Fibrinolysis e etsahala ka hemostasis ea 'mele, ka mor'a ho kopana ha mali, ho felisa lesela la hemostatic le entsoeng ke fibrin. Ha e le teng ka bongata haholo, e ka lebisa ho thehoeng ha leqeba phallong ea mali ka likotsi tse hlahang. Tlhaloso, lisosa le liphekolo, ha re hlahlobeng lintlha.

Fibrinolysis ke ts'ebetso ea timetso e kenyelletsang ho qhibiliha ha maqeba a intravascular tlas'a ketso ea plasmin. Ka ts'ebetso ena, e tlosa ho potoloha ha litšila tsa fibrin maling 'me ka hona e thusa ho sireletsa' mele khahlanong le kotsi ea thrombosis (blood clot).

Plasmin, e hlahisoang ke sebete, ke protheine e ka sehloohong e etsang hore fibrinolysis e sebetse. Plasmin e fetoleloa ho plasminogen ka li-tissue plasminogen activator (tPA) le urokinase.

Plasminogen e na le concordance bakeng sa fibrin 'me e bokelloa ka lesela nakong ea ho thehoa ha eona (e tla lumella hore e robehe hamorao). Phetoho ho tloha ho plasminogen ho ea ho plasmin e etsahala haufi le lesela.

Sistimi ea fibrinolytic e tlameha ho tsamaea lipakeng tsa ho pshatla maqeba a intravascular a hlahang le hore a se ke a tsoa mali ha mali a hemostatic le fibrinogen a qhibiliha.

Haeba lesela le qhibiliha ka potlako, ka phekolo, ka lefu kapa ka ho se tloaelehe ha haemostasis, joale le ka ikarabella bakeng sa ho tsoa mali ka linako tse ling.

Ho na le mefuta e 'meli ea fibrinolysis, fibrinolysis ea mantlha le ea bobeli. Fibrinolysis ea mantlha e hlaha ka tlhaho, 'me fibrinolysis ea bobeli e hlaha ka lebaka la sesosa se itseng sa kantle joalo ka meriana kapa boemo ba bongaka.

Haeba fibrin e le teng ka bongata haholo, e ka etsa hore ho thehoe leqeba phallo ea mali, ho baka likotsi tsa venous thrombosis (phlebitis) kapa arterial (ischemia).

Bofokoli ba fibrinolysis bo lebisa ho thrombophilia e ikarabellang bakeng sa sebopeho se feteletseng sa mali a behang bophelo kotsing:

• Acute coronary syndrome (ACS) ke ho se sebetse hantle ha pelo ho bakoang ke methapo e le 'ngoe kapa tse ngata tse koetsoeng;
• Haufinyane tjena myocardial infarction: ho kenella ka hare ho lihora tse tharo tsa pele ho molemo;
• Ischemic stroke nakong ea lefu la tsoekere;
• Embolism ea pulmonary e nang le ho se tsitse ha hemodynamic;
• Ho tsosolosoa ha patency ea li-catheter tsa venous (li-catheter tse bohareng tsa venous le dialysis catheters), ha ho e-na le tšitiso e amanang le thrombus e ntseng e hōla kapa e sa tsoa thehoa.

Maemong 'ohle a boletsoeng ka holimo, ketso ea fibrinolytics e tla sebetsa feela ho itšetlehile ka nako ea tsamaiso ha e bapisoa le ho qala ha matšoao a pele.

Ka hona, phekolo e tloaelehileng ea hona joale, fibrinolysis, e tlameha ho fanoa kapele kamoo ho ka khonehang 'me e kenyelletsa ho kenya mokuli ka mochine oa plasminogen activator e tla leka ho qhaqha lesela lena' me kahoo e phahamise tšitiso ea sekepe.

Fibrinolytics e potlakisa ho qhibiliha ha methapo ea methapo 'me e sebetsa ka ho fetola plasminogen e sa sebetseng hore e be plasmin e sebetsang, e leng enzyme e ikarabellang bakeng sa ho senyeha ha fibrin 'me kahoo e baka lysis ea thrombus.

Re khetholla:

• Streptokinase ea tlhaho ea tlhaho ke protheine e hlahisoang ke β-hemolytic streptococcus, ka hona ea tlhaho e sa tloaelehang ebile e khona ho etsa hore ho thehoe li-antibodies;
• Urokinase ke protease, ea tlhaho ea tlhaho, e sebetsang ka ho toba ho plasminogen;
• Li-derivatives tsa tissue plasminogen activator (t-PA), tse fumanoang ka ho kopanya liphatsa tsa lefutso ho tloha ho gene encoding t-PA, li tla fetola plasminogen ka ho toba hore e be plasmin ka ho etsisa ketso ea t-PA. Li-derivatives tsa t-PA li bontšoa ke rt-PA (alteplase), r-PA (reteplase) le TNK-PA (tenecteplase).

  Heparin le / kapa aspirin hangata li amahanngoa le kalafo ka fibrinolytics.

Mekhoa ea ho hlahloba fibrinolysis.

Liteko tsa lefats'e: Nako ea ho felisoa ha li-euglobulins

Pula ea li-euglobulins e lumella ho arolelana fibrinogen, plasminogen le li-activator tsa eona tsa protease inhibitor. Nako e tloaelehileng e kholo ho feta lihora tse 3 empa ha ho na le nako e fokolang, re belaela "hyperfibrinolysis".

Litlhahlobo tsa tlhahlobo

• Tlhahlobo ea Plasminogen: tshebetso le immunological;
• TPA (lithapo tsa plasminogen) tlhahlobo: mekhoa ea immunoenzymatic;
• Tekanyetso ea antiplasmin.

Liteko tse sa tobang

• Boikemisetso ba fibrinogen: ena ke tlhahlobo e sa tobang ea fibrinolysis. Ka fibrinogen e tlaase, "hyperfibrinolysis" e belaelloa;
• Nako ea Reptilase le / kapa nako ea thrombin: li lelefalitsoe ka pel'a lihlahisoa tsa ho senyeha ha fibrin;
• Boikemisetso ba li-PDF (lihlahisoa tsa ho senyeha ha Fibrin le fibrinogen): holimo ha ho etsoa ts'ebetso ea fibrinolysis;
• D-dimer assay: li lumellana le likaroloana tsa PDF 'me li phahame ha ho etsoa fibrinolysis.