Transcript Tanamedrove laboratoriuli teqnologiebi

simsivnesTan asocirebuli serologiuri markerebi
Tbilisi
2014
კლინიკო-დიაგნოსტიკური
ლაბორატორია
• laboratoria amkvidrebs profesiuli saqmianobis umaRles standartebs da moqmedebs mxolod pacientis
interesebis Sesabamisad.
• aRWurvilia uaxlesi mRalteqnologiuri diagnostikuri aparaturiT
• laboratoriaSi muSaoben maRali kvalifikaciis specialistebi, maT Soris mecnierebaTa akademuri doqtorebi
•
laboratoriaSi sruldeba sxvadasxva tipis uzustesi hematologiuri, koagulaciuri, bioqimiuri, imunologiuri
kvlevebi
შესრულებული სამუშაო
25315
30000
პაციენტის რაოდენობა
კვლევების რაოდენობა
კარდიო. პაციენტი
25000
20000
15000
7134
10000
505
5000
0
2013
laboratoriaSi xorcieldeba Semdegi imunologiuri gamokvlevebi:
• farisebri jirkvlis hormonebi: T3, T4, FT3,
FT4, TSH, Anti-TG, Anti-TPO
• sasqeso hormonebi: PRL, E2, LH, FSH,
TESTO, FTESTO, PROG, 17-OHPROG, DHEA-S
• onko-markerebi: CEA, CA-125, CA-153, CA-19-9, PSA, FPSA, AFP, HCG,
BAP, SCC, S100, HE4, ROMA
• infeqciuri daavadebebi: HBsAg, HCV, HIV
• HSV IgG/IgM; CMV IgG/IgM;
TOXO IgG/IgM; Chlam Tr. IgG/IgM
• sxvadasxva: Insulin, C-Peptide,
Cortisol da a.S.
garda imisa, rom laboratoriaSi yoveldRiurad xorcieldeba Sida laboratoriuli xarisxis kontroli, igi
CarTulia gare xarisxis kontrolis saerTaSoriso programaSi – RIQAS (External Quality
Assessment (EQA) Program) Randox, UK, romlis axali cikli iwyeba 2013 wlis
ianvridan
laboratoria gaerTianebulia 3 programaSi:
Monthly Immunology programme
Monthly Coagulation programme
Monthly Clinical Chemistry programme
laboratoria registrirebulia kompaniis saitze, yovelTviurad igzavneba Sedegebi internetiT da
ramdenime dReSi miviRebT statistikurad damuSavebul Sedegebs.
simsivnesTan asocirebuli serologiuri markerebi
markerebi – nivTierebebia, romelTa koncentracia matulobs sxvadasxva biologiur siTxeebSi
(sisxli, Sardi, kistis SigTavsi, ascituri siTxe da a.S.) onkologiuri daavadebebis mqone
pacientebSi.
simsivnesTan asocirebuli serologiuri markerebi
om-s diagnostikuri Rirebuleba ganisazRvreba maTi specifiurobiTa da mgrZnobelobiT.
• mgrZnobeloba – onkologiur pacientebSi realurad dadebiTi Sedegis sixSire, gamosaxuli procentSi.
• specifiuroba – janmrTel da keaTilTvisebiani daavadebebis mqone adamianebSi realurad uaryofiTi Sedegis
sixSire, gamosaxuli procentSi.
• om iTvleba idealurad, Tu misi specifiuroba da mgrZnobeloba Seadgenas 100%.
klasifikacia
• lokalizaciis mixedviT - specifiuroba da informatiuloba
• biologiuri – qimiuri struqtura, ujreduli funqcia, embriogenezi
• simsivnesTan asocirebuli glikoproteinebi (CA-125, CA-19-9, CA-15-3, CA72-4, CA-242 da a.S.)
