第五章--血液的组成与功能.ppt

* * 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adhesion；表达plasminogen activator inhibitor增多，抑制纤溶活性等作用，促进凝血。 * * 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. * 蛋白C 蛋白S are synthesized in the liver * * * * * * 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 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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, * * * 组织因子途径抑制物 Tissue Factor Pathway Inhibitor(TFPI) Ca2+,Xa Ⅶ,X失活 内皮细胞 TFPI 1、正常血管内皮完整光滑，不易激活FⅫ，不易使 血小板吸附和聚集；血液中又无FⅢ，故不会启 动内源或外源性凝血过程。 2、血液不断流动，即使血浆中有一些凝血因子被激 活，也会不断地被稀释运走。 3、血液中具有纤溶系统，能促使纤维蛋白溶解。 血液不易发生凝固的其它因素： 1、加速凝血  (1)加钙