Troponin ndi chiyani? Linalake, zowonetsera ndi matanthauzo

Mu 2000, European Community Cardiology ndi College American wa Cardiology agwirizana pa matenda a infarction m'mnyewa wamtima. Kutsimikizira matenda anaganiza ntchito kusanthula mlingo wa troponins mtima, monga amaona kutchula kwa matenda a mtima minofu kuwonongeka kuposa creatine, ngakhale milandu laling'ono m'mnyewa wamtima necrosis.

troponins

Troponin - mapuloteni molekyulu ongokhala subunits atatu (T, C, 1). Malowa ali pamtunda pa filaments akitini mu minofu infarction ndi mtsikanayu mabala ake. Lililonse kagawo kakang'ono akukwaniritsa udindo yake yeniyeni mu malamulo ntchito za minofu mtima. Mu thupi, ku mbali yaikulu, kutsogozedwa omangidwa troponin. Normal magazi (ng / ml) - 2.0, chifukwa pafupifupi isanu ndi umodzi mapuloteni amenewa akupezeka cytosol lapansi.

Zinawululidwa kuti chiwonongeko cha cardiomyocytes mu magazi zotumphukira kuchuluka misinkhu ya tuzigawo twa zosiyanasiyana troponin. Nthawi zina chithunzi pamwambapa ponseponse mu mazanamazana ngakhalenso zikwizikwi za nthawi.

ntchito

Monga tanenera kale pamwambapa, troponin Ufumuyo mapuloteni tropomyosin. Mu boma wofooka, pamene minofu ndi omasuka, mapuloteni izi kumathandiza kutsatira wa myosin kuti akitini. Pamene kanthu angathe ukufika ena a minofu analandira ayoni ndithu mlandu kudzera njira kashiamu mu cytoplasm selo. Part kashiamu ndi Ufumuyo troponin ndi anzake. Zimenezi zimathandiza mwayi kwa myosin ndi akitini filaments chifukwa chidule.

Osati myocardium ndi troponin. Wakudziko kumanga ake ndi nainte-faifi. Mavesi ndi mu mkhalidwe ufulu kapena kufalitsidwa ku mitundu ina ya minofu minofu. Kusiyana kwambiri ndi mu minofu chigoba troponin subunits zinayi, ndi minofu mtima - atatu.

Maphunziro Akakhalidwe Kazolengedwa

Acronyms mitundu yonse ya minofu ndi mgwirizano ndi kusintha ndende ya ayoni okhudza maselo ambiri calcium. Pamene chiwerengero chawo chinawonjezeka zosiyanasiyana minofu, ndi mosemphanitsa. Mapuloteni kumene khola amamangiriridwa kashiamu - ndi troponin. malo ponseponse ake tropomyosin limafanana ndi kutalika kwa otsiriza, ndicho nanometers 40.

Troponin ali subunits atatu, omwe ndi ntchito yake. Pamene kashiamu amamangiriridwa ku C-mpukutu, tropomyosin pa akitini filament chimachititsa kuti myosin akhoza nayenso. Ngati kashiamu zokwanira, tropomyosin midadada malo yogwira ndi kukhala kosatheka angagwirizanitse kwa myosin myofilaments.

Wa tizilombo tosaoneka ndi maso ndi histology anapezanso kuti troponin 1 limaleka mapangidwe ziwiya latsopano magazi. Troponin C chimamanga kashiamu ayoni, ndipo zimenezi zimachititsa kusintha troponin 1. Troponin T chofunika kulankhula ndi tropomyosin ndi troponin 1 chimamanga kuti akitini, ndipo kumathandizanso kucheza ndi akitini myosin pamene kashiamu ayoni mu cytoplasm ndi osakwanira.

Kukonzekera ndi kusanthula mwa zizindikiro ndi cholinga

Pa mlingo wa troponin ndi wabwinobwino magazi zotumphukira mwa ubwino wake adzaweruzidwa ndi kusanthula kachulukidwe. Yobereka ake sikutanthauza kukonzekera mwachindunji, koma, ngati milandu onse chopereka magazi, ndi bwino kuchita izo mu maora anayi mutadya.