• fermentebi (PSA, NSE)
• citokinebi (IL-6, IL-10, EGF (epidermaluri zrdis faqtori)
• mwvave fazis cilebi (feritini, CRP)
sxvadasxva lokaciis SedarebiT informatiuli om
karcinomis lokalizacia
rekomendirebuli om
sarZeve jirkvlis simsivne
CA-15-3, CEA, CA-72-4, PRL, E2
sakvercxis simsivne:
epiTelaruli
herminogenuli
granulomatozuri
CA-125, CA-72-4, CA-19-9
HCG/βHCG, AFP
E2, Inhibin-B
saTesle jirkvlis simsivne
HCG/βHCG, AFP, LDH
saSvilosnos yelis simsivne
SCC, CEA
vulvis simsivne
SCC
endometriumis simsivne
CA-125, CA-72-4, CA-19-9, CEA
kuWnawlavis traqtis simsivne
CA-72-4, CEA, CA-19-9
koloreqtaluri simsivne
CEA, CA-19-9, CA-72-4
kuWqveSa jirkvlis simsivne
CA-19-9, CA-242
sxvadasxva lokaciis SedarebiT informatiuli om
karcinomis lokalizacia
rekomendirebuli om
Sardis buStis simsivne
UBC, CYFRA-21-1, SCC
Tirkmlis simsivne
Tu M2-PK, SCC, CA-125
winamdebare jirkvlis simsivne
PSA, FPSA/PSA
filtvis simsivne:
wvrilujredovani
brtyelujredovani
adenokarcinoma
msxvilujredovani
NSE, CEA, ProGRP
CYFRA-21-1, SCC
CEA, CA-72-4, CA-125
CUFRA-21-1, SCC, CEA
farisebri jirkvlis simsivne:
folikularuli, papilaruli
medularuli
TG, TSH
Calcitonin, CEA
metastazebi Zvlovan qsovilSi
Ostease(BAP), TRAP-5b
melanoma
S-100
Tavis da kisris simsivneebi
CYFRA-21-1, SCC
serologiuri onkomarkeri CA-125
•
CA-125 - maRalmolekuluri mucinis glikoproteinuri epitopia, romelic miekuTvneba onkofetaluri cilebis klass
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normis farglebi janmrTeli qalebisaTvis: < 35 U/ml
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mis momatebas ganapirobebs avTvisebiani axalwarmonaqmnebi: sakvercxis, sarZeve jirkvlis, endometriozis simsivne,
filtvis adenokarcinoma, kuWqveSa jirkvlis, hepatocelularulisimsivne, metastazi RviZlSi.
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serozuli tipis sakvercxis simsivnis dros CA-125-isdiagnostikuri mgrZnobeloba varirebs 42% -dan (I-II stadia)
99%-mde (IV stadia)
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CA-125-is mgrZnobeloba sisxlSi sakvercxis serozuli tipis kibos recidivis dros aRemateba 90%-s.
serologiuri onkomarkeri HE4
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HE4 miekuTvneba proteinazebis inhibitors
•
mJava glikoproteinia oTxi disupfiduri bmiT da 25 kdaltoni masiT
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HE4 eqspresirdeba reproduqtiuli organoebis, zeda sasunTqi gzebis da kuWqveSa jirkvlis normalur epiTelSi. cilis
momatebuli warmoqmna ZiriTadad gamovlenilia sakvercxisa da endometriumis simsivnis, iSviaTad filtvis
adenokarcinomis gavrcelebuli formis dros.
•
kvlevebma aCvenes, rom ori markeris HE4 da CA-125 erToblivi gansazRvra mniSvnelovnad zrdis maT
diagnostikur Rirebulebas sakvercxis simsivnis aRmoCenis adreul stadiaze da mcire menjis avTvisebiani da
keTilTvisebiani warmonaqmnebis diferencialur diagnostikaSi.
serologiuri onkomarkeri HE4
• HE4 da CA-125 –is kombinirebuli gansazRvra mniSvnelovnad zustad gansazRvravs avTvisebiani
warmonaqmnis arsebobas, vidre nebismieri sxva markeri calke aRebuli an romelime sxva markerTan
kombinaciaSi
• mecnierebis mier SemuSavebulia sakvercxis avTvisebiani simsivnis ganviTarebis gansazRvris algoriTmi –
Risk of Ovarian Malignancy Algorithm – ROMA – post- da premenopauzis
mqone qalebSi sakvercxis epiTeluri simsivnis ganviTarebis riskis Sesafaseblad.
• algoriTmi iTvaliswinebs HE4 da CA-125 –is koncentraciis gansazRvras sisxlSi, aseve pacientis
menopauzis statuss. is saSualebas iZleva gaiTvalos sakvercxis epiTeluri simsivnis aRmoCenis albaToba.
