I-Fibrinolysis yenzeka ku-physiological hemostasis, ngemuva kokuhlangana kwegazi, ukuze kuqedwe ihlule le-hemostatic elakhiwe yi-fibrin. Ukwethulwa ngobuningi obukhulu kakhulu, kungaholela ekwakhekeni kwehlwili ekusakazeni kanye nezingozi ezingaba khona. Incazelo, izimbangela kanye nokwelashwa, ake sibheke.

I-Fibrinolysis iyinqubo yokubhubhisa ehlanganisa ukuqedwa kwamahlule e-intravascular ngaphansi kwesenzo se-plasmin. Ngale nqubo, isusa ukujikeleza kwemfucuza ye-fibrin egazini futhi ngenxa yalokho isiza ukuvikela umzimba engozini ye-thrombosis (ihlule legazi).

I-Plasmin, ekhiqizwa isibindi, yiprotheni eyinhloko esebenzisa i-fibrinolysis. I-Plasmin iguqulwa ibe yi-plasminogen nge-activator ye-tissue plasminogen (tPA) ne-urokinase.

I-Plasminogen inekhonkodensi ye-fibrin futhi ihlanganiswa ehlule ngesikhathi sokwakheka kwalo (okuzovumela ukuthi liphulwe kamuva). Ushintsho lusuka ku-plasminogen luye ku-plasmin lwenzeka eduze kwehlule.

Uhlelo lwe-fibrinolytic kufanele luhambe phakathi kokuqhekeka kwamahlule asebenza ngaphakathi futhi angabangeli ukopha lapho amahlule we-hemostatic ne-fibrinogen encibilika.

Uma iqhwa linyibilika masishane, ngokwelashwa, ngezifo noma ngokungajwayelekile kwe-heestasis, lapho-ke lingabhekana nokopha kwesinye isikhathi okuphawulekayo.

Kunezinhlobo ezimbili ze-fibrinolysis, eyokuqala neyesibili ye-fibrinolysis. I-fibrinolysis eyinhloko yenzeka ngokwemvelo, futhi i-fibrinolysis yesibili yenzeka ngenxa yesizathu esithile sangaphandle njengemithi noma isimo sezokwelapha.

Uma i-fibrin ikhona ngobuningi obukhulu, ingabangela ukwakheka kwehlule ekujikelezeni kwegazi, okubangele izingozi ze-venous thrombosis (phlebitis) noma i-arterial (ischemia).

Ukukhubazeka kwe-fibrinolysis kuholela ku-thrombophilia ebangela ukwakheka ngokweqile kwamahlule egazi asongela ukuphila:

• I-acute coronary syndrome (ACS) ukungakwazi ukusebenza kahle kwe-coronary okubangelwa imithambo ye-coronary eyodwa noma ngaphezulu evinjiwe;
• I-infarction yakamuva ye-myocardial: ukungenelela ngaphakathi kwamahora amathathu okuqala kungcono;
• I-Ischemic stroke esigabeni esibi;
• I-pulmonary embolism ngokungazinzi kwe-hemodynamic;
• Ukubuyiselwa kwe-patency ye-venous catheter (i-venous catheter emaphakathi kanye nama-dialysis catheter), uma kwenzeka ukuvimbela okuhlobene ne-thrombus ekhulayo noma esanda kwakhiwa.

Kuzo zonke izimo ezibalulwe ngenhla, isenzo se-fibrinolytics sizosebenza kuphela kuye ngokuthi isikhathi sokuphatha uma kuqhathaniswa nokuqala kwezimpawu zokuqala.

Ngakho-ke ukwelashwa okujwayelekile kwamanje, i-fibrinolysis, kufanele kunikezwe ngokushesha ngangokunokwenzeka futhi kuhlanganisa ukujova isiguli nge-activator ye-tissue plasminogen ezozama ukuhlakaza leli hlule futhi ngaleyo ndlela iphakamise ukuvinjelwa komkhumbi.

I-Fibrinolytics isheshisa ukuqedwa kwamahlule e-intravascular futhi isebenze ngokushintsha i-plasminogen engasebenzi ibe yi-plasmin esebenzayo, i-enzyme ebhekele ukuwohloka kwe-fibrin futhi ngaleyo ndlela icuphe i-lysis ye-thrombus.

Sihlukanisa:

• I-Streptokinase yemvelaphi yemvelo iyiphrotheni ekhiqizwa i-β-hemolytic streptococcus, ngakho-ke imvelaphi yangaphandle futhi ekwazi ukubangela ukwakheka kwamasosha omzimba;
• I-Urokinase iyi-protease, yemvelo yemvelo, esebenza ngokuqondile ku-plasminogen;
• Okuphuma kokuphuma ku-tissue plasminogen activator (t-PA), okutholwe ngokuhlanganiswa kabusha kofuzo kusuka ku-gene encoding t-PA, kuzoguqula ngokuqondile i-plasminogen ibe i-plasmin ngokulingisa isenzo se-t-PA. Okuphuma kokunye kwe-t-PA kukhonjiswe yi-rt-PA (alteplase), r-PA (reteplase) kanye ne-TNK-PA (tenecteplase).

  I-Heparin kanye / noma i-aspirin kuvame ukuhlotshaniswa nokwelashwa nge-fibrinolytics.

Izindlela zokuhlola i-fibrinolysis.

Ukuhlolwa komhlaba wonke: Isikhathi sokuchithwa kwama-euglobulins

Imvula yama-euglobulins ivumela ukwabelana kwe-fibrinogen, i-plasminogen kanye nama-activator ayo e-protease inhibitor. Isikhathi esivamile sikhulu kunamahora angu-3 kodwa uma kunesikhathi esincane, sisola “i-hyperfibrinolysis”.

Ukuhlolwa kwe-Analytical

• Ukuhlolwa kwe-Plasminogen: ukusebenza kanye ne-immunological;
• Ukuhlolwa kwe-TPA (izicubu ze-plasminogen): amasu e-immunoenzymatic;
• Isilinganiso se-antiplasmin.

Ukuhlolwa okungaqondile

• Ukunqunywa kwe-fibrinogen: lokhu ukuhlolwa okungaqondile kwe-fibrinolysis. Nge-fibrinogen ephansi, "i-hyperfibrinolysis" isolwa;
• Isikhathi se-Reptilase kanye / noma isikhathi se-thrombin: zandiswa phambi kwemikhiqizo yokuwohloka kwe-fibrin;
• Ukunqunywa kwama-PDF (imikhiqizo ye-Fibrin ne-fibrinogen degradation): ephezulu uma kwenzeka kusebenze i-fibrinolysis;
• I-D-dimer assay: ihambisana nezingcezu ze-PDF futhi iphezulu uma kwenzeka i-fibrinolysis.