Fibrinolysis inoitika mune yemuviri hemostasis, mushure mekugwamba kweropa, kubvisa iyo hemostatic clot inogadzirwa nefibrin. Ichipo muhuwandu hwakawanda kwazvo, zvinogona kutungamira mukuumbwa kwechimbo mukutenderera pamwe nenjodzi dzinoguma. Tsananguro, zvinokonzera uye kurapwa, ngatitorei stock.

Fibrinolysis inzira yekuparadza iyo inosanganisira kuparara kwemukati wemukati weropa pasi pekuita kweplasmin. Nekuita uku, inobvisa kutenderera kwetsvina yefibrin muropa uye nekudaro inobatsira kudzivirira muviri kubva panjodzi yethrombosis (blood clot).

Plasmin, inogadzirwa nechiropa, ndiyo puroteni huru inoita fibrinolysis. Plasmin inoshandurwa kuita plasminogen netissue plasminogen activator (tPA) uye urokinase.

Plasminogen ine concordance ye fibrin uye yakaunganidzwa mune iyo clot panguva yekuumbwa kwayo (iyo inobvumidza iyo kuti iputsike pasi gare gare). Shanduko kubva kuplasminogen kuenda kuplasmin inoitika pedyo negwamba.

Iyo fibrinolytic system inofanirwa kufamba pakati pekupwanya iyo intravascular clots iyo inogadzira uye isingakonzere kubuda kweropa apo iyo hemostatic clots uye fibrinogen inoparara.

Kana iro bundu rikanyungudika nekukurumidza, nekurapwa, nechirwere kana neyakajairika yeheestasis, inogona kuve nemhosva yekumwe kubuda kweropa kwakanyanya.

Kune mhando mbiri dze fibrinolysis, yekutanga uye yechipiri fibrinolysis. Primary fibrinolysis inowanzoitika, uye yechipiri fibrinolysis inoitika nekuda kwechimwe chikonzero chekunze senge mushonga kana chirwere chekurapa.

Kana iyo fibrin iripo muhuwandu hwakawandisa, inogona kukonzera kuumbwa kwegwamba mukutenderera, zvichikonzera njodzi dzevenous thrombosis (phlebitis) kana arterial (ischemia).

Kukanganisa mufibrinolysis kunotungamirira ku thrombophilia inokonzera kuumbwa kwakanyanya kweropa rinopisa hupenyu:

• Acute coronary syndrome (ACS) iko kusakwana kwecoronary kunokonzerwa neimwe kana yakawanda yakavharika tsinga dzekoronon;
• Kwakanyanya myocardial infarction: kupindira mukati memaawa matatu ekutanga kunodiwa;
• Ischemic sitiroko mune acute phase;
• Pulmonary embolism nekusagadzikana kwehemodynamic;
• Kudzoreredzwa kwe patency ye venous catheters (yepakati venous catheters uye dialysis catheters), mune chiitiko chekuvharirwa kwakabatana neiri kusimukira kana ichangobva kuumbwa thrombus.

Muzviitiko zvese zvataurwa pamusoro apa, chiito che fibrinolytics chichava chinoshanda chete zvichienderana nenguva yekutonga zvichienzaniswa nekutanga kwezviratidzo zvekutanga.

Iyo yazvino standard kurapwa, fibrinolysis, inofanirwa kupihwa nekukasira uye inobaya jekiseni murwere netissue plasminogen activator iyo ichaedza kupwanya ichi uye nekudaro kusimudzira kutadza kwemudziyo.

Fibrinolytics inokonzeresa kuparara kwezvivharo zvemukati uye inoshanda nekushandura plasminogen isingashande muplasmin inoshanda, enzyme inokonzera kuparara kwefibrin uye iyo inokonzera lysis ye thrombus.

Isu tinosiyanisa:

• Streptokinase yemabviro echisikigo ipuroteni inogadzirwa ne β-hemolytic streptococcus, saka ine exogenous mavambo uye inokwanisa kukonzera kuumbwa kwemasoja ekudzivirira chirwere;
• Urokinase iprotease, yezvakasikwa, iyo inoshanda zvakananga pa plasminogen;
• Izvo zvigadzirwa zvetissue plasminogen activator (t-PA), inowanikwa negenetic recombination kubva kugene encoding t-PA, inoshandura yakananga plasminogen muplasmin nekutevedzera zvinoitwa ne t-PA. Zvigadzirwa zve t-PA zvinoratidzwa ne rt-PA (alteplase), r-PA (reteplase) uye TNK-PA (tenecteplase).

  Heparin uye / kana aspirin inowanzobatanidzwa nekurapa ne fibrinolytics.

Nzira dzekutsvaga fibrinolysis.

Miedzo yepasi rose: Nguva yekuparara kweeuglobulins

Kunaya kwe euglobulins kunobvumira kugovana kwefibrinogen, plasminogen uye yayo protease inhibitor activators. Nguva yakajairwa yakakura kudarika maawa matatu asi kana iri shoma nguva, isu tinofungidzira "hyperfibrinolysis".

Ongororo bvunzo

• Plasminogen assay: inoshanda uye immunological;
• TPA (tishu plasminogen) kuyedza: immunoenzymatic maitiro;
• Chipimo chemushonga antiplasmin.

Bvunzo dzisina kunanga

• Kugadziriswa kwe fibrinogen: uku kuongororwa kusinganzwisisike kwe fibrinolysis. Iine low fibrinogen, "hyperfibrinolysis" inofungidzirwa;
• Reptilase nguva uye / kana thrombin nguva: ivo vanorebeswa pamberi pefibrin degradation zvigadzirwa;
• Kutsunga kwePDFs (Fibrin uye fibrinogen degradation products): yakakwirira muchiitiko chekushandiswa kwe fibrinolysis;
• D-dimer assay: inoenderana nezvimedu zvePDF uye yakakwirira muchiitiko che fibrinolysis.