sakvercxis simsivne
sakvercxis simsivnis dReisaTvis SedarebiT Seswavlili serologiuri om
markeri
gamoyenebis sfero
CA-125
diferencirebuli diagnostika, monitoringi, prognozi
osteopontini
diagnostika, monitoringi
CEA
monitoringi
SMRP /mezoTelini/
diagnostika, monitoringi, prognozi
HE4
diagnostika, monitoringi, prognozi
inhibin B
kalikreinebi
diagnostika, monitoringi
PAI-1
prognozi
IL-6
prognozi
HCG
prognozi
IGFBP-2
prognozi
monitoringi, prognozi
individualuri da kombinirebuli simsivnuri markerebis mgrZnobeloba 90%-iani specifiurobis dros
markeri
yvela stadia
I stadia
II-IV stadia
CA-125
34.6%
30.0%
46.7%
HE4
55.0%
48.4%
71.4%
CA-72-4
10.2%
7.6%
17.6%
CA-125+HE4
57.3%
51.6%
73.0%
siaxle! pirvelad saqarTveloSi Tbilisis onkologiuri dispanseris laboratoriaSi sruldeba
sakvercxis avTvisebianobis riskis algoriTmis (ROMA) gamoTvla
•
•
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ROMA – Risk of Ovarian Malignancy
Algorithm – gamoiyeneba pre- da postnopauzis
mqone qalebSi sakvercxis epiTeluri sim-sivnis
ganviTarebis riskis Sesafaseblad
algoriTmi saSualebas iZleva ganisazRvros sakvercxis
epiTeluri simsivnis avTvise-bianobis xarisxi
kvleva
sruldeba
kompania
“Fujirebio
Diagnostics, Inc” (Sweden) – warmoebuli
umaRlesi xarisxis test-sistemebiT
•
•
•
•
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TiToeul pacients utardeba ori kvleva: CA-125 da
HE4
miRebuli Sedegebi muSavdeba specialuri programis
saSualebiT
algoriTmi iTvaliswinebs CA-125 da HE4-is
koncentracias sisxlSi, aseve pacientis meno-pauzis
statuss
premenopauza:
dabali riski <13
maRali riski >13
postmenopauza:
dabali riski <28
maRali riski >28
markerebis kvleva da masalis aReba
• om-s Semcvelobas sisxlSi gansazRvraven radioimunuri, imunofermentuli da
qemiluminescentuli meTodebiT.
• zusti Sedegebis misaRebad Zalian didi mniSvneloba aqvs sakvlevi masalis sworad
aRebas da Senaxvas.
• ZiriTadi sakvlevi masalaa Srati, romelic miiReba uzmod aRebuli venuri sisxlidan.
hemolizuri nimuSebis saanalizod gamoyeneba araa rekomendirebuli.
sisxlis Segroveba saanalizod
1. SearCieT sisxlis asaRebi adgili
2. moamzadeT yvela saWiro nivTi da gaikeTeT
xelTaTmani
3. daawereT sinjaras pacientis saidentifikacio nomeri (Tu
aseTi arsebobs) an saxeli da gvari
4. moargeT pacients Jguti
sisxlis Segroveba saanalizod
5. daamuSaveT spirtiT sisxlis aRebis adgili
6. daafiqsireT kani da dabalkuTxiani daxriT SeiyvaneT nemsi venaSi
7. aiReT sisxli sinjaraSi e.w. Clot Activator (Sratis misaRebad)
8. Jguti unda moixsnas rogorc ki sisxlis nakadi wamova sinjaraSi
9. gamoiReT nemsi venidan da daaWireT punqciis adgilas
10. SeamowmeT punqciis adgili daakariT leikoplastiri
11. gamoyenebuli nemsi gadaagdeT
sisxlis Segroveba saanalizod
12. aRebuli sisxli nazad gadaatrialeT 5-6-jer sisxlis da Sededebis
aqtivatoris SerevisaTvis
13. moixseniT xelTaTmanebi da daibaneT xelebi
14. sinjarebi moaTavseT StativSi vertikalur poziciaSi da daayovneT
oTaxis temperaturaze minimum 30wT
sisxlis Segroveba saanalizod
15. Sratis gamosayofad sinjarebi daacentrifugeT 10 wT 1300g oTaxis
temperaturis pirobebSi. Tu ar moxda Sratis srulad gamoyofa, saWiroa
kidev damatebiT dacentrifugeba 6-8wT
16. analizisaTvis Srati unda gadatanil iqnas pasteris pipetiT an
avtomaturi pipetiT 1.5-2ml-ian ependorfSi da SevinaxoT macivarSi
(4-8C). SeniSvna: yoveli nimuSisaTvis unda gamoviyenoT axali
pipeti an pipetis wveri
sisxlis Segroveba saanalizod
• transportireba:
 yvela nimuSi misi aRebisa da momzadebis Semdeg unda gadavagzavnoT
Tbilisis onkologiuri dispanseris laboratoriaSi.
 yvela sinjs Tan unda axldes Sesabamisi ganacxadi, sadac aRniSnuli
iqneba masalis aRebis TariRi, pacientis saxeli, gvari, asaki da menopauzis
statusi. aseve masalis gamogzavnis TariRi. M
 masala transportirdeba samedicino sinjebis transportirebisaTvis
gankuTvnili specialuri TermoCanTebiT (2-8C)
 TiToeuli sinji mowmdeba da dadasturdeba laboratoriaSi miRebisTanave.
saTanado identifikaciis armqone pirveladi sinjebi laboratoriis mier ar miiReba
da Sesabamisad ar damuSavdeba!
Sedegad, andeT Tqveni janmrTeloba pacientis da
mis ukan mdgomi ojaxis winaSe udidesi
pasuxismgeblobis mqone profesionalebs!
didi madloba!