Ib yam ntawm cov txheej txheem tseem ceeb hauv peb lub cev yog ntshav txhaws. Nws cov tswv yim yuav tau piav qhia hauv qab no (cov duab kuj tau muab rau kom pom tseeb). Thiab txij li qhov no yog txheej txheem nyuaj, nws tsim nyog xav txog nws kom meej.
Yuav ua li cas?
Yog li, cov txheej txheem qhia yog lub luag haujlwm txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhav
Hauv cov ntsiab lus yooj yim, muaj peb theem. Qhov thib ib yog qhib kom ua. Tom qab kev puas tsuaj rau cov hlab ntsha, cov tshuaj tiv thaiv zoo pib tshwm sim, uas thaum kawg ua rau kev tsim cov hu ua prothrombinase. Qhov no yog ib tug complex complex muaj xws li V thiab X clotting yam. Nws yog tsim rau ntawm phospholipid nto ntawm platelet membranes.
theem ob yog coagulation. Nyob rau theem no, fibrin yog tsim los ntawm fibrinogen - high-molecular protein, uas yog lub hauv paus ntawm cov ntshav txhaws, qhov tshwm sim ntawm implies ntshav txhaws. Daim duab hauv qab no qhia txog theem no.
Thiab thaum kawg, theem peb. Nws suav nrog kev tsim cov fibrinclot, characterized los ntawm ib tug ntom qauv. Los ntawm txoj kev, nws yog los ntawm kev ntxuav thiab ziab kom nws thiaj li tau txais "cov khoom siv", uas yog siv los npaj cov yeeb yaj kiab uas tsis muaj menyuam thiab daim txhuam cev kom tsis txhob los ntshav los ntawm kev tawg ntawm cov hlab ntsha me me thaum ua haujlwm phais.
About reactions
Cov ntshav txhaws tau piav qhia luv luv saum toj no. Lub tswv yim, los ntawm txoj kev, tau tsim rov qab rau xyoo 1905 los ntawm tus kws kho mob coagulologist hu ua Paul Oskar Morawitz. Thiab nws tseem tsis tau poob nws qhov cuam tshuam rau hnub no.
Tab sis txij li xyoo 1905, ntau yam tau hloov pauv hauv kev nkag siab txog ntshav coagulation raws li txheej txheem nyuaj. Nrog kev vam meej, tau kawg. Cov kws tshawb fawb tau tshawb pom ntau ntau qhov kev tawm tsam tshiab thiab cov proteins uas koom nrog hauv cov txheej txheem no. Thiab tam sim no tus qauv cascade ntawm cov ntshav coagulation yog ntau dua. Ua tsaug rau nws, kev nkag siab thiab kev nkag siab ntawm cov txheej txheem nyuaj no ua rau nkag siab me ntsis ntxiv.
Raws li koj tuaj yeem pom hauv daim duab hauv qab no, qhov tshwm sim yog qhov "tshem tawm". Nws yuav siv sij hawm mus rau hauv tus account lub sab hauv thiab sab nraud system - ntshav thiab cov ntaub so ntswg. Txhua tus yog tus cwj pwm los ntawm qee yam deformation uas tshwm sim los ntawm kev puas tsuaj. Hauv cov ntshav, kev puas tsuaj yog ua rau cov phab ntsa vascular, collagen, proteases (splitting enzymes) thiab catecholamines (mediator molecules). Hauv cov ntaub so ntswg, kev puas tsuaj ntawm tes raug pom, vim tias thromboplastin raug tso tawm los ntawm lawv. Uas yog qhov tseem ceeb tshaj plaws stimulator ntawm cov txheej txheem coagulation (lwm yam hu ua coagulation). Nws mus ncaj qha rau hauv cov ntshav. Nov yog nws txoj kevtab sis nws yog kev tiv thaiv. Tom qab tag nrho, nws yog thromboplastin uas pib cov txheej txheem txhaws. Tom qab nws tso rau hauv cov ntshav, qhov kev siv ntawm peb theem saum toj no pib.
sijhawm
Yog li, dab tsi yog ntshav coagulation, lub tswv yim pab kom nkag siab. Tam sim no kuv xav tham me ntsis txog lub sijhawm.
