Lub kaw lus ntawm hemostasis lossis ntshav coagulation yog txheej txheej txheej txheem tsim nyog los tiv thaiv thiab tsis txhob los ntshav, nrog rau kev tswj xyuas cov kua hauv cov ntshav. Cov ntshav ntws ib txwm ua kom cov pa oxygen thiab cov as-ham rau cov ntaub so ntswg thiab lub cev.
Types of hemostasis
Cov ntshav txhaws muaj peb lub ntsiab:
- qhov tseeb coagulation system - tiv thaiv thiab tshem tawm cov ntshav poob;
- anti-clotting system - tiv thaiv cov ntshav txhaws;
- fibrinolysis system - dissolves twb tsim cov ntshav txhaws.
Tag nrho peb cov khoom no yuav tsum muaj qhov sib npaug tas li txhawm rau tiv thaiv cov hlab ntsha los ntawm cov ntshav txhaws, lossis, qhov sib txawv, ntshav poob siab.
Hemostasis, uas yog, txwv tsis pub los ntshav, yog ob hom:
- platelet hemostasis - muab los ntawm adhesion (gluing) ntawm platelets;
- coagulative hemostasis - muab los ntawm cov plasma proteins tshwj xeeb - yam ntawm cov ntshav coagulation system.
YPlatelet hemostasis
Hom ntshav txhaws no suav nrog hauv kev ua haujlwm ua ntej, txawm tias ua ntej ua kom cov coagulation. Yog hais tias lub hlab ntsha puas lawm, nws cov spasm yog pom, uas yog, nqaim ntawm lub lumen. Platelets tau qhib thiab ua raws li cov phab ntsa vascular, uas yog hu ua adhesion. Tom qab ntawd lawv lo ua ke ntawm lawv tus kheej thiab cov xov fibrin. Lawv raug muab sau ua ke. Thaum xub thawj, cov txheej txheem no thim rov qab, tab sis tom qab tsim cov fibrin ntau, nws yuav hloov tsis tau.
Hom hemostasis no ua haujlwm tau zoo los ntshav los ntawm cov hlab ntsha me me: capillaries, arterioles, venules. Rau qhov kawg ntawm kev los ntshav los ntawm cov hlab ntsha nruab nrab thiab cov hlab ntsha loj, nws yog ib qho tsim nyog yuav tau ua kom coagulation hemostasis, uas yog muab los ntawm cov ntshav txhaws.
Hom ntshav txhaws no, tsis zoo li platelet, suav nrog hauv kev ua haujlwm me ntsis tom qab, xav tau sijhawm ntxiv kom tsis txhob poob ntshav hauv txoj haujlwm no. Txawm li cas los xij, qhov hemostasis no yog qhov ua tau zoo tshaj plaws rau qhov kawg ntawm kev los ntshav.
Coagulation yam yog tsim nyob rau hauv daim siab thiab circulate nyob rau hauv cov ntshav nyob rau hauv ib tug inactive daim ntawv. Thaum cov phab ntsa ntawm cov hlab ntsha puas lawm, lawv tau qhib. Ua ntej tshaj plaws, prothrombin yog qhib, uas tom qab ntawd hloov mus ua thrombin. Thrombin splits loj fibrinogen rau hauv me me molecules, uas nyob rau hauv lub tom ntej no theem yog ua ke dua rau hauv ib tug tshiab tshuaj - fibrin. Ua ntej, soluble fibrin ua insoluble thiab muab qhov kawg nres ntawm los ntshav.
Cov khoom tseem ceeb ntawm coagulation hemostasis
Raws li tau sau tseg saum toj no, cov khoom tseem ceeb ntawm coagulation hom hemorrhage yog cov teeb meem hauv plab. Nyob rau hauv tag nrho, lawv txawv los ntawm 12 daim, txhua tus uas qhia los ntawm Roman tus lej:
- I - fibrinogen;
- YII - prothrombin;
- III - thromboplastin;
- IV - calcium ions;
- V - proaccelerin;
- VII - proconvertin;
- VIII - antihemophilic globulin A;
- IX - Christmas factor;
- X - Stuart-Prower factor (thrombotropin);
- XI - Rosenthal factor (precursor ntawm plasma thromboplastin);
- XII - Hageman factor;
- XIII - fibrin stabilizing factor.
