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simsivnesTan asocirebuli serologiuri markerebi

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Presentation on theme: "simsivnesTan asocirebuli serologiuri markerebi"— Presentation transcript:

1 simsivnesTan asocirebuli serologiuri markerebi
Tbilisi 2014

2 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

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4 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-OH-PROG, DHEA-S onko-markerebi: CEA, CA-125, CA-15-3, 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.

5 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.

6 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.

7 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%.

8 klasifikacia lokalizaciis mixedviT - specifiuroba da informatiuloba
biologiuri – qimiuri struqtura, ujreduli funqcia, embriogenezi simsivnesTan asocirebuli glikoproteinebi (CA-125, CA-19-9, CA-15-3, CA-72-4, CA-242 da a.S.) fermentebi (PSA, NSE) citokinebi (IL-6, IL-10, EGF (epidermaluri zrdis faqtori) mwvave fazis cilebi (feritini, CRP)

9 karcinomis lokalizacia
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

10 karcinomis lokalizacia
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

11 serologiuri onkomarkeri CA-125
CA maRalmolekuluri mucinis glikoproteinuri epitopia, romelic miekuTvneba onkofetaluri cilebis klass normis farglebi janmrTeli qalebisaTvis: < 35 U/ml mis momatebas ganapirobebs avTvisebiani axalwarmonaqmnebi: sakvercxis, sarZeve jirkvlis, endometriozis simsivne, filtvis adenokarcinoma, kuWqveSa jirkvlis, hepatocelularulisimsivne, metastazi RviZlSi. serozuli tipis sakvercxis simsivnis dros CA-125-isdiagnostikuri mgrZnobeloba varirebs 42% -dan (I-II stadia) 99%-mde (IV stadia) CA-125-is mgrZnobeloba sisxlSi sakvercxis serozuli tipis kibos recidivis dros aRemateba 90%-s.

12 serologiuri onkomarkeri HE4
HE4 miekuTvneba proteinazebis inhibitors mJava glikoproteinia oTxi disupfiduri bmiT da 25 kdaltoni masiT 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.

13 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.

14 sakvercxis simsivnis dReisaTvis SedarebiT Seswavlili serologiuri om
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 inhibin B kalikreinebi monitoringi, prognozi PAI-1 prognozi IL-6 HCG IGFBP-2

15 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%

16 siaxle! pirvelad saqarTveloSi Tbilisis onkologiuri dispanseris laboratoriaSi sruldeba sakvercxis avTvisebianobis riskis algoriTmis (ROMA) gamoTvla 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 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

17 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.

18 SearCieT sisxlis asaRebi adgili
sisxlis Segroveba saanalizod SearCieT sisxlis asaRebi adgili moamzadeT yvela saWiro nivTi da gaikeTeT xelTaTmani daawereT sinjaras pacientis saidentifikacio nomeri (Tu aseTi arsebobs) an saxeli da gvari moargeT pacients Jguti

19 daamuSaveT spirtiT sisxlis aRebis adgili
sisxlis Segroveba saanalizod daamuSaveT spirtiT sisxlis aRebis adgili daafiqsireT kani da dabalkuTxiani daxriT SeiyvaneT nemsi venaSi aiReT sisxli sinjaraSi e.w. Clot Activator (Sratis misaRebad) Jguti unda moixsnas rogorc ki sisxlis nakadi wamova sinjaraSi gamoiReT nemsi venidan da daaWireT punqciis adgilas SeamowmeT punqciis adgili daakariT leikoplastiri gamoyenebuli nemsi gadaagdeT

20 moixseniT xelTaTmanebi da daibaneT xelebi
sisxlis Segroveba saanalizod aRebuli sisxli nazad gadaatrialeT 5-6-jer sisxlis da Sededebis aqtivatoris SerevisaTvis moixseniT xelTaTmanebi da daibaneT xelebi sinjarebi moaTavseT StativSi vertikalur poziciaSi da daayovneT oTaxis temperaturaze minimum 30wT

21 sisxlis Segroveba saanalizod
Sratis gamosayofad sinjarebi daacentrifugeT 10 wT 1300g oTaxis temperaturis pirobebSi. Tu ar moxda Sratis srulad gamoyofa, saWiroa kidev damatebiT dacentrifugeba 6-8wT analizisaTvis Srati unda gadatanil iqnas pasteris pipetiT an avtomaturi pipetiT ml-ian ependorfSi da SevinaxoT macivarSi (4-8C). SeniSvna: yoveli nimuSisaTvis unda gamoviyenoT axali pipeti an pipetis wveri

22 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!

23 Sedegad, andeT Tqveni janmrTeloba pacientis da mis ukan mdgomi ojaxis winaSe udidesi pasuxismgeblobis mqone profesionalebs!

24 didi madloba!


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