Kuyini troponin? Norm, izinkomba main netinchazelo tawo

Ngo-2000, i-European Community nezenhliziyo futhi American College of nezenhliziyo bavumile wokuhlola isilethikusebenza. Ukuze uqinisekise uphethwe wanquma ukusebenzisa ukuhlaziywa ezingeni troponins inhliziyo, njengoba icatshangelwe ethize sitholakele senhliziyo esilimele umonakalo kuka creatine, ngisho ezimeni ezincane necrosis esivimba amanzi.

troponins

Troponin - molecule amaprotheni ehlanganisa subunits ezintathu (T, C, 1). Itholakala kwi kwayo actin ezicutshini infarction futhi uhlanganyela ukusikeka yayo. subunit ngalinye uyasigcwalisa indima yayo eqondile ukulawula umsebenzi imisipha yenhliziyo. Emzimbeni, esikhathini esiningi, wabusa troponin lesibopho. igazi Okuvamile (ng / ml) - 2.0, ngoba amaphesenti ayisithupha kuphela yalezi amaprotheni atholakala kule cytosol.

Lase kwembulwe ukuthi ukubhujiswa cardiomyocytes egazini neuropathy kukhuphuke namazinga kwamafrakshini ezihlukahlukene troponin. Ngezinye izikhathi sibalo ngenhla kuyinsakavukela emakhulwini noma ngisho izinkulungwane zezikhathi.

umsebenzi

Njengoba sekushiwo ngenhla, troponin enamathiselwe tropomyosin amaprotheni. Esimweni ngasebenzi, lapho imisipha ekhululekile, lokhu amaprotheni kuvimbela ukunamathela ka myosin ukuze actin. Lapho engaba isinyathelo ifinyelela imisipha amaseli wathola ion kahle icala ngemigudu calcium cytoplasm cell. Ingxenye calcium unamathele troponin nabangane. Lokhu kuvumela ukufinyelela myosin futhi actin sesigcilikisha imbangela ukusikwa.

Hhayi kuphela myocardium kuyinto troponin. Norm ngibopha salo amaphesenti ayisishiyagalolunye nanhlanu. Ingxenye esele isebujameni khulula noma kwasakazwa nezinye izinhlobo kwemisipha izicubu. Umehluko esiyinhloko siwukuthi ezicutshini lwamathambo troponin subunits wezingane ezine, futhi imisipha yenhliziyo - ezintathu.

izitho zomzimba

Nema zonke izinhlobo imisipha lezonhlelo ngokushintsha lokuhlushwa intracellular calcium ion. Lapho inani lawo likhuphuka, izivumelwano kwemisipha, kanye okuphambene nalokho. I amaprotheni lapho yezinyoni unamathele calcium - kuyinto troponin. indawo kuyinsakavukela yayo ku tropomyosin oluhambisana ubude yokugcina, okungukuthi 40 nanometer.

Troponin has subunits ezintathu, ngamunye ephethe lwenza umsebenzi walo ohlukile. Lapho i-calcium unamathele C-cezu, tropomyosin ku uhamba actin intambo ukuze myosin ungase umjoyine. Uma calcium eyanele, tropomyosin amabhlogo amasayithi asebenzayo futhi kukwenza kungenzeki ukunamathisela myosin myofilaments.

Yamagciwane futhi Histology kwalokho kwatholakala ukuthi troponin 1 suppresses kumiswa imikhumbi igazi. Troponin C sibopha calcium ion, futhi lokhu kubangela izinguquko troponin 1. Troponin T liyadingeka ukuze ukuxhumana tropomyosin futhi troponin 1 sibopha ukuthi actin, futhi kuyasiza uxhumana actin myosin lapho calcium ion in the cytoplasm enganele.

Ukulungiselela kanye nokuhlaziywa izinkomba nenhloso

On ezingeni troponin futhi evamile igazi neuropathy e okusemandleni akhe yahlulelwe ukuhlaziywa ambalwa. Ukuze kwezidingo zayo Akudingi ukulungiselela othize, kodwa, njengoba kuzo zonke izimo of blood donation, kungcono ukukwenza amahora amane emva kokudla.

