刺激素（FSH）67.13.8-17.2中期峰值可2倍于基础值青春期前<5绝经后>40IU/L3睾酮（TTE）0.90.3-3.0nmol/L4雌二醇（E2）156.2卵泡期：92-275中期峰：734-2200黄体期：367-1100绝经后：<100pmol/L5垂体泌乳素（PRL）13.33-30ng/ml检验起始时间：2006.02.2009：04报告时间：2006.02.2013：17检验者：审核者：27

生殖内分泌激素2006.07.19浙江大学医学院附属妇产科医院检验报告单姓名：吴兰姣性别：女年龄：37岁门诊号：03261049科别：妇科专家临床诊断：标本种类：血清标本编号：L060718865送检医生：流水号：2247采样时间：07.18.15：22备注：No

项目结果参考值单位1黄体生成素（LH）50.43.8-20.0中期峰值可5倍于基础值青春期前<5绝经后>25IU/L2卵泡刺激素（FSH）109.93.8-17.2中期峰值可2倍于基础值青春期前<5绝经后>40IU/L3睾酮（TTE）0.90.3-3.0nmol/L4雌二醇（E2）52.2卵泡期：92-275中期峰：734-2200黄体期：367-1100绝经后：<100pmol/L5孕酮（P）2.9卵泡期：0.3-4.8黄体期：8-89.0绝经后：<2.2nmol/L6垂体泌乳素（PRL）13.33-30ng/ml检验起始时间：2006.07.1909：04报告时间：2006.07.1913：17检验者：审核者：28ClinicaldataarenecessaryTheexactageThelastmenstrualperiodSamplingtimeClinicaldiagnosisThetraitsofbloodspecimenSpecialnote:choosesamplingtimeaccordingtotheneedofillnessLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityPhysiologicalparticularityofthepregnancyBloodroutineexaminationcoagulationmarkersThyroidfunctionSugarmetabolismindicators2023/4/1329ThecharacteristicsoflabdiagnosisingynecologyandobstetricsLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityFetalthyroidglanddevelopmentAftergestationalage10~12weeksPituitary-thyroidaxisbegantofunctionBegantosynthesizethyroidhormonesTSH,T4,TBGcanbedetectedinthefetusserumFetal,FT4,FT3,TBGgraduallyriseEnrichmentofiodineinfetalsideofplacenta,fetalthyroidenrichediodinemorethanmaternalRadioactiveiodineorlargeconventionaliodinearebadtothefetusBefore36weeksagofetalpituitaryisnotsensitivetonegativefeedback.LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityMotherthyroidfunctionandpregnancyThyroiddiseasearecommoninchildbearingagewomenTheincidenceofhyperthyroidism,hypothyroidism,thyroiditisare1%respectivelyAutoimmunethyroiddiseaseswillrelieveinpregnancyandaggravatepostpartumItisimportanttoreasonableiodineintakeduringpregnancyLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityFetaldevelopmentarecloselyrelatedtomaternalthyroidfunctionFetaldevelopmentrelyonmaternalT4,especiallyinfirsttrimesterThedrugsthateffectofmaternalthyroidfunctioncanalsoaffectfetalthyroidThyroidautoantibodiescanincreasetherateofabortioninfirsttrimesterUncontrolledhyperthyroidism/hypothyroidismisassociatedwithadversepregnancyoutcomesMotherthyroidfunctionandpregnancyLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityThetestsrelatedtobirthdefectcontrolPrenatalscreeningofDownsyndromeNeuraltubedefectsscreeningThetestsofinfectiousdiseasesinvolvingthefetus2023/4/1333Thecharacteristicsoflabdiagnosisingynecologyandobstetrics2023/4/1334ThediseasecanbescanedprenatalandafterbirthAfterbirth:Phenylketonuria(PKU)

CongenitalhypothyroidPrenatal:Downsyndrome

(Mongolism,21-trisomysyndrome)

)

Edwardsyndrome

(18-trisomysyndrome)Neuraltubedefects(NTD):

(AnNTDisanopeninginthespinal)LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity35染色体与染色体病23对（46条）染色体3万基因30亿对碱基基因chromosome36Chromosome&ChromosomaldiseaseNumericalandstructuralchromosomalabnormalitiesLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1337Downsyndromebrachycephalyshortneckepicanthicfoldsonthemedialaspectoftheeyesaninwarddown-mongoloid-slanttotheeyesBrushfieldspotsontheirisalmondshapedeyessmallsimpleears,whichmaybelowsetflatnasalbridgeprotrudingtongue,mouthhangingopennarrowhigharchedpalateLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1338LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1339Maternalserumbiochemicalmarkeralpha-fetoprotein

（AFP）hCG、beta-hCG（Freebeta-hCG）UnconjugatedE3（

uE3）PregnantAssociated

PlasmaProteinA（PAPP-A）InhibinAPlacentalisoferrintin

（P43）,beta-corehCGLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1340Calculationofthechangeofmaternalserumbiochemicalmarkerscan

Thevalue“MoM”beusedin

LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1341LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1342SelectionofbiochemicalmarkerAFP+Freebeta-hCG（62.3~64.1%）AFP+Freebeta-hCG+uE3（65.6~67.3%）AFP+Freebeta-hCG+uE3+InhibinA（72.0~73.4%）AFP+Freebeta-hCG+PAPP-A（73.7%）Freebeta-hCG+PAPP-A（69.1%）LuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityThetestsrelatedtobirthdefectcontrolPrenatalscreeningofDownsyndromeNeuraltubedefectsscreeningThetestsofinfectiousdiseasesinvolvingthefetus2023/4/1343ThecharacteristicsoflabdiagnosisingynecologyandobstetricsLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversityThetestsrelatedtobirthdefectcontrolPrenatalscreeningofDownsyndromeNeuraltubedefectsscreeningThetestsofinfectiousdiseasesinvolvingthefetus2023/4/1344ThecharacteristicsoflabdiagnosisingynecologyandobstetricsLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity2023/4/1345TORCHT（To）：Toxoplasma，TOXOO：Others：R：Rubellavirus，RVC：cytomegalovirus,CMVH：Herpessimplexvirus，HSVLuShiming

Women’HospitalSchoolofMedicineZhejiangUniversity461stepassayImmunocapture+CoatedmicroparticulesSamplewithspecificandnonspecificIgMToxoplasmamembranantigens-alkalinephosphataseconjugateWash3timesAddsubstrateIncubate5minutesDioxetaneDioxetane-PLight+SignalproducedisproportionaltotheantiT.gondiiIgMconcentrationinthesamplePolyclonalanti-humanIgMIncubation37°C20minutesLUMIPHOSPPPPPPPPPPPPP47QuestionsinoutpatientservicearemorethanhereditaryproblemsDrugtakeninthefirsttrimesterofpregnancyWhenshoulddothetype-Bultrasonicduringpregnancy?Ifitisharmf