Yintoni troponin? Liyana, izalathisi eziphambili kunye neentsingiselo zawo

Ngo-2000, i-European Community Cardiology kunye American College of Cardiology sivumelene lokufunyaniswa iposi engabalulekanga. Ukuze uqinisekise uxilongo isigqibo ukusebenzisa uhlahlelo umgangatho troponins kwentliziyo, njengokuba kubhaliwe ingqalelo ngakumbi ngenxa uxilongo komonakalo umsipha ngaphezu creatine, nokuba kwiimeko necrosis minor engabalulekanga.

troponins

Troponin - molecule protein eliquka subunits ezintathu (T, C, 1). Oku kubekwe phezu kwayo actin kwi iposi kwezihlunu kwaye inxaxheba amanxeba ayo. enganeno nganye uzalisekisa indima yayo ezithile elawula umsebenzi imisipha yenhliziyo. Emzimbeni, kuba becala, alawule troponin ebophe. igazi Eqhelekileyo (ng / ml) - 2.0, ngokuba amathandathu ekhulwini kuphela ezi iiproteni ziyafumaneka kwi cytosol.

Batyhilelwa ukuba ukutshatyalaliswa cardiomyocytes egazini peripheral kumanqanaba iincindi eziliqela ze troponin. Ngamanye amaxesha nani phezu sisithethe kwi amakhulu okanye amawaka amaxesha.

umsebenzi

Njengoko sele kukhankanyiwe ngentla apha, troponin edityaniswe tropomyosin protein. Kwimeko opholileyo, xa izihlunu ekhululekile, le iproteni kuthintela ezizigwagwisa myosin ukuya actin. Xa amandla intshukumo ifikelela iiseli izihlunu wafumana ion ngokuqinisekileyo kuhlawuliswa ngokusebenzisa amajelo calcium esiseleni kukho icytoplasm. Inxalenye calcium iqhotyoshelwe troponin kunye nabo. Oku kukuvumela ukufikelela kwi myosin kunye actin kwayo kubangela ukusikwa.

Akukho kuphela myocardium yi troponin. Liyana ndibopha yayo asithoba anesihlanu ekhulwini. Inxalenye eseleyo sikwimo simahla okanye yathunyelwa kwezinye iintlobo esiqwini kwezihlunu. Umahluko ophambili kukuba umsipha skeletal troponin subunits ezine, yaye imisipha intliziyo - ezintathu.

zomzimba

Nema zonke iindidi izihlunu kuququzelelwa ngokutshintsha lwee- ion calcium intracellular. Xa inani labo liyanda, izivumelwano izihlunu, kwaye vice versa. Neprothini apho ebuhlanti iqhotyoshelwe apha calcium - i troponin. indawo norm yayo kwi tropomyosin ingqinelana nobude yokugqibela, oko kukuthi neenanometer 40.

Troponin uye subunits ezintathu, nganye eneyazo umsebenzi walo. Xa calcium iqhotyoshelwe kwi-C-ngqangi, tropomyosin phezu lihamba actin cingwana ukuya myosin ukuba azibandakanye naye. Ukuba calcium ngokwaneleyo, iibhloko tropomyosin sites esebenzayo kwaye kwenza kube nzima ukuba qhoboshela myosin myofilaments.

Of eziphilayo kunye histology kwakhona lwafumanisa ukuba troponin 1 ayisayicinezeli ukuyilwa iimpahla ezintsha yegazi. Troponin C ubophelela ion calcium, yaye oku kubangela utshintsho troponin 1. Troponin T siyafuneka ukuze banxibelelane tropomyosin kunye troponin 1 enebana actin, kwaye kuyanceda ukuba basebenzisane kunye actin myosin xa ion calcium kwi icytoplasm ayonelanga.

Ukulungiswa kunye nohlahlelo okukhomba ukuba injongo

Kwinqanaba troponin negazi eziqhelekileyo neuropathy yakhe ephambili kugwetywa uhlalutyo oluninzi. Kuba zayo ayidingi ukulungiselela ethile, kodwa ke, njengokuba kunjalo kuwo onke amatyala blood donation, kungcono ukwenza oko iiyure ezine emva kokutya.

