Tunani: A ƙarƙashin yanayin ilimin halittar jiki na yau da kullun

1. Me yasa jinin da ke gudana a cikin jijiyoyin jini ba ya taruwa?

2. Me yasa jijiyar jini da ta lalace bayan rauni zai iya dakatar da zubar jini?

Da tambayoyin da ke sama, za mu fara karatun yau!

A yanayin da ake ciki na jiki, jini yana gudana a cikin jijiyoyin jinin ɗan adam kuma ba zai yi ambaliya a wajen jijiyoyin jini don haifar da zubar jini ba, haka nan ba zai taru a cikin jijiyoyin jini ba kuma ya haifar da thrombosis. Babban dalili shine jikin ɗan adam yana da ayyuka masu rikitarwa da cikakke na hemostasis da anticoagulant. Idan wannan aikin ya zama ba daidai ba, jikin ɗan adam zai kasance cikin haɗarin zubar jini ko thrombosis.

1. Tsarin zubar jini

Duk mun san cewa tsarin hemostasis a jikin ɗan adam da farko shine matsewar jijiyoyin jini, sannan kuma mannewa, tarawa da kuma sakin abubuwa daban-daban na procoagulant na platelets don samar da embol mai laushi na platelet. Wannan tsari ana kiransa hemostasis mai mataki ɗaya.

Amma, mafi mahimmanci, yana kunna tsarin coagulation, yana samar da hanyar sadarwa ta fibrin, sannan a ƙarshe ya samar da thrombus mai ƙarfi. Wannan tsari ana kiransa hemostasis na biyu.

2. Tsarin haɗin gwiwa

Hadin jini tsari ne da ake kunna abubuwan da ke haifar da hada jini a wani tsari don samar da thrombin, kuma a ƙarshe fibrinogen ya canza zuwa fibrin. Tsarin hada jini za a iya raba shi zuwa matakai uku na asali: samuwar hadadden prothrombinase, kunna thrombin da kuma samar da fibrin.

Abubuwan da ke haifar da coagulation sune sunan gama gari na abubuwan da ke da hannu kai tsaye a cikin coagulation na jini a cikin plasma da kyallen takarda. A halin yanzu, akwai abubuwan da ke haifar da coagulation guda 12 da aka sanya wa suna bisa ga lambobin Romawa, wato abubuwan da ke haifar da coagulation Ⅰ~XⅢ (VI ba a sake ɗaukarsa a matsayin abubuwan da ke haifar da coagulation masu zaman kansu ba), sai dai Ⅳ Yana cikin siffar ionic, sauran kuma sunadaran ne. Samar da Ⅱ, Ⅶ, Ⅸ, da Ⅹ yana buƙatar haɗin VitK.

Dangane da hanyoyi daban-daban na farawa da abubuwan da ke haifar da coagulation, hanyoyin da ake bi don samar da hadaddun prothrombinase za a iya raba su zuwa hanyoyin coagulation na ciki da hanyoyin coagulation na waje.

Hanyar hada jini a cikin jini (gwajin APTT da aka fi amfani da shi) yana nufin cewa duk abubuwan da ke tattare da hada jini a cikin jini sun fito ne daga jini, wanda yawanci yakan fara ne ta hanyar taba jinin da saman jikin da ke dauke da sinadarai marasa kyau (kamar gilashi, kaolin, collagen, da sauransu); Tsarin hada jini da aka fara da fallasa ga sinadarin nama ana kiransa hanyar hada jini a waje (gwajin PT da aka fi amfani da shi).

Idan jiki yana cikin yanayin rashin lafiya, endotoxin na ƙwayoyin cuta, complement C5a, hadaddun garkuwar jiki, ciwon daji na tumor necrosis factor, da sauransu na iya ƙarfafa ƙwayoyin endothelial na jijiyoyin jini da kuma monocytes don bayyana sinadarin nama, ta haka ne ke fara aikin coagulation, wanda ke haifar da diffus intravascular coagulation (DIC).

3. Tsarin hana zubar jini

a. Tsarin antithrombin (AT, HC-Ⅱ)

b. Tsarin Protein C (PC, PS, TM)

c. Mai hana hanyoyin nama (TFPI)

Aiki: Rage samuwar fibrin da kuma rage matakin kunnawa na abubuwa daban-daban na coagulation.

4. Tsarin Fibrinolytic

Idan jini ya taru, ana kunna PLG zuwa PL a ƙarƙashin aikin t-PA ko u-PA, wanda ke haɓaka narkewar fibrin kuma yana samar da samfuran lalata fibrin (proto) (FDP), kuma fibrin mai haɗin gwiwa yana lalacewa azaman takamaiman samfuri. Ana kiransa D-Dimer. Kunna tsarin fibrinolytic galibi an raba shi zuwa hanyar kunnawa ta ciki, hanyar kunnawa ta waje da hanyar kunnawa ta waje.

Hanyar kunnawa ta ciki: Ita ce hanyar PL da aka samar ta hanyar raba PLG ta hanyar hanyar hada jini ta ciki, wacce ita ce tushen ka'idar fibrinolysis na biyu. Hanyar kunnawa ta waje: Ita ce hanyar da t-PA da aka saki daga ƙwayoyin jijiyoyin jini ke raba PLG don samar da PL, wanda shine tushen ka'idar fibrinolysis na farko. Hanyar kunnawa ta waje: Magungunan thrombolytic kamar SK, UK da t-PA waɗanda ke shiga jikin ɗan adam daga duniyar waje na iya kunna PLG zuwa PL, wanda shine tushen ka'idar maganin thrombolytic.

A zahiri, hanyoyin da ke tattare da tsarin coagulation, anticoagulation, da fibrinolysis suna da rikitarwa, kuma akwai gwaje-gwaje da yawa masu alaƙa da dakin gwaje-gwaje, amma abin da muke buƙatar kulawa da shi shine daidaiton yanayin da ke tsakanin tsarin, wanda ba zai iya zama mai ƙarfi ko rauni sosai ba.