Yav dhau los, yam VI (accelerin) kuj muaj nyob rau hauv kev faib tawm, tab sis nws tau raug tshem tawm ntawm kev faib tawm niaj hnub no, vim nws yog ib qho tseem ceeb ntawm V.
Ntxiv rau, ib qho ntawm cov khoom tseem ceeb tshaj plaws ntawm coagulation hemostasis yog vitamin K. Qee qhov cotting yam thiab vitamin K yog nyob rau hauv kev sib raug zoo, vim hais tias cov vitamin no yog tsim nyog rau cov synthesis ntawm II, VII, IX thiab X.
hom yam tseem ceeb
Lub 12 lub ntsiab tseem ceeb ntawm coagulation hemostasis teev saum toj no yog cuam tshuam nrog cov ntshav coagulation yam. Qhov no txhais tau hais tias cov tshuaj no ncig hauv lub xeev dawb hauv cov ntshav plasma.
Tseem muaj cov tshuaj uas muaj nyob hauv platelets. Lawv hu ua platelet clotting factor. Hauv qab no yog cov tseem ceeb:
- PF-3 - platelet thromboplastin - ib qho nyuaj uas muaj cov proteins thiab lipids, ntawm lub matrix uas cov txheej txheem ntshav coagulation tshwm sim;
- PF-4 - tshuaj tiv thaiv heparin;
- PF-5 - muab cov nplaum nplaum rau ntawm phab ntsa ntawm cov hlab ntsha thiab nrog rau ib leeg;
- PF-6 - xav tau los kaw cov ntshav txhaws;
- PF-10 - serotonin;
- PF-11 - muaj ATP thiab thromboxane.
Tib lub tebchaw yog qhib rau lwm cov qe ntshav: erythrocytes thiab leukocytes. Thaum lub sij hawm hemotransfusion (ntshav ntshav) nrog ib pab pawg neeg tsis sib haum, cov hlwb no raug puas tsuaj loj heev thiab platelet coagulation yam tseem ceeb hauv cov khoom loj tuaj, uas ua rau muaj kev ua haujlwm ntawm ntau cov ntshav txhaws. Tus mob no hu ua disseminated intravascular coagulation syndrome (DIC).
hom coagulation hemostasis
Nws muaj ob txoj hauv kev ntawm coagulation: sab nraud thiab sab hauv. Cov ntaub so ntswg yuav tsum tau ua kom lub cev sab nraud. Ob lub tswv yim sib koom ua ke los tsim cov khoom ua kom ntshav X, uas yog qhov tsim nyog rau kev tsim cov thrombin, uas tig mus hloov fibrinogen rau fibrin.
Qhov cascade ntawm cov tshuaj tiv thaiv no yog inhibited los ntawm antithrombin III, uas tuaj yeem khi txhua yam tshwj tsis yog VIII. Tsis tas li ntawd, cov txheej txheem coagulation cuam tshuam los ntawm cov protein C - protein S system, uas inhibit qhov kev ua ntawm yam V thiab VIII.
theem ntawm cov ntshav coagulation
Peb ntu sib law liag yuav tsum dhau mus kom tsis txhob los ntshav.
Nyob ntevyog thawj theem. Cov txheej txheem ntau tshaj plaws tshwm sim nyob rau theem no.
Txhawm rau pib lub sijhawm no, ib qho kev ua haujlwm prothrombinase yuav tsum tau tsim, uas, dhau los, yuav ua rau prothrombin nquag. Ob hom tshuaj no yog tsim: ntshav thiab cov ntaub so ntswg prothrombinase.