Ukuba esibhedlele ufumana ngomonde iqhosha etsolo engabalulekanga, iye yathathwa uvavanyo lwegazi. Ngokutsho protocol kuyimfuneko ukuba siphinda-4 iiyure, uze emva koko nge imini 8. Emva troponin wenziwe kanye ngemini iiveki ezimbini. Xa amayeza mihla, iindlela yokuqingqa inani le protini ngqo kwi kwebhedi ngokusebenzisa iinkqubo zovavanyo. Isiphumo esibi uvumela ukuba ngaphandle izigulane ezifana ukusuka abo syndrome coronary etsolo basenokuba kwixa elizayo.

eluchaza of iqhosha etsolo engabalulekanga (MI), inani analysis troponin kwenziwa ukuchonga sub-aksenti ifom iqhosha microinfarction, "cwaka" ukuhlaselwa yintliziyo, kwaye kananjalo ukuba esweni umgangatho unyango thrombolytic kunye nefuthe isenzo ngqo anticoagulants, ezifana lweeHedfowuni.

troponin Ukwandiswa 1

Troponin 1 (normal serum kunye 0.1 ng / ml) kungandisa emva kokuba ungenelelo zotyando entliziyweni. Ngoko ke, nale abohlukeneyo troponin xi ukunyuka ukuya nanograms-5 milliliter nganye. Eli xabiso zingagcinwa ukuya kwiinyanga ezintathu.

isifo sentliziyo yokukrala kunye nomenzakalo ebangela ukunyuka okungephi kwinqanaba troponin T, kodwa Dynamics utshintsho zalo egazini yahlukile kuloo MI. Ummiselo egazini troponin kumadoda nabafazi ngokufanayo. Esi salathisi akazalani isini okanye ubudala isigulane. Maxa wambi kusenokubakho ubuxoki uvavanyo result HIV ukuba isigulane sikwimo kunxilwe utywala ahlekise.

A ukunyuka okungephi xa troponin kunokwenzeka kunye umonakalo omkhulu ukuya umsipha skeletal. Thelekisa, creatine phosphokinase (CPK) kwezi zigulane kwandisa kakhulu, nto leyo ubhaliso engachanekanga iposi engabalulekanga.

iqhosha Acute engabalulekanga

Troponin 1 (umyinge igazi 0.1 ng / ml) na umqondiso pathognomonic ahlekise iposi engabalulekanga kuphela xa ixabiso layo lidlula 100 ng / ml, nengaphezu kwe-99 percentile uluhlu yesiqhelo. Kodwa kuphela kunye neempawu zeklinikhi isisixhobo of ischemia engabalulekanga.

Ngenxa ziqaliswe yezonyango kolu hlahlelo, inani iSifo of isifo sentliziyo kakhulu, ekubeni olu vavanyo sensitive ngaphezu creatine kinase. Ngaphezulu, ngokubhekiselele eyandileyo troponin prognostic ingumqondiso negative. Abanye abaphandi bathi ukuba ubukhulu thrombus kuba umlinganiselo ngqo umgangatho troponin kwi serum egazini.

Ukwandisa izinga le iiprothini izigulane engabalulekanga abhalwe kwiiyure ezintandathu emva kokuqala yokuhlaselwa intlungu. iintsuku ezilishumi elinesine troponin ukuy kwinqanaba aqhubele ubuyele esiqhelweni.

Ezifo ivaleke syndrome

igazi troponin yesiqhelo kunye acute coronary syndrome (ACS) ingqinelana ukuba iposi engabalulekanga kwaye ukusuka 50 ukuya 100 ng / ml. Ukwandisa protein ACS ivumela ukuba umahluko angina ezingazinzanga. Maxa wambi, izigulane ezineempawu ezithile zekliniki kunye namanqanaba troponin esiphakamileyo angiography coronary akabhaliswanga yanyhashwa of hemodynamics. Isizathu sale meko - kulogo ukubunjwa umonakalo leyo kwakhawuleza ngexesha unyango thrombolytic. Le mbono yesibini ubanga ukuba ihlwili nje iwela ngaphantsi ezityeni, kwaye ibonakale kwikhusi.

ukungenelela Percutaneous ivaleke

Troponin (norm ku 2.0 ng / ml) yanyuswa kancinane emva angioplasty okanye stent ukufakwa. Oosonzululwazi Akukho mathandabuzo ukuba iiproteni, ekuye kwagqitywa, iphuma cardiomyocytes. Isizathu kukuba ixesha ischemia bavela edlulayo, nto leyo ibangelwa wakrwada ibhaluni kunye nokubotshwa imithambo yenhliziyo.

