Fibrinolysis tshwm sim hauv lub cev hemostasis, tom qab ntshav coagulation, kom tshem tawm cov ntshav khov ua los ntawm fibrin. Tam sim no muaj ntau qhov ntau, nws tuaj yeem ua rau tsim cov ntshav khov hauv kev ncig nrog qhov tshwm sim txaus ntshai. Kev txhais lus, ua rau thiab kho mob, cia peb nqis peev.

Fibrinolysis yog txheej txheem ntawm kev puas tsuaj uas suav nrog kev sib tawg ntawm cov hlab ntsha hauv cov hlab ntshav raws li kev ua ntawm plasmin. Los ntawm cov txheej txheem no, nws tshem tawm cov fibrin pov tseg hauv cov ntshav thiab yog li ntawd pab tiv thaiv lub cev tiv thaiv kev pheej hmoo ntawm cov ntshav txhaws (ntshav khov).

Plasmin, tsim los ntawm lub siab, yog cov protein tseem ceeb uas ua rau fibrinolysis. Plasmin tau hloov pauv mus rau plasminogen los ntawm cov ntaub so ntswg plasminogen activator (tPA) thiab urokinase.

Plasminogen muaj qhov sib npaug rau fibrin thiab tau sib sau ua ke hauv cov hlab ntshav thaum nws tsim (uas yuav tso cai rau nws tawg tom qab). Kev hloov pauv los ntawm plasminogen mus rau plasmin yuav siv qhov chaw nyob ze rau qhov khov.

Cov kab ke fibrinolytic yuav tsum ua haujlwm nruab nrab ntawm kev tawg ntawm cov hlab ntshav hauv lub cev uas tsim thiab tsis ua rau ntshav thaum cov ntshav txhaws thiab fibrinogen yaj.

Yog tias cov ntshav tawg sai dhau, los ntawm kev kho mob, los ntawm tus kab mob lossis los ntawm qhov txawv txav ntawm hemostasis, nws tuaj yeem ua lub luag haujlwm rau qee zaum los ntshav tseem ceeb.

Muaj ob hom fibrinolysis, thawj thiab theem ob fibrinolysis. Thawj fibrinolysis tshwm sim ib txwm muaj, thiab theem ob fibrinolysis tshwm sim vim qee qhov ua rau sab nraud xws li siv tshuaj lossis kho mob.

Yog tias fibrin muaj nyob hauv ntau ntau, nws tuaj yeem ua rau tsim cov ntshav khov hauv qhov ncig, ua rau muaj kev pheej hmoo ntawm cov hlab ntshav txhaws (phlebitis) lossis hlab ntsha (ischemia).

Kev ua tsis tiav hauv fibrinolysis ua rau thrombophilia ua lub luag haujlwm tsim cov ntshav txhaws ntau dhau:

• Mob hnyav mob plawv (ACS) yog mob hlab ntsha tsis txaus tshwm sim los ntawm ib lossis ntau qhov thaiv cov hlab ntshav hlab ntshav;
• Tsis ntev los no myocardial infarction: kev cuam tshuam hauv thawj peb teev yog qhov zoo dua;
• Ischemic stroke nyob rau theem mob hnyav;
• Pulmonary embolism nrog hemodynamic instability;
• Kev rov kho dua tshiab ntawm kev tiv thaiv kab mob venous catheters (hauv nruab nrab cov hlab ntshav catheters thiab cov hlab ntshav lim ntshav), thaum muaj kev cuam tshuam cuam tshuam nrog kev txhim kho lossis nyuam qhuav tsim thrombus.

Hauv txhua qhov xwm txheej hais los saum no, kev ua ntawm fibrinolytics tsuas yog ua tau zoo nyob ntawm lub sijhawm tswj hwm piv rau qhov pib ntawm thawj cov tsos mob.

Cov txheej txheem kev kho mob tam sim no, fibrinolysis, yuav tsum tau muab sai li sai tau thiab muaj nyob rau hauv kev txhaj tshuaj rau tus neeg mob nrog cov nqaij plasminogen activator uas yuav sim ua kom cov ntshav khov no thiab yog li nqa qhov thaiv ntawm lub nkoj.

Fibrinolytics ua rau kom qhov sib tawg ntawm cov hlab ntshav txhaws thiab ua haujlwm los ntawm kev hloov pauv plasminogen tsis ua haujlwm rau hauv plasmin nquag, ib qho enzyme uas ua lub luag haujlwm rau kev puas tsuaj ntawm fibrin thiab uas yog li ua rau lysis ntawm thrombus.

Peb paub qhov txawv:

• Streptokinase ntawm lub hauv paus chiv keeb yog cov protein tsim los ntawm β-hemolytic streptococcus, yog li ntawm keeb kwm exogenous thiab muaj peev xwm ua rau tsim cov tshuaj tiv thaiv;
• Urokinase yog ib qho protease, ntawm keeb kwm ntuj, uas ua ncaj qha rau ntawm plasminogen;
• Cov txiaj ntsig ntawm cov nqaij mos plasminogen activator (t-PA), tau txais los ntawm kev tshuaj ntsuam genetic recombination los ntawm cov noob encoding t-PA, yuav ncaj qha hloov plasminogen rau hauv plasmin los ntawm kev coj ua ntawm t-PA. T-PA derivatives tau qhia los ntawm rt-PA (alteplase), r-PA (reteplase) thiab TNK-PA (tenecteplase).

  Heparin thiab / lossis tshuaj aspirin feem ntau cuam tshuam nrog kev kho nrog fibrinolytics.

Txoj hauv kev tshawb nrhiav fibrinolysis.

Kev ntsuas thoob ntiaj teb: Lub sijhawm sib xyaw ntawm euglobulins

Cov nag los ntawm euglobulins tso cai sib koom ntawm fibrinogen, plasminogen thiab nws cov protease inhibitor activators. Lub sijhawm ib txwm ntau dua 3 teev tab sis yog lub sijhawm tsawg dua, peb xav tias "hyperfibrinolysis".

Kev tshuaj ntsuam xyuas

• Kev ntsuam xyuas Plasminogen: muaj nuj nqi thiab tiv thaiv kab mob;
• TPA (cov ntaub so ntswg plasminogen) kuaj: cov txheej txheem immunoenzymatic;
• Kev noj tshuaj antiplasmin.

Kev xeem tsis ncaj

• Kev txiav txim siab ntawm fibrinogen: qhov no yog kev ntsuas ncaj qha ntawm fibrinolysis. Nrog qis fibrinogen, "hyperfibrinolysis" xav tias yog;
• Lub sij hawm Reptilase thiab / los yog lub sij hawm thrombin: lawv lengthened nyob rau hauv lub xub ntiag ntawm fibrin degradation khoom;
• Kev txiav txim siab ntawm PDFs (Fibrin thiab fibrinogen degradation khoom): siab nyob rau hauv qhov kev tshwm sim ntawm kev ua kom fibrinolysis;
• Kev ntsuas D-dimer: lawv sib raug rau cov PDF tawg thiab yog qhov siab thaum muaj fibrinolysis.