Fibrinolysis imapezeka mu thupi hemostasis, pambuyo coagulation magazi, kuthetsa hemostatic kuundana opangidwa ndi fibrin. Zikakhala zochulukirachulukira, zimatha kupangitsa kuti magazi aziundana m'magazi ndi zoopsa zomwe zingabwere. Tanthauzo, zoyambitsa ndi mankhwala, tiyeni tikambirane.

Fibrinolysis ndi njira yowononga yomwe imakhala ndi kusungunuka kwa magazi m'mitsempha pansi pa zochita za plasmin. Mwanjira imeneyi, imachotsa kufalikira kwa zinyalala za fibrin m'magazi motero zimathandiza kuteteza thupi ku chiopsezo cha thrombosis (magazi a magazi).

Plasmin, yopangidwa ndi chiwindi, ndiye puloteni yayikulu yomwe imayambitsa fibrinolysis. Plasmin imasinthidwa kukhala plasminogen ndi minofu plasminogen activator (tPA) ndi urokinase.

Plasminogen ili ndi concordance ya fibrin ndipo imasonkhanitsidwa mu kuundana kwake (komwe kumalola kuti iphwanyidwe pambuyo pake). Kusintha kuchokera ku plasminogen kupita ku plasmin kumachitika pafupi ndi magazi.

Dongosolo la fibrinolytic liyenera kusuntha pakati pa kuthyola magazi omwe amaundana komanso osatulutsa magazi pamene magazi a hemostatic ndi fibrinogen asungunuka.

Ngati magaziwo asungunuka mofulumira kwambiri, mwa chithandizo, chifukwa cha matenda kapena chifukwa cha vuto la hemostasis, nthawi zina amatha kutaya magazi kwambiri.

Pali mitundu iwiri ya fibrinolysis, primary and secondary fibrinolysis. Primary fibrinolysis imachitika mwachibadwa, ndipo yachiwiri fibrinolysis imachitika chifukwa cha zina zakunja monga mankhwala kapena matenda.

Ngati fibrin ilipo mochulukirachulukira, imatha kupangitsa kuti magazi aziundana, zomwe zimapangitsa kuti pakhale ngozi ya venous thrombosis (phlebitis) kapena arterial (ischemia).

Kuwonongeka kwa fibrinolysis kumayambitsa thrombophilia yomwe imayambitsa mapangidwe owopsa a magazi omwe amawopseza moyo:

• Acute coronary syndrome (ACS) ndi kulephera kwa mtima komwe kumachitika chifukwa cha kutsekeka kwa mitsempha imodzi kapena zingapo;
• Posachedwapa myocardial infarction: kulowerera mkati mwa maola atatu oyambirira ndikwabwino;
• Ischemic sitiroko mu gawo pachimake;
• Embolism yamapapo ndi kusakhazikika kwa hemodynamic;
• Kubwezeretsanso patency ya venous catheters (pakati venous catheters ndi dialysis catheters), pakakhala chotchinga chokhudzana ndi thrombus yomwe ikukula kapena posachedwapa.

Pazochitika zonse zomwe tazitchula pamwambapa, zochita za fibrinolytics zidzakhala zogwira mtima malinga ndi nthawi ya utsogoleri poyerekeza ndi kuyambika kwa zizindikiro zoyamba.

Chithandizo chamakono chamakono, fibrinolysis, chiyenera kuperekedwa mwamsanga ndipo chimaphatikizapo jekeseni wodwala ndi minofu ya plasminogen activator yomwe idzayesa kusungunula chotchinga ichi ndikukweza kutsekereza kwa chotengeracho.

Fibrinolytics imayambitsa kusungunuka kwa mitsempha ya m'mitsempha ndikugwira ntchito mwa kusintha plasminogen yosagwira ntchito kukhala plasmin yogwira ntchito, puloteni yomwe imayambitsa kuwonongeka kwa fibrin ndipo motero imayambitsa lysis ya thrombus.

Timasiyanitsa:

• Streptokinase yachirengedwe ndi mapuloteni opangidwa ndi β-hemolytic streptococcus, motero amachokera kunja ndipo amatha kuchititsa kupanga ma antibodies;
• Urokinase ndi protease, yochokera ku chilengedwe, yomwe imagwira ntchito mwachindunji pa plasminogen;
• Zochokera ku minofu ya plasminogen activator (t-PA), yomwe imapezedwa ndi genetic encoding t-PA, idzasintha mwachindunji plasminogen kukhala plasmin potengera zochita za t-PA. Zomwe zimachokera ku t-PA zimasonyezedwa ndi rt-PA (alteplase), r-PA (reteplase) ndi TNK-PA (tenecteplase).

  Heparin ndi / kapena aspirin nthawi zambiri zimagwirizanitsidwa ndi chithandizo cha fibrinolytics.

Njira zowunikira fibrinolysis.

Mayeso apadziko lonse lapansi: Kutha kwa nthawi ya euglobulins

Mpweya wa euglobulins umalola kugawana kwa fibrinogen, plasminogen ndi ma protease inhibitor activators. Nthawi yabwinobwino ndi yayikulu kuposa maola atatu, koma ngati nthawi yocheperako, timakayikira "hyperfibrinolysis".

Mayeso a analytics

• Kuyeza kwa Plasminogen: ntchito ndi immunological;
• TPA (minofu ya plasminogen) kuyesa: njira za immunoenzymatic;
• Mlingo wa antiplasmin.

Mayeso osalunjika

• Kutsimikiza kwa fibrinogen: uku ndikuwunika kosalunjika kwa fibrinolysis. Ndi fibrinogen yochepa, "hyperfibrinolysis" amakayikira;
• Nthawi ya reptilase ndi / kapena nthawi ya thrombin: amatalikitsidwa pamaso pa zinthu zowonongeka za fibrin;
• Kutsimikiza kwa ma PDF (Fibrin ndi fibrinogen degradation product): apamwamba pakachitika kutsegulidwa kwa fibrinolysis;
• D-dimer assay: amafanana ndi zidutswa za PDF ndipo amakhala okwera kwambiri pakachitika fibrinolysis.