Nokuba kwimeko unxinzelelo micro baba troponins ezibuthathaka kakhulu iqhosha, leyo, Kakade ke, kubonakala neuropathy wegazi. Kodwa ke, ngaphezu kwabo bonke, oko kubonisa ukuba izigulane kunye nengozi efanayo kumanqanaba aphezulu utshintsho iiprothini kuphuhliso syndrome coronary kunye iposi engabalulekanga. Ngelishwa, amanani ezithile, apho oogqirha ukuba kukhokelwa iingqikelelo zabo akakho. Abanye intetho malunga pathophysiology zinika iposi engabalulekanga xa inqanaba troponin ngaphaya izihlandlo ezingaphezu kwezintathu.

utyando

Troponin (norm ku 2.0 ng / ml) landa emva utyando olukhulu kwi imisipha intliziyo. Oku kungenxa iintsilelo izenzo cardioprotective. Ngethiyori, bathi bekufanele ukuba ukukhusela emzimbeni ngokuthi hypoxia, kodwa practice oku akusoloko nekhulu ekhulwini. Kodwa hayi kuzo zonke iimeko ezandayo troponin kufuneka ithathwe njenge iqhosha perioperative engabalulekanga.

Iya kuthakazelelwa imali kunye nexesha lo msebenzi, kwakunye kwinqanaba lokuqala kwiproteni. Uxilongo "iposi engabalulekanga" kunokwenzeka kuphela bubukho lwezonyango, elebhu kunye nemiqondiso zomculo ngaxeshanye.

elinye ilizwe

izifundo ezininzi yaqinisekisa ukuba troponin (eliqhelekileyo 2.0 ng / ml) yi isiphawuli kakhulu ethile iposi engabalulekanga. Kodwa kukho inani iimeko lwezidumbu, ezo kwakhona sikhatshwe kukwanda kwimali le protini egazini peripheral. Ezi ziquka nokudumba, Embolism pulmonary (eBhayi), ukusilela intliziyo, ukudumba kwisingxobo intliziyo, myocarditis, ukusilela ezondeleyo kwezintso, umthambo ngokugqithiseleyo, abohlukeneyo intliziyo, ichemotherapy.

Le nto ke ibangwa ifiva, tachycardia, hypoxia, yaphula microvasculature, ukunciphisa uxinzelelo kunye nezinye. Konke oku kukhokelela ischemia engabalulekanga nokonakaliswa cardiomyocytes, nto leyo ebangela ukwanda troponin.

1 okanye troponin T

igazi troponin eqhelekileyo 2.0 ng / ml, kodwa kukho iindlela ezahlukahlukeneyo yokuqingqa amaqhezu troponin namhlanje. Kuvumelekile ukuba ukubonisa ngokuchanekileyo ukuba lingakanani na umonakalo myocardium. Ngokuba inani lezifundo luye lwabonisa ukuba troponin-T uthambekele ngakumbi ukusilela kwezintso, lo troponin 1, kodwa ezinye i parameters ezifanayo, benjenjalo ixabiso efanayo diagnostic.

Le peculiarity of troponin T kwinto yokuba uvelisa ikhithi zokuxilonga ngokuqinileyo omnye kuphela, ngoxa troponin 1, kukho iinkqubo zovavanyo ezininzi. Ngenxa yoko, kusenokubakho abathile ubunzima ngokuthelekisa iziphumo. Kodwa abezonyango abazama ukuzisa indlela efanayo ngazo Nokwethisa umahluko kwiziphumo phakathi parameters ezahlukeneyo labolatoriya.