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جمعه 15 مرداد 1395 :: نویسنده : navid akbari
تست پروتئین بنس جونز
Bence-Jones Protein Test
تست پروتئین بنس جونز (BJP) سطح این پروتئین را در ادرار اندازه گیری می کند. این پروتئین در ادرار افراد سالم یافت نمی شود. پروتئین بنس جونز بخشی از آنتی بادی است که زنجیره ی سبک نامیده می شود. برخی اوقات بدن به میزان زیادی آنتی بادی می سازد که در این صورت سطح زنجیره های سبک افزایش می یابد. وجود این پروتئین در ادرار معمولاً نشانه ی مولتیپل میلوما (multiple myeloma) می باشد. مولتیپل میلوما نوعی از سرطان مغز استخوان (Bone Marrow Cancer) هست. پروتئین بنس جونز از نام هنری بنس جونز (Henry Bence-Jones) گرفته شده است. وی کاشف این پروتئین در سال ۱۸۴۷ است.
تست بنس جونز برای چه مواردی استفاده می شود؟
مغز استخوان در مرکز یک استخوان بزرگتر هست. وظیفه ی مغز استخوان ساخت گلبول های قرمز و سفید و نیز پلاکت می باشد. مولتیپل میلوما بیماری هست که در آن یک نوع از گلبول های سفید به صورت بیش از حد ساخته می شود.
گلبول های سفید نرمال خون، سازنده ی انواع مختلفی از آنتی بادی ها هستند. آن ها نقش مهمی را در سیستم ایمنی بدن ایفا می کنند. اگرچه، در افراد مبتلا به مولتیپل میلوما وضعیت فرق می کند. در این حالت، رشد یکی از سازنده های گلبول سفید، از کنترل خارج شده و باعث می شود فقط یک نوع آنتی بادی تولید شود. بدتر از آن، این سلول ها باعث می شوند سلول های طبیعی نیز عملکرد خود را از دست دهند. با این کار بدن برای ابتلا به انواع بیماری ها آماده می شود.
مولتیپل میلوما در بیماران بالای ۶۰ سال شایع است. بیماران ممکن است سال ها علائم بیماری را نشان ندهند. زمانی که علائم بیماری ظاهر می شود، ممکن است در نگاه اول با بیماری های دیگر اشتباه گرفته شود. بنابراین، برای تشخیص مولتیپل میلوما باید تست هایی انجام شود. یکی از این تست ها، تست پروتئین بنس جونز می باشد.
علائم بیماری مولتیپل میلوما :
علائم مالتیپل میلوما به سبب رشد بیش از حد گلبول های سفید خون می باشد. زیرا سلول های میلوما کنترل استخوان ها را از داخل به خارج در دست گرفته و به احتمال زیاد باعث شکستگی استخوان ها می شوند. اگر فرد در حین انجام کار روزانه دچار شکستگی استخوان شود، پزشک ممکن است مشکوک به مولتیپل میلوما گردد. علائم دیگر شامل :
  • مشکلات کلیوی، به خاطر افزایش ساخت آنتی بادی
  • آنمی، که باعث خستگی یا ضعف می شود
  • پاهای ورم کرده یا ضعیف
  • درد در دنده ها و یا پشت
  • فشار به اعصاب و نخاع، به خاطر شکستگی استخوان
  • تشنگی بیش از حد
  • دهیدراتاسیون و کم آبی بدن
  • تکرر ادرار و یبوست (در اثر تجزیه و شکسته شدن استخوان و آزاد سازی کلسیم در خون)
  • احساس گیجی
  • عفونت های مکرر
  • خونریزی بیش از حد، حتی در موارد زخم های جزئی
وجود چنین علائمی در فرد باعث می شود که پزشک درخواست تست پروتئین بنس جونز نماید.
روش های تشخیص پروتئین بنس جونز در ادرار :
روش های تشخیص پروتئین بنس جونز در ادرار شامل الکتروفورز پروتئین (protein electrophoresis)، الکتروفورز ایمونوفیکساسیون (immunofixation electrophoresis) و ایمونواسی برای زنجیره ی سبک آزاد می باشد. پروتئین بنس جونز در دمای بین ۴۰ تا ۶۰ درجه ی سانتی گراد رسوب می کند و دوباره در دمای نزدیک ۱۰۰ درجه محلول می شود. زمانی که میزان کمی از پروتئین بنس جونز در ادرار وجود داشته باشد و یا گلبولین های دیگری نیز وجود داشته باشند، نتایج تست ممکن است درست نباشد. در روش رسوب گرمایی واکنش مثبت کاذب زمانی دیده می شود که گلبولین های دیگری توسط استیک اسید رسوب کرده باشند. واکنش منفی کاذب زمانی رخ می دهد که غلظت پروتئین بنس جونز به قدری زیاد باشد که رسوب، در حرارت نتواند دوباره محلول شود.
نتایج تست پروتئین بنس جونز :
به صورت نرمال و طبیعی پروتئین بنس جونز در ادرار یافت نمی شود. اگر نتیجه ی تست مثبت شد، احتمالاً شخص مبتلا به مولتیپل میلوما می باشد. همچنین در انواع دیگری از سرطان ها هم نتیجه ی تست مثبت است.
نتایج غیر طبیعی می تواند به دلایل زیر باشد :
  • آمیلوئیدوز (Amyloidosis)
  • لوسمی مزمن لنفوئیدی (Chronic lymphocytic leukemia)
  • سرطان دستگاه لنفاوی یا لنفوم (Lymph system cancer or lymphoma)
  • گاموپاتی منوکلونال با اهمیت ناشناخته (Monoclonal gammopathy of unknown significance or MGUS)
  • ماکروگلوبولینمی والدنشتروم (Waldenstrom macroglobulinemia)
نحوه ی گرفتن نمونه ی ادرار در تست پروتئین بنس جونز :
تست پروتئین بنس جونز یک تست ادرار می باشد. نمونه ی ادراری که جمع آوری می شود باید فاقد آلودگی باشد. برای این منظور :
  • اطراف مجرای ادرار را تمیز کنید
  • شروع به ادرار کردن در توالت کنید
  • پس از ریختن اول ادرار، ظرف مخصوص جمع آوری ادرار را جلوی جریان ادرار بگیرید
  • پس از جمع آوری نمونه ی مورد نیاز، درب ظرف را بسته و ادرار خود را در توالت تمام کنید
  • ظرف حاوی نمونه ی ادرار را به آزمایشگاه تحویل دهید
اگر بخواهید نمونه ادرار را از یک نوزاد بگیرید، نیاز به یک یورین بگ دارید. سپس برای گرفتن نمونه ادرار، ابتدا اطراف مجرای ادرار را تمیز کرده و بعد از این کار یورین بگ را متصل کنید. وقتی که نوزاد ادرار کرد، کیسه را بردارید. سپس ادرار را در ظرف مخصوص ریخته و به آزمایشگاه منتقل کنید.
برای تست پروتئین بنس جونز نیازی به هیچ گونه آمادگی خاصی نیست.




نوع مطلب :
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دوشنبه 15 مهر 1398 07:29 ب.ظ
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چهارشنبه 27 شهریور 1398 05:02 ق.ظ
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