Uma esibhedlela uthola isiguli acute isilethikusebenza, uye ngokushesha nje ngafakwa ukuhlolwa igazi. Ngokwe-protocol kuyadingeka ukuphinda amahora phezu 4, bese ngokusebenzisa usuku 8. Ngemva troponin eyenziwa kanye ngosuku amasonto amabili. Ngo inqubo yokwelapha yesimanje, izindlela yokunquma inani yalesi amaprotheni ngqo embhedeni usebenzisa ukuhlolwa izinhlelo. A yi negative evumela ukuba ngakususi iziguli enjalo evela kulabo babe sibi syndrome senhliziyo angagcina esikhathini esizayo esiseduze.

definition obengeziwe acute isilethikusebenza (MI), inani troponin ukuhlaziywa kwenziwa ukuhlonza sub-acute ifomu infarction microinfarction, 'ithule "isifo senhliziyo, futhi ukuze kuqashwe izinga yokwelapha thrombolytic kanye umphumela waleso senzo ngqo ka anticoagulants, ezifana heparin.

troponin Ukwandiswa 1

Troponin 1 (evamile serum kanye 0.1 ng / ml) kungase kwandise ngemva ukungenelela kuhlinzwa inhliziyo. Ngakho, nale isitho ukufakelwa troponin lokuhlushwa ukukhuphuka 5 nanograms ngemililitha ngayinye. Lokhu value zingagcinwa isikhathi esingangezinyanga ezintathu.

Okuvuthayo isifo senhliziyo kanye ukulimala kubangela ukukhuphuka kancane ezingeni troponin T, kodwa Dynamics izinguquko zalo egazini sihlukile e MI. Uthola igazi troponin in abesilisa nabesifazane ngokufanayo. Le nkomba awahlobene ubulili kanye neminyaka isiguli. Ngezinye izikhathi kungase kube omuhle test yi zamanga uma isiguli in a state of sibi utshwala ukudakwa.

A ukwanda kancane troponin zingenzeka umonakalo omkhulu kwemisipha lwamathambo. Ukuze uqhathanise, creatine phosphokinase (CPK) kulezi iziguli kwandisa kakhulu, okuholela yokubhalisa engalungile isilethikusebenza.

Acute isilethikusebenza

Troponin 1 (igazi rate 0.1 ng / ml) yisibonakaliso pathognomonic ka-acute isilethikusebenza kuphela uma inani layo lidlula 100 ng / ml, noma enkulu kuno-99 iphesenti senhlobo evamile. Kodwa kuphela ngokuhlangana ne izimpawu zokwelashwa nowezinsimbi of ischemia esivimba amanzi.

Ngenxa yethula zokwelapha zalesi ukuhlaziywa, inani izifo yinhliziyo yanda, njengoba le yokuhlola more sensitive kuka creatine kinase. Ngaphezu kwalokho, ngokuya lenyuka troponin prognostic liyisibonakaliso ezimbi. Abanye abacwaningi baye bame kwelokuthi ubukhulu thrombus ngokuqondile ezilinganiselwe ezingeni troponin ku serum igazi.

Ukwandisa izinga yalesi amaprotheni in iziguli esivimba amanzi eqoshiwe emahoreni ayisithupha ngemva nokuqala kwemihelo-ubuhlungu kuhlasela. izinsuku eziyishumi nane troponin ezingeni ukwehla kancane kancane futhi ubuyele evamile.

Sibi syndrome senhliziyo

Jwayelekile igazi troponin nge acute yenhliziyo syndrome (ACS) oluhambisana ukuthi isilethikusebenza futhi kusuka 50 kuya 100 ng / ml. Ukwandisa amaprotheni ACS kusivumela ukuhlukanisa i-angina engazinzile. Ngezikhathi ezithile, iziguli ezinemishini izimpawu zokwelashwa ejwayelekile futhi kuphakeme troponin amazinga angiography yenhliziyo ongabhalisiwe eziwukwephulwa okukhulu hemodynamics. Isizathu salokhu mkhuba - nokuguqulwa kumiswa zingcwecwe okuyinto ancibilikisa ngesikhatsi ukwelashwa thrombolytic. Imfundiso wesibili uthi ihlule nje lize liba ngaphansi kwe ezitsheni, akuyona ebonakalayo esikrinini.