Ngati kuchipatala amalandira wodwala ndi pachimake m'mnyewa wamtima infarction, iwo nthawi yomweyo anatenga magazi. Malinga ndi protocol wa m'pofunika kubwereza pa 4 maola, kenako kupyolera tsiku 8. troponin ikuchitika kamodzi pa tsiku kwa masabata awiri. Mu mankhwala amakono, njira kudziwa kuchuluka kwa mapuloteni chimenechi pa bedi ntchito machitidwe mayeso. Chifukwa zoipa zimathandiza kuti achotse odwala otero ochokera kwa amene ali pachimake inatsekeratu syndrome angathe posachedwapa.

tanthauzo Komanso wa pachimake m'mnyewa wamtima infarction (MI), chiwerengero cha kusanthula troponin zachitika kudziwa boma pachimake mawonekedwe infarction microinfarction, "chete" vuto la mtima, ndiponso kuyan'ana khalidwe la mankhwala thrombolytic ndi zotsatira za mwachindunji wa anticoagulants, monga heparin.

Kuchuluka troponin 1

Troponin 1 (yachibadwa seramu ndi 0,1 ng / ml) achuluke pambuyo zikunena opaleshoni pa mtima. Motero, izi limba kupatsidwa zina troponin ndende ukuwonjezeka kuti nanograms 5 pa milliliter. Khalidwe limeneli akhoza kusungidwa kwa miyezi itatu.

Yotupa matenda a mtima ndi kuvulala amachititsa kuwonjezeka pang'ono mlingo wa troponin T, koma mphamvu ya kusintha ake m'magazi isiyana kuti MI. Ponseponse mu troponin magazi a amuna ndi akazi mofanana. chizindikiro Izi sizikugwirizana ndi akazi kapena amuna kapena m'badwo wa wodwalayo. Nthawi zina zikhoza kukhala wabodza zabwino chifukwa mayeso ngati wodwalayo mu mkhalidwe kuledzera pachimake mowa.

A kuwonjezeka pang'ono troponin n'zotheka ndi kuwonongeka chachikulu kwa minofu chigoba. Yerekezerani creatine phosphokinase (CPK) odwala awa kumawonjezera kwambiri, chifukwa mu kulembetsa pachithunzichi wa infarction m'mnyewa wamtima.

Pachimake m'mnyewa wamtima infarction

Troponin 1 (mlingo magazi 0,1 ng / ml) ndi pathognomonic chizindikiro cha pachimake m'mnyewa wamtima infarction pokhapokha ngati mtengo wake kuposa 100 ng / ml, kapena kuposa 99 percentile cha uthunthu yachibadwa. Koma molumikizana ndi zizindikiro matenda zoimbidwa wa ischemia m'mnyewa wamtima.

Chifukwa cha oyamba mu ntchito zachipatala a kusanthula izi, chiwerengero cha diagnoses a mtima kuchuluka, kuyambira yesero ili ndi tcheru koposa creatine kinase. Komanso, mwa mawu a kuchuluka troponin prognostic ndi chizindikiro chochotsera. Akatswiri ena amanena kuti thrombus kukula ndi mwachindunji njila kwa mlingo wa troponin mu seramu magazi.

Kuwonjezeka mlingo zomanga thupi ili odwala ndi m'mnyewa wamtima olembedwa pasanathe maola asanu pambuyo isanayambike ululu kuukira. Fortini masiku troponin mlingo pang'onopang'ono m'tali ndipo amabwerera yachibadwa.

Pachimake inatsekeratu syndrome

Normal magazi troponin ndi pachimake inatsekeratu syndrome (ACS) limafanana kuti infarction m'mnyewa wamtima ndi 50 100 ng / ml. Kuwonjezeka mapuloteni ACS amatilola kusiyanitsa ku wosakhazikika angina. Nthawi zina odwala ndi zizindikiro mmene matenda ndi milingo okwera troponin mu angiography inatsekeratu si mayina kuswa wa hemodynamics. Chifukwa cha ichi chodabwitsa - mowiriza mapangidwe mipukutuyi omwe amasungunula pa chithandizo thrombolytic. The Ofufuza amanena kuti aumirira chabe kugwa m'munsimu zida, ndipo kulibe kuonekera pa TV.