Rau qhov tsim ntawm thawj zaug, qhov ua kom muaj Hageman yog qhov tsim nyog, uas tshwm sim vim kev sib cuag nrog cov fibers ntawm cov phab ntsa vascular puas. Factor XII kuj xav tau siab molecular hnyav kininogen thiab kallikrein. Lawv tsis suav nrog hauv kev faib tawm tseem ceeb ntawm cov ntshav coagulation yam, txawm li cas los xij, hauv qee qhov chaw lawv raug xaiv los ntawm tus lej XV thiab XIV, feem. Tsis tas li ntawd, Hageman qhov tseem ceeb ua rau XI Rosenthal yam. Qhov no ua rau kev ua kom muaj txiaj ntsig IX ua ntej, thiab tom qab ntawd VIII. Antihemophilic globulin A yog qhov yuav tsum tau rau qhov X kom ua haujlwm, tom qab ntawd nws khi rau calcium ions thiab factor V. Yog li, cov ntshav prothrombinase yog synthesized. Tag nrho cov tshuaj tiv thaiv no tshwm sim ntawm platelet thromboplastin (PF-3) matrix. Cov txheej txheem no ntev dua thiab siv sijhawm txog 10 feeb.
Kev tsim cov ntaub so ntswg prothrombinase tshwm sim sai thiab yooj yim dua. Ua ntej, cov ntaub so ntswg thromboplastin tau qhib, uas tshwm hauv cov ntshav tom qab kev puas tsuaj rau phab ntsa vascular. Nws ua ke nrog yam VII thiab calcium ions, yog li ua kom muaj zog Stuart-Prower factor X. Tom qab ntawd, nyob rau hauv lem, interacts nrog cov ntaub so ntswg phospholipids thiab proaccelerin, uas ua rau zus tau tej cov ntaub so ntswg prothrombinase. Lub tshuab no nrawm dua - txog li 10 vib nas this.
theem ob thiab thib peb
theem thib ob pib nrog kev hloov pauv ntawm prothrombin mus rau hauv lub zog thrombin los ntawm kev ua haujlwm ntawm prothrombinase. Cov theem no yuav tsum tau ua ntawm cov plasma coagulation yam xws li IV, V, X. Cov theem xaus nrog kev tsim cov thrombin thiab ua tiav hauv ob peb feeb.
theem thib peb yog hloov pauv ntawm fibrinogen rau hauv cov dej tsis huv. Ua ntej, fibrin monomer yog tsim, uas yog muab los ntawm kev ua ntawm thrombin. Tsis tas li ntawd, nws hloov mus ua fibrin polymer, uas twb yog ib qho insoluble compound. Qhov no tshwm sim nyob rau hauv kev cuam tshuam ntawm fibrin-stabilizing yam. Tom qab tsim cov fibrin clot, cov qe ntshav tau tso rau ntawm nws, uas ua rau muaj cov ntshav txhaws.
Tom qab, nyob rau hauv kev cuam tshuam ntawm calcium ions thiab thrombostenin (ib qho protein synthesized los ntawm platelets), cov hlab ntshav tau thim rov qab. Thaum lub sij hawm retraction, lub thrombus poob mus txog ib nrab ntawm nws qhov loj me, raws li cov ntshav (plasma tsis muaj fibrinogen) yog nyem tawm. Cov txheej txheem no siv sijhawm ntau teev.
Fibrinolysis
Yog li tias qhov tshwm sim thrombus tsis tuaj yeem txhaws lub lumen ntawm lub nkoj thiab tsis tso tseg cov ntshav mus rau cov ntaub so ntswg sib raug rau nws, muaj qhov system ntawm fibrinolysis. Nws muab kev sib cais ntawm fibrin clot. Cov txheej txheem no tshwm sim tib lub sijhawm raws li qhov tuab ntawm cov thrombus, tab sis qeeb qeeb dua.
Rau qhov kev siv ntawm fibrinolysis, qhov kev txiav txim ntawm ib yam khoom tshwj xeeb yog tsim nyog -plasmin. Nws yog tsim nyob rau hauv cov ntshav los ntawm plasminogen, uas yog activated vim muaj cov plasminogen activators. Ib yam khoom zoo li no yog urokinase. Thaum pib, nws kuj tseem nyob hauv lub xeev tsis ua haujlwm, pib ua haujlwm nyob rau hauv kev cuam tshuam ntawm adrenaline (ib yam tshuaj hormone secreted los ntawm cov qog adrenal), lysokinases.