Txhua tus txheej txheem yuav siv sijhawm ntev li 7 feeb. Thawj theem kav los ntawm tsib mus rau xya. Thaum lub sij hawm no, prothrombin yog tsim. Cov khoom no yog ib hom complex ntawm cov qauv protein ua lub luag haujlwm rau cov txheej txheem coagulation thiab lub peev xwm ntawm cov ntshav kom tuab. Uas yog siv los ntawm peb lub cev txhawm rau tsim cov ntshav txhaws. Nws clogs qhov chaw puas, kom cov ntshav nres. Tag nrho cov no siv sijhawm 5-7 feeb. Qhov thib ob thiab thib peb theem tshwm sim sai dua. Rau 2-5 vib nas this. Vim tias cov theem ntawm cov ntshav txhaws (daim duab qhia saum toj no) cuam tshuam cov txheej txheem uas tshwm sim txhua qhov chaw. Thiab qhov ntawd txhais tau tias ntawm qhov chaw ntawm kev puas tsuaj ncaj qha.
Prothrombin, nyob rau hauv lem, yog tsim nyob rau hauv daim siab. Thiab nws yuav siv sij hawm los ua ke. Yuav ua li cas sai npaum li cas ntawm prothrombin yog tsim nyob ntawm seb cov vitamin K muaj nyob rau hauv lub cev. Yog tias tsis txaus, cov ntshav yuav tsum nres. Thiab qhov no yog ib qho teeb meem loj. Txij li thaum tsis muaj vitamin K qhia txog kev ua txhaum ntawm kev sib txuas ntawm prothrombin. Thiab qhov no yog ib qho mob uas yuav tsum tau kho.
Synthesis Stabilization
Zoo, cov txheej txheem dav dav ntawm cov ntshav txhaws yog qhov tseeb - tam sim no ua rawsua tib zoo saib me ntsis rau lub ntsiab lus ntawm qhov yuav tsum tau ua kom rov qab tau cov vitamin K hauv lub cev.
Ua ntej, noj txoj cai. Qhov loj tshaj ntawm cov vitamin K muaj nyob rau hauv cov tshuaj yej ntsuab - 959 mcg ib 100 g! Peb zaug ntau dua, los ntawm txoj kev, dua li dub. Yog li ntawd nws tsim nyog haus nws nquag. Tsis txhob tso tseg zaub - spinach, zaub qhwv dawb, txiv lws suav, peas ntsuab, dos.
Nqaij kuj muaj vitamin K, tab sis tsis yog nyob rau hauv txhua yam - tsuas yog nyob rau hauv nqaij nyuj, nqaij nyug siab, yaj. Tab sis tsawg kawg ntawm tag nrho nws yog nyob rau hauv muaj pes tsawg leeg ntawm qej, raisins, mis nyuj, txiv apples thiab grapes.
Txawm li cas los xij, yog tias qhov xwm txheej hnyav, nws yuav nyuaj los pab nrog ntau yam zaub mov. Feem ntau, cov kws kho mob xav kom muab koj cov khoom noj nrog cov tshuaj uas lawv tau sau tseg. Kev kho mob yuav tsum tsis txhob ncua. Nws yog ib qho tsim nyog yuav tau pib sai li sai tau kom normalize cov ntshav coagulation. Txoj kev kho mob yog muab ncaj qha los ntawm tus kws kho mob, thiab nws tseem yuav tsum ceeb toom tias yuav muaj dab tsi tshwm sim yog tias cov lus pom zoo tsis saib xyuas. Thiab qhov tshwm sim tuaj yeem ua rau lub siab ua haujlwm tsis zoo, thrombohemorrhagic syndrome, pernicious anemia, qog cov kab mob thiab kev puas tsuaj rau pob txha pob txha qia hlwb.
Schmidt scheme
Tus kws kho mob lub cev nto moo thiab kws kho mob kev tshawb fawb tau nyob rau thaum xaus ntawm lub xyoo pua 19th. Nws lub npe yog Alexander Alexandrovich Schmidt. Nws nyob tau 63 xyoo, thiab mob siab rau feem ntau ntawm nws lub sijhawm los kawm txog cov teeb meem ntawm hematology. Tab sis tshwj xeeb tshaj yog ua tib zoo kawm txog cov ntsiab lus ntawm cov ntshav coagulation. Nws tswj los tsim kom muaj qhov enzymatic ntawm qhov notxheej txheem, raws li qhov tshwm sim ntawm cov kws tshawb fawb tau muab cov lus piav qhia theoretical rau nws. Uas qhia meej meej los ntawm cov ntshav coagulation daim duab hauv qab no.
