2017医学考研西综考点预测之NAP

2017医学考研西综考点预测之NAP

中性粒细胞碱性磷酸酶积分(NAP)，是血液系统疾病常见的实验室检查，也是医学考试中上镜率很高的知识点，对血液系统疾病的鉴别诊断有重要意义。了解到很多人对如何记忆血液系统疾病复杂的实验室检查感到头痛，其实只要理解了这项检查的原理，难题自然迎刃而解。

中性粒细胞碱性磷酸酶积分(NAP)，采用偶氮偶联法，即成熟中性碱性磷酸酶在PH9.6左右的碱性环境中，能水解基质液中的磷酸萘酚钠底物，释放出萘酚，后者与重氮盐偶联，生成不溶性的有色沉淀，定位于细胞质酶活性所在之处。不同的底物与重氮盐的组合不同。NAP染色只在中性分叶核、杆状核粒细胞中，偶在中性晚幼粒细胞中出现阳性，其他细胞一般阴性。

不同疾病NAP活性有变化，而且有些生理性因素可使酶活性发生改变，如应激状态、经前期、妊娠期、新生儿等可使NAP活性增加。 1、NAP积分增加：见于细菌感染(包括类白血病反应)、再生障碍性贫血、某些增殖性疾病(如慢性中性粒细胞白血病、骨髓纤维化、真性红细胞增多症、原发性血小板增多症)、慢性粒细胞白血病(加速期、急变期)、急性淋巴细胞白血病、慢性淋巴细胞白血病、恶性淋巴瘤、骨转移瘤、肾上腺糖皮质激素及雄激素治疗后等。

2、NAP积分下降：慢性粒细胞白血病慢性期、阵发性睡眠型血红蛋白尿症、骨髓增生异常综合征、恶性组织细胞病等。

不同的疾病，NAP有各自特异的表现，可以有效鉴别，常见的有：

1.慢粒细胞白血病(慢粒)的诊断及其与类白血病的鉴别：慢粒时，NAP积分值一般常为0分，个别可正常。在类白血病则积分显著增高。如慢粒合并感染或急变时可增高。

2.急性白血病细胞类型的鉴别：急性淋巴细胞白血病，NAP积分增高或正常，急性粒细胞白血病则降低，急性单核细胞白血病不定。

3.再生障碍性贫血(再障)与阵发性睡眠性血红蛋白尿的鉴别：急、慢性再障，积分增高，后者可明显降低。

4.白血病前期(白前)与再障鉴别：白前积分降低，而后者增高。

5.细菌性肺炎与病毒性肺炎鉴别：细菌性肺炎增高，后者降低。

6.真性与继发性红细胞增多症的鉴别：前者增高，后者若无感染则正常。

7.绿色瘤与神经母细胞瘤的鉴别：前者积分降低，后者则增高。

理解才是最高效的记忆方法，中性粒细胞碱性磷酸酶积分(NAP)的原理虽然属于检验学内容，并不在医学考试范围内，但是了解他的原理对记忆血液疾病实验室检查的鉴别诊断有很大帮助。理解了他，你再也不必为那些复杂的实验室检查鉴别诊断而头痛。

以上是为大家整理的全部西医综合备考的信息，希望能够帮助大家!

When you are old and grey and full of sleep, And nodding by the fire, take down this book, And slowly read, and dream of the soft look Your eyes had once, and of their shadows deep; How many loved your moments of glad grace, And loved your beauty with love false or true, But one man loved the pilgrim soul in you, And loved the sorrows of your changing face; And bending down beside the glowing bars, Murmur, a little sadly, how love fled And paced upon the mountains overhead And hid his face amid a crowd of stars.

The furthest distance in the world Is not between life and death

But when I stand in front of you Yet you don't know that I love you.

The furthest distance in the world Is not when I stand in front of you Yet you can't see my love

But when undoubtedly knowing the love from both Yet cannot be together.

The furthest distance in the world Is not being apart while being in love But when I plainly cannot resist the yearning Yet pretending you have never been in my heart. The furthest distance in the world Is not struggling against the tides But using one's indifferent heart To dig an uncrossable river For the one who loves you.

When you are old and grey and full of sleep,

And nodding by the fire, take down this book, And slowly read, and dream of the soft look Your eyes had once, and of their shadows deep; How many loved your moments of glad grace, And loved your beauty with love false or true, But one man loved the pilgrim soul in you, And loved the sorrows of your changing face; And bending down beside the glowing bars, Murmur, a little sadly, how love fled And paced upon the mountains overhead And hid his face amid a crowd of stars.

The furthest distance in the world Is not between life and death But when I stand in front of you Yet you don't know that I love you.

The furthest distance in the world Is not when I stand in front of you Yet you can't see my love

But when undoubtedly knowing the love from both Yet cannot be together.

The furthest distance in the world Is not being apart while being in love But when I plainly cannot resist the yearning Yet pretending you have never been in my heart. The furthest distance in the world Is not struggling against the tides But using one's indifferent heart To dig an uncrossable river For the one who loves you.