第十一章弥散性血管内凝血（DIC)4教学内容.pptVIP

Common causes of DIC. 感染性疾病细菌感染败血症、内毒素血症、病毒性肝炎、流行性出血热 广泛组织损伤大面积挫伤或烧伤、挤压综合症、大手术、器官移植 产科意外胎盘早剥、羊水栓塞、宫内死胎、妊娠中毒症、流产术 恶性实质肿瘤肺、消化系及泌尿系癌、转移癌、恶性葡萄胎、绒毛膜上皮癌 急性白血病急性早幼粒白血病 其他疾病内毒素休克、严重出血或过敏性休克、大面积心肌梗死、异型输血、巨大海棉状血管瘤、肾小球肾炎、类风湿关节炎、系统性红斑狼疮、肾移植排斥反应 外源性凝血系统: 15 seconds;内源性凝血系统, 1-6 min Clotting factors from livers: I, II, V, VII, IX, X, XI, XII, XIII From Platelet: III, IV(Ca2+), VIII, XIII From endothelial cells: VIII 高分子激肽原, 前激肽释放酶 are synthesized in the liver VIIIa increase the speed of the reaction from X to Xa 200,000-fold faster. IV: Ca2+ Source: Liver: fibrinogen (I), prothrombin (II), V,VII,IX,X,XI,XII,XIII Platelets: III, V,VIII,, XIII Endothelial cells: VIII, XIII Thrombin activates factor V VIII 组织因子 is a cofactor, it make VIIa 1000-fold more active; VIIIa increase the speed of the reaction from X to Xa 200,000-fold faster. 凝血酶激活:V, VIII, XII, PROTHROMBIN, 蛋白C 蛋白S are synthesized in the liver 抗凝血酶Ⅲ from the liver and the endothelium. The concentration of heparin is normally low so that only under special physiological conditions does it have significant antilant effects. Heparin is produced by many different cells of the body, but especially large quantities are formed by basophilic mast cells. Hepairn has no anticoagulation effect, however, it augments the antithrombin activity by a hundred to a thousand folds. The injured tissues and endothelium very slowly release tissue plasminogen activator (t-PA；组织纤溶酶原激活物) a day or later after clot is formed and convert plasminogen to plasmin. Plasmin具有广泛的丝氨酸水解酶活性，能水解凝血终产物fibrin生成可溶性的纤维蛋白降解产物（fibrin degradation products, FDP），也能水解fibrinogen和其他多种coagulation factors、血浆蛋白与组织蛋白。 尿激酶原 is from kidney. 纤溶酶原激活物抑制物(PAIs)：from endothelium and platelets 内皮细胞覆盖在整个血管壁内面，隔断流动血液与其他组织细胞的接触，内皮表面的负电荷也排斥血细胞，特别是platelets、白细胞与内皮细胞接触。正常内皮细胞具有分泌多种抗凝、纤溶物质，调节protein C系统活性和抑制platelets活化等功能，发挥极强的抗凝作用。因而当内皮细胞功能正常时，其表面难以发生凝血。 内皮细胞受损时其抗凝能力显著降低，分泌tissue factors、凝血因子Ⅴ和Ⅷ等，表现出潜在的促凝作用；分泌血管性假血友病因子（Von Willebrand factor）等多种粘附分子，介导platelets、白细胞与内皮细胞的