Ua ntej tshaj plaws, lub nkoj puas raug txo qis. Tom qab ntawd, ntawm qhov chaw ntawm qhov tsis xws luag, ib qho xoob, thawj platelet plug yog tsim. Ces nws thiaj muaj zog. Yog li ntawd, ib qho ntshav txhaws (lwm yam hu ua ntshav txhaws) yog tsim. Tom qab ntawd nws ib nrab los yog tag nrho dissolves.
Nyob rau hauv cov txheej txheem no, qee yam ua rau cov ntshav txhaws tshwm. Lub tswv yim, nyob rau hauv nws nthuav version, kuj qhia lawv. Lawv suav nrog cov lej Arabic. Thiab muaj 13 ntawm lawv tag nrho. Thiab txhua tus yuav tsum tau qhia.
Factors
Ib txoj kev ua kom ntshav coagulation ua tiav tsis tuaj yeem ua tsis tau yam tsis sau npe. Zoo, cia peb pib ntawm thawj tus.
Factor Kuv yog cov protein tsis muaj xim hu ua fibrinogen. Synthesized nyob rau hauv daim siab, yaj nyob rau hauv plasma. Factor II - prothrombin, uas twb tau hais saum toj no. Nws lub peev xwm tshwj xeeb yog nyob rau hauv kev khi ntawm calcium ions. Thiab nws yog qhov tseeb tom qab kev tawg ntawm cov tshuaj no uas cov coagulation enzyme tau tsim.
Factor III yog cov lipoprotein complex protein, cov ntaub so ntswg thromboplastin. Nws feem ntau hu ua kev thauj mus los ntawm phospholipids, cholesterol, thiab kuj triacylglycerides.
Qhov tseem ceeb tom ntej, IV, yog Ca2+ ions. Cov uas khi nyob rau hauv lub zog ntawm ib tug tsis muaj xim protein. Lawv koom nrog ntau cov txheej txheem nyuaj, ntxiv rau cov ntshav txhaws, hauv kev tso tawm ntawm cov neurotransmitters, piv txwv li.
Factor V yog globulin. Uas kuj tsim nyob rau hauv daim siab. Nws yog ib qho tsim nyog rau kev sib txuas ntawm corticosteroids (cov tshuaj hormones) thiab lawv kev thauj mus los. Factor VI muaj nyob rau qee lub sijhawm, tab sis tom qab ntawd nws tau txiav txim siab tshem tawm ntawm kev faib tawm. Txij li thaum cov kws tshawb fawb tau pom - nws suav nrog qhov xwm txheej V.
Tab sis qhov kev faib tawm tsis tau hloov pauv. Yog li, V yog ua raws li qhov VII. Xws li proconvertin, nrog kev koom tes ntawm cov ntaub so ntswg prothrombinase tsim (thawj theem).
Factor VIII yog cov protein uas qhia hauv ib txoj saw. Paub tias yog antihemophilic globulin A. Nws yog vim nws tsis muaj cov kab mob uas tsis tshua muaj tshwm sim raws li hemophilia tshwm sim. Factor IX yog "txog" rau cov lus hais dhau los. Vim nws yog antihemophilic globulin B. Factor X yog ncaj qha globulin synthesized nyob rau hauv daim siab.
Thiab thaum kawg, peb lub ntsiab lus kawg. Cov no yog Rosenthal, Hageman yam thiab fibrin stabilization. Ua ke, lawv cuam tshuam rau kev tsim cov ntawv cog lus intermolecular thiab kev ua haujlwm ntawm cov txheej txheem xws li ntshav txhaws.
Schmidt lub tswv yim suav nrog txhua yam no. Thiab nws yog qhov txaus kom paub nrog lawv luv luv kom nkag siab txog cov txheej txheem piav qhia no nyuaj thiab tsis meej.
Anti-clotting system
Lub tswv yim no kuj yuav tsum tau muab sau tseg. Cov ntshav coagulation system tau piav qhia saum toj no - daim duab kuj qhia meej txog cov txheej txheem no. Tab sis qhov hu ua "countercoagulation" kuj muaj qhov chaw ua.
pib nrog, Kuv xav kom nco ntsoov tias nyob rau hauv cov chav kawm ntawm evolution, cov kws tshawb fawb txiav txim siabob txoj haujlwm sib txawv kiag li. Lawv sim ua kom paub seb lub cev tswj hwm li cas los tiv thaiv cov ntshav los ntawm cov hlab ntsha puas, thiab tib lub sijhawm ua kom nws nyob hauv cov kua dej tsis zoo? Zoo, qhov kev daws teeb meem thib ob yog qhov kev tshawb pom ntawm kev tiv thaiv kab mob.
