Mene ne troponin? Na kullum, babban Manuniya da wurãrenta

A 2000, da Turai Community Cardiology da American College of Cardiology sun amince a kan ganewar asali da tsokar zuciya infarction. Don tabbatar da ganewar asali yanke shawarar amfani da bincike na matakin na cardiac troponins, kamar yadda aka gani mafi takamaiman ga ganewar asali na zuciya tsoka lalacewa fiye da creatine, har ma a lokuta da qananan tsokar necrosis.

troponins

Troponin - sunadarin ya kunshi uku subunits (T, C, 1). An located a kan actin filaments a tsoka infarction, kuma ya taimaka ta cuts. Kowane subunit cika ta musamman rawa a gudãnar da ayyukan zuciya tsoka. A cikin jiki, domin mafi yawan bangare, mamaye mamaye troponin. Al'ada jini (ng / ml) - 2.0, saboda kawai shida bisa dari na wadannan sunadarai suke samuwa a cikin cytosol.

Kuma aka yi wahayi da cewa halakar cardiomyocytes a gefe jini ya karu matakan daban-daban kasarun adadi na troponin. Wani lokaci adadi sama da na kullum a cikin daruruwan ko ma dubban sau.

aiki

Kamar yadda riga aka ambata a sama, troponin a haɗe zuwa mai gina jiki tropomyosin. A wani m jihar, a lokacin da tsoka ne annashuwa, wannan sunadari ya hana ta riko na myosin zuwa actin. Lokacin da mataki m kai tsoka Kwayoyin samu lallai cajin ions ta hanyar alli tashoshi a cikin cell cytoplasm. Part na alli ne a haɗe zuwa troponin da abokansu. Wannan damar samun da myosin da actin filaments hanyar ƙanƙancewa.

Ba wai kawai a cikin myocardium ne troponin. Kullum ta dauri ne casa'in da biyar bisa dari. Sauran kashi ne a cikin wani free jihar ko rarraba a sauran iri tsoka nama. A key bambanci shi ne, a cikin kwarangwal tsoka troponin subunits na hudu, kuma a cikin zuciya tsoka - uku.

Physiology

Acronyms iri daban-daban na tsokoki suna hadewa da canza taro na kwayuka alli ions. Lokacin da yawan qara, da tsoka kwangila, da kuma mataimakin versa. The gina jiki ga wanda keji ne a haɗe alli - shi ne troponin. wuri na ta na kullum a kan tropomyosin yayi dace da tsawon na karshen, wato 40 nanometers.

Troponin yana da uku subunits, kowanne daga abin na da aiki. Lokacin da alli ne a haɗe zuwa C-guntu, tropomyosin a kan actin filament motsa to myosin iya shiga ta. Idan isasshen alli, tropomyosin tubalan aiki shafukan da ke sa shi ba zai yiwu ba don hašawa zuwa myosin myofilaments.

Na ilimin da histology aka kuma gano cewa, troponin 1 cike da samuwar sabon jini. Troponin C ta ɗaure alli ions, kuma wannan ya haddasa canje-canje a troponin 1. Troponin T ake bukata domin sadarwa tare da tropomyosin da troponin 1 binds zuwa actin, da kuma taimaka wajen hul] a da actin myosin lokacin da alli ions a cikin cytoplasm kasa.

Shiri kuma bincike na alamomi ga manufar

A matakin troponin da kuma al'ada gefe jini a cikin mafi kyau hukunci da yawa analysis. Domin ta isar ba ya bukatar wani takamaiman shiri, amma, kamar yadda a duk lokuta na jini kyauta, shi ne mafi alhẽri a yi shi a cikin hudu bayan cin abinci.

Idan asibiti sami wani haƙuri tare da m tsokar zuciya infarction, shi ya nan da nan dauka a jini gwajin. Bisa ga yarjejeniya wajibi ne a maimaita a kan 4 hours, sa'an nan ta hanyar rana 8. Bayan troponin za'ayi sau daya a rana ga makonni biyu. A zamani magani, hanyoyin domin kayyade adadin wannan gina jiki kai tsaye a bedside amfani da gwajin tsarin. A korau sakamakon damar ware irin wannan marasa lafiya daga waɗanda suka yi m jijiyoyin zuciya ciwo iya ci gaba a nan gaba.

Bugu da ari definition of m tsokar zuciya infarction (MI), da yawan troponin bincike da aka yi don gano sub-m form infarction microinfarction, "shiru" ciwon zuciya, da kuma wajen saka idanu da ingancin thrombolytic far da kuma sakamakon da kai tsaye mataki na anticoagulants, kamar heparin.

Karuwan troponin 1

Troponin 1 (na al'ada magani da kuma 0.1 ng / ml) na iya kara bayan m shisshigi a kan zuciya. Saboda haka, tare da wannan sashin jiki dasawa troponin taro ƙaruwa zuwa 5 nanograms da milliliter. Wannan darajar za a iya adana har zuwa watanni uku.

Kumburi cututtukan zuciya da kuma raunin da ya haddasa wani kadan karuwa a matakin na troponin T, amma muhimmancin ta canje-canje a cikin jini ya bambanta daga abin da a MI. A kullum a jini troponin a maza da mata guda. Wannan nuna alama ba su da alaka da jinsi ko shekaru na haƙuri. Wani lokaci akwai iya zama wani ƙarya m gwajin sakamakon idan haƙuri ne a Jihar m barasa maye.

A kadan karuwa a troponin yiwu tare da m lalacewar kwarangwal tsoka. Don kwatanta, creatine phosphokinase (CPK) a cikin wadannan marasa lafiya qara muhimmanci, sakamakon ba daidai ba rajista na tsokar zuciya infarction.