Percutaneous kokungenela yenhliziyo

Troponin (kuyinsakavukela ukuba 2.0 ng / ml) ukuthi kancane lenyuka emva angioplasty noma stent ukubekwa. Ososayensi baye Akungabazeki ukuthi amaprotheni, okuyinto zinqunywa, iphuma cardiomyocytes. Isizathu ukuthi isikhathi ischemia yabo ukubukeka odlulayo, okuyinto kubangelwa uqhumise ibhaluni clamping imithambo yenhliziyo.

Ngisho esimweni ezibuhlungu micro babe troponins ebucayi kakhulu infarction, okuyinto, Yebo, njengoba kubonakala kula neuropathy segazi. Kodwa, ngaphezu kwakho konke, lokho kuyinkomba yokuthi leyompahla in iziguli ingozi efanayo amazinga aphezulu izinguquko iphrotheni ukuthuthukiswa syndrome senhliziyo futhi isilethikusebenza. Ngeshwa, izinombolo ezithile, odokotela abakwazanga ukuqondiswa izibikezelo alikho. Ezinye inkulumo mayelana pathophysiology ukunikela isilethikusebenza lapho ezingeni troponin kudlulwe izikhathi ezingaphezu kwezintathu.

ukuhlinzwa

Troponin (kuyinsakavukela ukuba 2.0 ng / ml) lenyuka emva ukuhlinzwa olukhulu ku imisipha yenhliziyo. Lokhu kungenxa amaphutha nezenzo cardioprotective. Ngo theory, kufanele avikele umzimba sesiguli hypoxia, kodwa umkhuba lokhu akukhona ngamaphesenti ayikhulu njalo. Kodwa hhayi kuzo zonke izimo okwandisa troponin kufanele abhekwe njengendoda infarction perioperative esivimba amanzi.

Kuzobakhuthaza wayazisa imali kanye nesikhathi ukusebenza, kanye ezingeni kokuqala amaprotheni. Sifo "isilethikusebenza" kungenzeka kuphela ngokususa khona emitholampilo, laboratory kanye izimpawu wezinsimbi kanyekanye.

nezinye isimo

Ukuhlola okuhlukahlukene isikuqinisekisile yokuthi troponin (evamile 2.0 ng / ml) uphawu ethize kakhulu ka isilethikusebenza. Kodwa zikhona eziningi izimo zokucabanga okubangelwa isifo, nayo ephelezelwa ukwanda inani le iphrotheni esegazini neuropathy. Lezi zihlanganisa sepsis, embolism yamaphaphu (PE), ukuhluleka kwenhliziyo, ukuvuvukala isikhwama senhliziyo, myocarditis, ezingamahlalakhona ukwehluleka kwezinso, umsebenzi ngokweqile, inhliziyo ukufakelwa, ngelashwa nangemithi.

Lesi simo esiyingqayizivele sibangelwa kubangelwa imfiva, tachycardia, hypoxia, ukunikezwa kwe-microvasculature, nokunciphisa ingcindezi futhi igazi. Konke lokhu kuholela ischemia esivimba amanzi nokubhujiswa cardiomyocytes, elibangela ukwanda troponin.

1 noma troponin T

Jwayelekile igazi troponin ukuba 2.0 ng / ml, kodwa zikhona izindlela ezihlukahlukene sokunquma kukhishwa nezingxenyana ezithile troponin namuhla. It is uvunyelwe ukunquma ngokunembile kabanzi umonakalo myocardium. Kwaphela ucwaningo luye lwabonisa ukuthi troponin-T usengozini yokuthola nokwehluleka ukusebenza kwezinso, le troponin 1, kodwa neminye imingcele zifana, ngakho kufanele ukubaluleka efanayo yokuhlola.

I engavamile troponin T in lokuthi sibangela kit zokuxilonga ngenxa yokuma eyodwa kuphela, kuyilapho troponin 1, zikhona izinhlelo test ambalwa. Ngenxa yalokhu, kungase kube khona ubunzima uqhathanisa imiphumela. Kodwa odokotela ozama ukuletha indlela efanayo ngawo iwukudambisa umehluko Imiphumela phakathi ezahlukene imingcele labolatoriya.