Nws yog ib qho ntawm cov plasma proteins uas tuaj yeem ua rau qeeb tus nqi ntawm cov tshuaj tiv thaiv. Qhov ntawd yog inhibit.
Thiab antithrombin III koom nrog hauv cov txheej txheem no. Nws lub luag haujlwm tseem ceeb yog tswj kev ua haujlwm ntawm qee yam uas suav nrog cov txheej txheem ntawm cov txheej txheem ntshav coagulation. Nws yog ib qho tseem ceeb kom paub meej: nws tsis tswj kev tsim cov ntshav txhaws, tab sis tshem tawm cov enzymes tsis tsim nyog uas tau nkag mus rau hauv cov hlab ntsha los ntawm qhov chaw uas nws tsim. Nws yog dab tsi? Txhawm rau tiv thaiv kev sib kis ntawm cov hlab ntsha mus rau thaj chaw ntawm cov hlab ntsha uas puas lawm.
Obstructive element
Tham txog dab tsi cov ntshav coagulation system yog (cov tswv yim uas tau hais los saum toj no), ib tus tsis tuaj yeem tsis nco qab cov tshuaj xws li heparin. Nws yog sulfur-muaj acidic glycosaminoglycan (ib hom polysaccharide).
Qhov no yog cov tshuaj tiv thaiv ncaj qha. Ib yam khoom uas pab txhawb rau inhibition ntawm kev ua haujlwm ntawm coagulation system. Nws yog heparin uas tiv thaiv kev tsim cov ntshav txhaws. Qhov no tshwm sim li cas? Heparin tsuas yog txo cov kev ua ntawm thrombin hauv cov ntshav. Txawm li cas los xij, nws yog ib yam khoom ntuj tsim. Thiab nws muaj txiaj ntsig. Yog tias koj qhia cov tshuaj tiv thaiv coagulant rau hauv lub cev, koj tuaj yeem pab txhawbKev ua kom muaj zog ntawm antithrombin III thiab lipoprotein lipase (enzymes uas zom triglycerides - lub ntsiab ntawm lub zog rau cov hlwb).
Zoo, heparin feem ntau siv los kho cov mob thrombotic. Tsuas yog ib qho ntawm nws cov molecules tuaj yeem qhib qhov loj ntawm antithrombin III. Raws li, heparin tuaj yeem suav hais tias yog ib qho catalyst - txij li qhov kev txiav txim hauv qhov no yeej zoo ib yam li cov nyhuv tshwm sim los ntawm lawv.
Muaj lwm yam tshuaj uas muaj cov nyhuv tib yam muaj nyob hauv cov ntshav ntshav. Piv txwv li, noj α2-macroglobulin. Nws pab txhawb kev sib cais ntawm cov thrombus, cuam tshuam cov txheej txheem ntawm fibrinolysis, ua haujlwm ntawm kev thauj mus los rau 2-valent ions thiab qee cov proteins. Nws kuj inhibits cov tshuaj koom nrog hauv cov txheej txheem txhaws.
Observed change
Muaj ib qho ntxiv uas cov txheej txheem ntshav coagulation tsis ua kom pom. Lub physiology ntawm peb lub cev yog xws li tias ntau cov txheej txheem koom nrog tsis tsuas yog tshuaj hloov pauv. Tab sis kuj yog lub cev. Yog tias peb tuaj yeem soj ntsuam cov ntshav txhaws nrog qhov muag liab qab, peb yuav pom tias cov duab ntawm cov platelets hloov pauv hauv cov txheej txheem. Lawv tig mus rau hauv cov hlwb sib npaug nrog cov txheej txheem spiny, uas yog qhov tsim nyog rau kev siv zog ntawm kev sib sau ua ke - kev sib koom ua ke ntawm cov ntsiab lus rau hauv ib qho tag nrho.