M tsokar zuciya infarction

Troponin 1 (jini kudi zuwa 0.1 ng / ml) ne pathognomonic ãyã daga m tsokar zuciya infarction kawai idan da darajar wuce 100 NG / ml, ko mafi girma daga 99 percentile na al'ada kewayo. Amma kawai a tare da tare da na asibiti da kuma instrumental bayyanar cututtuka na tsokar ischemia.

A sakamakon gabatarwar a cikin likita yi wannan bincike, yawan diagnoses na zuciya harin ya karu, tun da wannan gwajin ne mafi m fiye da creatine kinase. Bugu da ƙari, cikin sharuddan ƙãra prognostic troponin shi ne wani mummunan alama. Wasu masu bincike gardamar cewa thrombus size ne kai tsaye na gwargwado ga matakin na troponin a cikin jini magani.

Karuwa da furotin da matakan a marasa lafiya tare da tsokar rubuce cikin awa shida bayan farko na zafi hari. Kwana goma sha huɗu troponin matakin progressively declines da kuma ya koma ga al'ada.

M jijiyoyin zuciya ciwo

Al'ada jini troponin tare da m jijiyoyin zuciya ciwo (ACS) yayi dace da cewa a cikin tsokar zuciya infarction, kuma daga 50 zuwa 100 ng / ml. Kara gina jiki ACS yale mu mu bambance daga m angina. Lokaci-lokaci, marasa lafiya da hankula asibiti cututtuka da kuma dagagge troponin matakai a cikin jijiyoyin zuciya angiography ba rajista tsanani take hakki na hemodynamics. Dalilin wannan sabon abu - maras wata-wata samuwar plaques wanda dissolves a lokacin thrombolytic magani. Sannan mahanga ta biyu ikirarin cewa gudan kawai da dama a kasa da tasoshi, da kuma ba a bayyane a kan allo.

Percutaneous jijiyoyin zuciya shiga tsakani

Troponin (na kullum ga 2.0 ng / ml) da aka dan kadan ya karu bayan angioplasty ko stent jeri. Masana kimiyya da babu shakka cewa sunadaran, wanda aka ƙaddara, ka fito daga cardiomyocytes. Dalilin shi ne lokaci na su bayyanar wucewa ischemia, wanda aka sa ta hurawa up da balan-balan da clamping da jijiyoyin zuciya jijiyoyi.

Ko da a cikin hali na micro traumas kasance musamman m troponins infarction, wanda, ba shakka, nuna a cikin gefe jini count. Amma, a sama da dukan, shi ya nuna cewa a cikin marasa lafiya da wani irin hadarin high matakan da furotin da canje-canje a cikin ci gaban da jijiyoyin zuciya ciwo da kuma tsokar zuciya infarction. Abin baƙin ciki, musamman lambobin, wanda likitoci da za a iya shiryar da su kintace ba ya wanzu. Wasu magana game da pathophysiology bayar da tsokar zuciya infarction lokacin da troponin matakin wuce fiye da sau uku.

tiyata

Troponin (na kullum ga 2.0 ng / ml) ya karu bayan m tiyata a zuciya tsoka. Wannan shi ne saboda shortcomings cardioprotective ayyuka. A ka'idar, da suka kamata su kare haƙuri ta jiki ta hanyar hypoxia, amma a yi wannan ba ko da yaushe xari bisa dari. Amma ba a dukkan lokuta kara troponin ya kamata a daukarsa a perioperative tsokar zuciya infarction.

Za a yaba da adadin da tsawon aiki, kazalika da farko matakin na gina jiki. Ganewar asali "tsokar zuciya infarction" mai yiwuwa ne kawai ta gaban asibiti, dakin gwaje-gwaje da kuma instrumental ãyõyi lokaci guda.

sauran jihar

Da yawa karatu sun tabbatar da cewa troponin (al'ada 2.0 ng / ml) ne mai matuƙar takamaiman alama na tsokar zuciya infarction. Amma akwai wani yawan pathological yanayi, wanda ake ma tare da wani karuwa a yawan wannan gina jiki a gefe jini. Wadannan sun hada da sepsis, na huhu embolism (PE), zuciya rashin cin nasara, da ciwon kumburi daga cikin zuciya jakar, myocarditis, na kullum na koda gazawar da ya wuce kima da motsa jiki, zuciya dasawa, jiyyar cutar sankara.

Wannan sabon abu ne ya sa ta zazzabi, tachycardia, hypoxia, a take hakkin da microvasculature, da ragewa da matsa lamba da kuma anemia. Duk wannan take kaiwa zuwa tsokar ischemia da kuma lalata cardiomyocytes, wanda ya haddasa wani karuwa a troponin.

1 ko troponin T

Al'ada jini troponin zuwa 2.0 NG / ml, amma akwai hanyoyi daban-daban domin kayyade kasarun adadi na troponin yau. An yarda more daidai sanin ko lalacewar da myocardium. Domin a yawan karatu sun nuna cewa troponin-T ne mafi saukin kamuwa zuwa koda gazawar, da troponin 1, amma sauran sigogi ne irin wannan, don haka da wannan bincike darajar.

A peculiarity na troponin T a gaskiyar cewa shi samar da wani bincike kit for daya kawai m, alhãli kuwa troponin 1, akwai da dama da gwajin tsarin. Saboda wannan, akwai iya zama wasu wahala a gwada sakamakon. Amma clinicians kokarin kawo wannan dabara ta wanda ya kau da bambanci a sakamakon tsakanin daban-daban sigogi labolatoriya.