Percutaneous inatsekeratu alowererepo

Troponin (ponseponse kuti 2.0 ng / mL) anali pang'ono kuchuluka pambuyo angioplasty kapena stent Kusinthaku. Asayansi mosakayikira kuti mapuloteni, amene anatsimikiza, anatuluka cardiomyocytes lapansi. chifukwa ndi nthawi yawo ischemia maonekedwe likadutsa, amene amayamba ndi kumafufuma pa zibaluni ndi clamping mitsempha inatsekeratu.

Ngakhale pa nkhani ya mabvuto yaying'ono anali ankaganizira kwambiri troponins infarction, amene, ndithudi, zikupezeka mu magazi okwanira zotumphukira. Koma koposa zonse, izo zikusonyeza kuti odwala ndi chiopsezo chimodzimodzi mpweya wambiri wa kusintha mapuloteni mu chitukuko cha matenda inatsekeratu ndi m'mnyewa wamtima infarction. Mwatsoka, manambala enieni, limene madokotala akhoza azivala Zoneneratu awo kulibe. Ena nkhani za pathophysiology atakupatsani m'mnyewa wamtima infarction pamene mlingo troponin kuposa maulendo atatu.

opaleshoni

Troponin (ponseponse kuti 2.0 ng / ml) kuchuluka pambuyo opaleshoni kwakukulu pa minofu mtima. Ichi ndi chifukwa zolakwa zochita cardioprotective. Akuti, iwo akuyenera kuteteza thupi wodwalayo ndi hypoxia, koma kuchita zimenezi nthawi zana pa zana. Koma si milandu onse kuwonjezeka troponin ayenera kuonedwa ngati perioperative m'mnyewa wamtima infarction.

Adzakhululukidwa anayamikira ndalama ndi nthawi ya opaleshoni, komanso mlingo woyambilira wa mapuloteni a. Matendawa "m'mnyewa wamtima infarction" zimatheka ndi kukhalapo kwa matenda, zasayansi ndi zizindikiro malangizo imodzi.

boma ena

maphunziro ambiri anatsimikizira chakuti troponin (yachibadwa 2.0 ng / ml) ndi chikhomo kwambiri enieni infarction m'mnyewa wamtima. Koma pali mikhalidwe pathological, amenenso ali limodzi ndi kuwonjezeka mu kuchuluka kwa mapuloteni izi magazi zotumphukira. Zikuphatikizapo sepsis, embolism m'mapapo mwanga (Pe), matenda a mtima, kutupa thumba mtima, myocarditis, aakulu kulephera aimpso thupi kwambiri, mtima kupatsidwa zina, mankhwala amphamvu.

chodabwitsa chifukwa cha malungo, tachycardia, hypoxia, kuphwanya microvasculature ndi, kucheperachepera kuthamanga ndi magazi m'thupi. Zonsezi kumabweretsa ischemia m'mnyewa wamtima ndi chiwonongeko cha cardiomyocytes, zomwe zimabweretsa kuwonjezeka troponin.

1 kapena troponin T

Normal magazi troponin kwa 2.0 ng / ml, koma pali njira zosiyanasiyana kudziŵa tuzigawo twa a troponin lero. Iwo amaloledwa molondola kwambiri kudziwa kuwonongeka kwa myocardium lapansi. Kwa Kafukufuku wasonyeza kuti troponin-T ndi kuti atengeke kulephera impso, ndi troponin 1, koma magawo ena ofanana, kotero chimodzimodzi matenda phindu.

The peculiarity wa troponin T mu choona kuti amapangira zida matenda chifukwa cha kutsimikiza chimodzi chokha, pamene troponin 1, pali machitidwe angapo mayeso. Chifukwa cha ichi, pangakhale vuto kuyerekeza zotsatira. Koma clinicians akuyesera kubweretsa chilinganizo umenewu ndi umene kuti n'chongoletsa kusiyana zotsatira mwa magawo osiyana labolatoriya.