Tab sis tsis yog tag nrho. Thaum lub sij hawm ua cov txheej txheem, ntau yam tshuaj raug tso tawm los ntawm platelets - catecholamines, serotonin, thiab lwm yam. Vim li no, lub lumen ntawm cov hlab ntsha uas tau raug puas tsuaj nqaim. Dab tsi ua rau muaj kev ua haujlwm ischemia. ntshav txaus nyob rau hauv cov neeg raug mobqhov chaw raug txo. Thiab, raws li, lub outpouring kuj maj mam txo kom tsawg. Qhov no muab lub sijhawm rau platelets los npog thaj chaw puas. Lawv, vim lawv cov txheej txheem spiny, zoo li "txuas" rau cov npoo ntawm collagen fibers uas nyob ntawm cov npoo ntawm qhov txhab. Qhov no xaus rau thawj zaug, qhov ua kom ntev tshaj plaws. Nws xaus nrog kev tsim ntawm thrombin. Qhov no yog ua raws li ob peb feeb ntxiv ntawm theem ntawm coagulation thiab retraction. Thiab theem kawg yog kev kho kom rov zoo li qub ntawm cov ntshav. Thiab nws tseem ceeb heev. Vim qhov mob tag nrho kho tsis tau yog tsis muaj ntshav txaus.
Zoo kom paub
Zoo, qhov no yog qhov ua kom yooj yim cov ntshav coagulation zoo li hauv cov lus. Txawm li cas los xij, muaj qee qhov nuances ntxiv uas kuv xav sau nrog mloog.
Hemophilia. Nws twb tau hais saum toj no. Qhov no yog ib yam kab mob txaus ntshai heev. Tej hemorrhage los ntawm ib tug neeg raug kev txom nyem los ntawm nws yog tej yam nyuaj. Tus kab mob no yog los ntawm keeb kwm, tshwm sim vim qhov tsis xws luag ntawm cov proteins koom nrog hauv cov txheej txheem coagulation. Koj tuaj yeem pom nws yooj yim heev - nrog kev txiav me ntsis, tus neeg yuav poob ntshav ntau. Thiab nws yuav siv sijhawm ntau los nres nws. Thiab tshwj xeeb tshaj yog cov ntaub ntawv hnyav, hemorrhage tuaj yeem pib yam tsis muaj laj thawj. Cov neeg uas muaj hemophilia tuaj yeem ua tsis taus thaum ntxov. Txij li thaum nquag hemorrhages nyob rau hauv cov leeg nqaij (ib txwm hematomas) thiab hauv cov pob qij txha tsis yog qhov tsis tshua muaj. Puas yog kho tau? Nrog kev nyuaj siab. Ib tug neeg yuav tsum tau kho nws lub cev raws li lub cev tsis taus, thiab ib txwm uazoo. Yog tias los ntshav tshwm sim, pub ntshav tshiab uas muaj XVIII yuav tsum tau muab tshuaj sai sai.
Feem ntau cov txiv neej raug tus kab mob no. Thiab cov poj niam ua raws li cov neeg nqa khoom ntawm cov noob hemophilia. Interestingly, British poj huab tais Victoria yog ib tug. Ib tug ntawm nws cov tub kis tus kab mob. Lwm ob yog tsis paub. Txij thaum ntawd los, hemophilia, los ntawm txoj kev, feem ntau hu ua kab mob muaj koob muaj npe.
Tab sis kuj muaj cov xwm txheej rov qab. Qhov no yog hais txog kev nce ntshav txhaws. Yog pom tau, ces tus neeg kuj yuav tsum tau ceev faj tsis pub tsawg. Ua kom cov ntshav txhaws qhia tau tias muaj kev pheej hmoo siab ntawm intravascular thrombosis. Uas txhaws tag nrho cov hlab ntsha. Feem ntau qhov tshwm sim tuaj yeem yog thrombophlebitis, nrog rau kev mob ntawm cov phab ntsa venous. Tab sis qhov teeb meem no yooj yim dua kho. Feem ntau, los ntawm txoj kev, nws tau txais.
Nws yog qhov txaus ntshai npaum li cas tshwm sim hauv tib neeg lub cev thaum nws txiav nws tus kheej nrog daim ntawv. Koj tuaj yeem tham ntev ntev txog cov yam ntxwv ntawm cov ntshav, nws cov coagulation thiab cov txheej txheem uas nrog nws. Tab sis tag nrho cov ntaub ntawv nthuav dav tshaj plaws, nrog rau cov duab kos uas qhia meej meej, tau muab rau saum toj no. Tus so, yog tias xav tau, tuaj yeem saib tus kheej.