Plasmin decomposes fibrin rau hauv polypeptides, uas ua rau cov ntshav txhaws. Yog tias cov txheej txheem ntawm fibrinolysis cuam tshuam rau ib qho laj thawj, thrombus hloov los ntawm cov ntaub so ntswg. Nws tuaj yeem tawg tam sim ntawd ntawm phab ntsa ntawm cov hlab ntsha thiab ua rau muaj qhov thaiv ntawm lwm qhov hauv lub cev, uas yog hu ua thromboembolism.
Kev kuaj mob ntawm lub xeev hemostasis
Yog tias ib tus neeg muaj mob los ntshav ntau (los ntshav hnyav thaum muaj kev phais, qhov ntswg, lub tsev menyuam los ntshav, tsis muaj qhov nqaij tawv), nws tsim nyog xav tias muaj kab mob ntawm cov ntshav txhaws. Txhawm rau txheeb xyuas qhov ua rau muaj kev cuam tshuam ntawm coagulation, nws raug nquahu kom kuaj ntshav dav dav, coagulogram, uas yuav qhia txog lub xeev ntawm coagulation hemostasis.
Nws kuj tseem pom zoo kom txiav txim siab cov coagulation yam, uas yog VIII thiab IX yam. Txij li thaum qhov txo qis hauv cov ntsiab lus ntawm cov tshuaj no feem ntau ua rau cov ntshav txhaws.
Cov cim tseem ceeb qhia lub xeev ntawm cov ntshav coagulation system yog:
- platelet suav;
- sijhawm los ntshav;
- sijhawm ua ntshav;
- prothrombin sijhawm;
- Yprothrombin index;
- ua kom lub sijhawm thromboplastin ib nrab (APTT);
- fibrinogen nqi;
- kev ua ntawm yam VIII thiab IX;
- vitamin K ntau ntau.
YPathology ntawm hemostasis
Cov kab mob uas tshwm sim ntau tshaj plaws yog qhov tsis txaus siab yog hemophilia. Qhov no yog kab mob pathology kis nrog rau X chromosome. Feem ntau cov tub hluas muaj mob, thiab cov ntxhais tuaj yeem ua tus kab mob. Qhov no txhais tau hais tias cov ntxhais tsis tsim cov tsos mob ntawm tus kab mob, tab sis lawv tuaj yeem kis tus kab mob hemophilia mus rau lawv cov xeeb ntxwv.
Nrog qhov tsis txaus ntawm coagulation yam VIII, hemophilia A tshwm sim, nrog qhov txo qis ntawm IX - hemophilia B. Thawj qhov sib txawv yog qhov hnyav dua thiab muaj qhov tsis zoo.
Kho mob, hemophilia tshwm sim los ntawm kev poob ntshav ntau ntxiv tom qab kev phais, cov txheej txheem kho kom zoo nkauj, nquag qhov ntswg lossis uterine (hauv cov ntxhais) los ntshav. Ib tug yam ntxwv feature ntawm no pathology ntawm hemostasis yog tsub zuj zuj ntawm cov ntshav nyob rau hauv cov pob qij txha (hemarthrosis), uas yog manifested los ntawm lawv mob, o thiab liab.
Kev kuaj mob thiab kho mob hemophilia
Kev kuaj mob muaj nyob rau hauv kev txiav txim siab txog kev ua haujlwm ntawm cov khoom (tso qis heev), ua cov coagulogram (lub sijhawm ntev ntawm cov ntshav txhaws thiab APTT, nce lub sijhawm rov ua dua cov ntshav plasma).
Hemophilia tau kho nrog kev kho mob ntshav qab zib kom lub neej (VIII thiab IX). Kuj pom zoo siv tshuaj uas ntxiv dag zog rau phab ntsa vascular("Trental").
Yog li, cov khoom ua kom ntshav txhaws ua lub luag haujlwm tseem ceeb hauv kev ua kom lub cev ua haujlwm zoo. Lawv cov dej num ua kom muaj kev sib koom ua haujlwm ntawm txhua lub hauv nruab nrog cev vim yog xa cov pa oxygen thiab cov as-ham tseem ceeb rau lawv.
