出血性疾病的临床与实验室诊断.ppt

溶栓治疗是应用药物将已形成的血栓溶解，促使血管的再通。主要用于血栓栓塞性疾病的治疗。临床常用的溶栓药物有：链激酶、尿激酶等。这些药物主要通过激活纤溶酶原，活化纤溶系统，溶解血栓中纤维蛋白，或直接裂解纤维蛋白来清除血管中的血栓。 实验室监测的主要目标是纤维蛋白（原）及其降解产物。 1、适应症： 深静脉血栓形成、急性心肌梗死、肺栓塞、脑血栓、视网膜中央静脉血栓形成以及肝、肾、肠系膜静脉血栓形成等。 2、副作用： 主要副作用是出血。引起出血的原因是由于药物所致血液中纤维蛋白原及部分凝血因子的过多降解，使血液处于低凝状态有关。 3、实验室监测： 1）FIB：应维持FIB定量在1.2-1.5g/L，较为适宜，极限不应低于1.0g/L。否则易发生出血。 2）TT：溶栓治疗效果判断一般认为应维持在正常对照的1.5-2.5倍为宜。极限不应超过正常对照的3-4倍。 3）FDP：正常值血清含量﹤10mg/L。溶栓治疗维持FDP值在300-400mg/L。 D-Dimer is defined as the smallest of the cross-linked fibrin degradation products (XL-FbDP) generated by plasmin-mediated lysis of cross linked fibrin. The next few slides will clarify this definition. The formation of fibrin clots occurs via the cleavage of fibrinogen by thrombin. Fibrinogen is composed of a central nodule called the E-domain and is connected by way of six polypeptide chains held together by disulfide bonds to two terminal noduli named D-domains. In addition, the carboxy-terminal end of the A? exists as an unusually polar and exposed protuberance that is very sensitive to proteolytic attack. The cleaved fibrinogen is known as fibrin monomer. The initial step begins with thrombin-catalyzed cleavage of fibrinogen and the accompanying release of two sets of small peptides called fibrinopeptides A and B (FpA,FpB) First a dimer with a half-staggered overlap (called a DE-stag) is formed between two monomers, enabling it to grow in either direction forming a fibrin polymer. The action of Factor XIIIa plus calcium ions leads to cross-linking of the fibrin polymer at the D domains When plasmin acts on cross-linked fibrin a number of fragments may be generated. The smallest of which is D-dimer. Hence D-dimer is the smallest of the cross linked fibrin degradation products (XL-FbDP) generated by plasmin-mediated lysis of cross linked fibrin (re-state the definition). Let us now explore the role that D-Dimer plays in clinical terms. Both fibrinogen and fibrin are degraded by plasmin resulting in FDP’s. (fibr